0
Original Research: Sleep Disorders |

Prognosis for Spontaneous Resolution of OSA in ChildrenSpontaneous Resolution of OSA in Children

Ronald D. Chervin, MD; Susan S. Ellenberg, PhD; Xiaoling Hou, MS; Carole L. Marcus, MBBCh; Susan L. Garetz, MD; Eliot S. Katz, MD; Elise K. Hodges, PhD; Ron B. Mitchell, MD; Dwight T. Jones, MD; Raanan Arens, MD; Raouf Amin, MD; Susan Redline, MD; Carol L. Rosen, MD, FCCP; for the Childhood Adenotonsillectomy Trial
Author and Funding Information

From the Department of Neurology and Sleep Disorders Center (Dr Chervin), Department of Otolaryngology/Head and Neck Surgery and Sleep Disorders Center (Dr Garetz), and Division of Neuropsychology (Dr Hodges), Department of Psychiatry, University of Michigan, Ann Arbor, MI; Department of Biostatistics and Epidemiology (Dr Ellenberg and Ms Hou), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics (Dr Marcus), Sleep Center, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA; Division of Respiratory Diseases (Dr Katz), Boston Children’s Hospital, Boston, MA; Departments of Otolaryngology and Pediatrics (Dr Mitchell), University of Texas Southwestern Medical Center, Dallas, TX; Department of Otolaryngology/Head & Neck Surgery (Dr Jones), University of Nebraska College of Medicine, University of Nebraska Medical Center, Omaha, NE; Division of Respiratory and Sleep Medicine (Dr Arens), The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx NY; Division of Pulmonary Medicine (Dr Amin), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Medicine (Dr Redline), Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pediatrics (Dr Rosen), Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

CORRESPONDENCE TO: Ronald D. Chervin, MD, Michael S. Aldrich Sleep Disorders Laboratory, C728 Med Inn, Box 5845, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5845; e-mail: chervin@umich.edu


FOR EDITORIAL COMMENT SEE PAGE 1129

FUNDING/SUPPORT: This study was supported by the National Institutes of Health [Grants HL083075, HL083129, UL1 RR024134, and UL1 RR024989].

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


Chest. 2015;148(5):1204-1213. doi:10.1378/chest.14-2873
Text Size: A A A
Published online

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.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543