title: Prognosis for Spontaneous Resolution of OSA in Children.
abstract: BACKGROUND
  Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment.
  
  
  METHODS
  The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline.
  
  
  RESULTS
  After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors.
  
  
  CONCLUSIONS
  Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.
authors: Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI. Electronic address: chervin@umich.edu.
authors: Ronald D
authors: RD
authors: Chervin
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Susan S
authors: SS
authors: Ellenberg
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Xiaoling
authors: X
authors: Hou
authors: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors: Carole L
authors: CL
authors: Marcus
authors: Department of Otolaryngology/Head and Neck Surgery and Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
authors: Susan L
authors: SL
authors: Garetz
authors: Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA.
authors: Eliot S
authors: ES
authors: Katz
authors: Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI.
authors: Elise K
authors: EK
authors: Hodges
authors: Department of Otolaryngology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ron B
authors: RB
authors: Mitchell
authors: Department of Otolaryngology/Head & Neck Surgery, University of Nebraska College of Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Dwight T
authors: DT
authors: Jones
authors: Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx NY.
authors: Raanan
authors: R
authors: Arens
authors: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Raouf
authors: R
authors: Amin
authors: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors: Susan
authors: S
authors: Redline
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors: Carol L
authors: CL
authors: Rosen
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011379:Prognosis; D011788:Quality of Life; D012075:Remission, Spontaneous; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery; D011795:Surveys and Questionnaires; D014068:Tonsillectomy