Effect of Adenotonsillectomy on Parent-Reported Sleepiness in Children with Obstructive Sleep Apnea

Sleep. 2016 Nov 1;39(11):2005-2012. doi: 10.5665/sleep.6232.

Abstract

Study objectives: To describe parental reports of sleepiness and sleep duration in children with polysomnography (PSG)-confirmed obstructive sleep apnea (OSA) randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC) in the ChildHood Adenotonsillectomy Trial (CHAT). We hypothesized children with OSA would have a larger improvement in sleepiness 6 mo following eAT compared to WWSC.

Methods: Parents of children aged 5.0-9.9 y completed the Epworth Sleepiness Scale modified for children (mESS) and the Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). PSG was performed at baseline and at 7-mo endpoint. Children underwent early adenotonsillectomy or WWSC.

Results: The mESS and PSQ-SS classified 24% and 53% of the sample as excessively sleepy, respectively. At baseline, mean mESS score was 7.4 ± 5.0 (SD) and mean PSQ-SS score was 0.44 ± 0.30. Sleepiness scores were higher in African American children; children with shorter sleep duration; older children; and overweight children. At endpoint, mean mESS score decreased by 2.0 ± 4.2 in the eAT group versus 0.3 ± 4.0 in the WWSC group (P < 0.0001); mean PSQ-SS score decreased 0.29 ± 0.40 in eAT versus 0.08 ± 0.40 in the WWSC group (P < 0.0001). Despite higher baseline sleepiness, African American children experienced similar improvement with adenotonsillectomy than other children. Improvement in sleepiness was weakly associated with improved apnea-hypopnea index or oxygen desaturation indices, but not with change in other polysomnographic measures.

Conclusions: Sleepiness assessed by parent report was prevalent; improved more after eAT than after WWSC; and was not strongly predicted by sleep disturbances identified by PSG.

Clinical trial registration: Childhood Adenotonsillectomy Study for Children with OSA (CHAT). ClinicalTrials.gov Identifier #NCT00560859.

Keywords: Epworth Sleepiness Scale; OSA; OSAS; Pediatric Sleep Questionnaire; adenotonsillectomy; apnea-hypopnea index; pediatric; polysomnogram; sleepiness.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adenoidectomy*
  • Child
  • Child, Preschool
  • Disorders of Excessive Somnolence / diagnosis
  • Disorders of Excessive Somnolence / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Parents
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / surgery*
  • Sleep Stages*
  • Tonsillectomy*
  • Treatment Outcome
  • Watchful Waiting

Associated data

  • ClinicalTrials.gov/NCT00560859