Clinical assessment of pediatric obstructive sleep apnea.

Abstract

OBJECTIVE:

To determine whether children with a clinical assessment suggestive of obstructive sleep apnea (OSA) but with negative polysomnography (PSG) have improvement in their clinical assessment score after tonsillectomy and adenoidectomy (T&A) as compared with similar children who do not undergo surgery.

METHODS:

In a prospective, randomized, investigator-blinded, controlled trial, 59 otherwise healthy children (mean age: 6.3 years [3.0]; 31 boys, 28 girls) with a clinical diagnosis of OSA (clinical assessment score 40) were recruited from the pediatric otolaryngology and pediatric pulmonary private offices and clinics of a tertiary care, academic medical center. A standardized assessment was performed on all patients, including history, physical examination, voice recording, tape recording of breathing during sleep, lateral neck radiograph, echocardiogram, and PSG. A clinical assessment score was assigned. Children with positive PSG (n = 27) were scheduled for T&A, whereas children with negative PSG (n = 29) were randomized to T&A (n = 15) or no surgery (n = 14). Children were reassessed in an identical manner at a planned 6-month follow-up.

RESULTS:

Follow-up was available for 21 patients with positive PSG, 11 patients with negative PSG randomized to T&A, and 9 nonsurgery patients. In the randomized subjects, the median reduction in clinical assessment score was 49 (range: 32-61) for the T&A patients as compared with 8 (range: -9 to 29) for the nonsurgery patients. Nine (82%) of the T&A patients were asymptomatic (clinical assessment score <20) compared with 2 (22%) of the nonsurgery patients.

CONCLUSION:

Children with a positive clinical assessment of OSA but negative PSG have significant improvement after T&A as compared with observation alone, thus validating the clinician's role in diagnosing upper airway obstruction.

• Authors: Nira A Goldstein, Vasanthi Pugazhendhi, Sudha M Rao, Jeremy Weedon, Thomas F Campbell, Andrew C Goldman, J Christopher Post, Madu Rao
• Journal: Pediatrics (Pediatrics) Vol. 114 Issue 1 Pg. 33-43 (Jul 2004) ISSN: 1098-4275 [Electronic] United States
• PMID: 15231905 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adenoidectomy
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Humans
• Infant
• Logistic Models
• Male
• Observer Variation
• Polysomnography
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Sensitivity and Specificity
• Severity of Illness Index
• Single-Blind Method
• Sleep Apnea, Obstructive (diagnosis, surgery)
• Tonsillectomy