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David Gozal, MD, FCCP; Leila Kheirandish-Gozal, MD
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From the Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, The University of Chicago.

CORRESPONDENCE TO: David Gozal, MD, FCCP, Department of Pediatrics, University of Chicago, 5721 S Maryland Ave, Chicago, IL 60637; e-mail: dgozal@peds.bsd.uchicago.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Gozal is the recipient of an investigator-initiated grant from ResMed Corp on urine biomarkers in adult sleep apnea. Dr Kheirandish-Gozal was the recipient of an investigator-initiated grant from Merck & Co Inc on the effect of montelukast in the treatment of pediatric sleep apnea. Drs Gozal and Kheirandish-Gozal are supported by the US National Institutes of Health [Grants HL-65270, HL-086662, and HL-107160].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):e226-e227. doi:10.1378/chest.14-2043
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To the Editor:

We greatly appreciate the favorable comments of Drs Traeger and Prashad regarding our clinical experience using antiinflammatory therapy in children with mild OSA as an alternative to surgical adenotonsillectomy (T&A).1 They raise a major and pertinent clinical question as to whether persistence or changes in clinical symptoms associated with treatment can guide the need for a follow-up polysomnographic evaluation after completion of treatment or guide the need for continued antiinflammatory treatment or alternative treatments. Because of the retrospective nature of our study, we are clearly unable to formulate a scientifically valid answer to this query. However, some of our previous studies focused on T&A for pediatric OSA would suggest that the presence or absence of clinical symptoms after treatment are markedly unreliable in the identification of residual OSA, while also suggesting specific high-risk groups that are more likely to exhibit residual OSA after T&A (eg, presence of obesity, older age, severe OSA pre-T&A).2-4 Furthermore, we would strongly endorse implementation of coordinated multicenter efforts aimed at delineating instruments that incorporate both symptoms and physical findings in the pursuit of not only the diagnosis of OSA but also the presence of residual OSA after treatment.5

References

Kheirandish-Gozal L, Bhattacharjee R, Bandla HPR, Gozal D. Antiinflammatory therapy outcomes for mild OSA in children. Chest. 2014;146(1):88-95. [CrossRef] [PubMed]
 
Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803-808. [CrossRef] [PubMed]
 
Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676-683. [CrossRef] [PubMed]
 
Marcus CL, Moore RH, Rosen CL, et al; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368(25):2366-2376. [CrossRef] [PubMed]
 
Villa MP, Paolino MC, Castaldo R, et al. Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J. 2013;41(6):1355-1361. [CrossRef] [PubMed]
 

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Tables

References

Kheirandish-Gozal L, Bhattacharjee R, Bandla HPR, Gozal D. Antiinflammatory therapy outcomes for mild OSA in children. Chest. 2014;146(1):88-95. [CrossRef] [PubMed]
 
Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149(6):803-808. [CrossRef] [PubMed]
 
Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676-683. [CrossRef] [PubMed]
 
Marcus CL, Moore RH, Rosen CL, et al; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368(25):2366-2376. [CrossRef] [PubMed]
 
Villa MP, Paolino MC, Castaldo R, et al. Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J. 2013;41(6):1355-1361. [CrossRef] [PubMed]
 
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