A shared decision‐making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Bergeron, Mathieu; Duggins, Angela; Cohen, Aliza P.; Tiemeyer, Karin; Müllen, Lisa A.; Crisalli, Joseph; McArthur, A. M.; Ishman, Stacey L.

doi:10.1002/lary.26967

Cited by 23 publications

(26 citation statements)

References 28 publications

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“…However, data regarding clinical outcomes with SDM are limited. We initially demonstrated that patients using SDMTs had less decisional conflict during the first phase of our study; however, the current study demonstrates that the decreased conflict may account for improvement for clinical outcomes.…”

Section: Discussionmentioning

confidence: 60%

“…Using a standardized process, we developed a SDMT for children with obstructive sleep apnea (OSA) without tonsillar hypertrophy (Supporting Appendices 1–3). Our previous work has demonstrated that families who were counseled regarding treatment options using our SMDTs had significantly less DC than those who did not use them. It was also demonstrated that patients felt more informed about their treatment options; a fact that is significant given there are numerous surgical and medical treatment options for children with OSA.…”

Section: Introductionmentioning

confidence: 84%

“…The first phase of the study (Fig. ) was to evaluate the effect of the SDMT on familial decisional conflict using three validated questionnaires: the Decisional Conflict Scale, the SURE (Sure of myself; Understand information; Risk‐benefit ratio; Encouragement) scale, and the CollaboRATE.…”

Section: Methodsmentioning

confidence: 99%

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Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Bergeron¹,

Duggins

Chini

et al. 2019

The Laryngoscope

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Objectives:To determine if shared decision-making tools (SDMTs) improve clinical outcomes for these children. Shared decision making (SDM) is a collaborative process in which patients and clinicians jointly establish treatment plans that integrate clinical evidence and patient values/preferences. We previously reported less decisional conflict using a SDMT for families of children with obstructive sleep apnea (OSA) without tonsillar hypertrophyl; however, the clinical impact of this finding is unknown.Methods: Prospective single-blind randomized controlled trial for consecutive patients referred to a multidisciplinary upper airway center. The study group used a SDMT, whereas the control group did not; all were followed until their next appointment and polysomnogram.Results: We assessed 50 families (24 study, 26 controls); mean age of patients was 8.8 (95% confidence interval 6.9-10.6) years, and 44% were female. After their initial visit, there was agreement between families and providers on the best treatment option for 22 of 24 (91.7%) study patients and 12 of 26 (46.2%) controls (P < 0.001). Before the first follow-up, four control families (15.4%) modified their treatment plan, whereas none of the study families did so (P = 0.04). Continuous positive airway pressure (CPAP) compliance was 27% (3 of 11) for controls and 57% (5 of 8) for study patients (P = 0.11). The median obstructive apnea-hypopnea index significantly improved in study patients from 13.4 (range, 20.0-57.2) to 3.5 (range 0.4-45.5, P = 0.01] events per hour, but not in controls, with 9.4 (range, 0.9-76.2) to 4.9 (range, 0-116, P = 0.10) events per hour.Conclusion: Families of children with OSA without tonsillar hypertrophy who were counseled regarding treatment options using SMDTs were more likely to undergo agreed upon treatment and had higher CPAP compliance.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 84%

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Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Bergeron¹,

Duggins

Chini

et al. 2019

The Laryngoscope

Self Cite

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“…However, given the complexity of these patients, DISE might be useful to provide information about the site(s) of obstruction and to tailor surgery for the specific site(s) of obstruction . Moreover, parents would ideally be involved in the decision making regarding the optimal medical or surgical management of sleep disorders . Finally, OSA should not be overlooked in this population because treatment has proven to improve patient and family quality of life in both typical children and those with syndromes; the same conclusion could reasonably be extrapolated to this population …”

Section: Discussionmentioning

confidence: 99%

Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

2019

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Objectives Cornelia de Lange syndrome (CdLS) is a rare genetic disorder. Our goal was to systematically review the literature regarding otolaryngology manifestations of CdLS. Methods We systematically reviewed the PubMed, Embase, CINAHL, Scopus, and Google Scholar databases for original articles of otolaryngology manifestations for patients with CdLS. These articles were analyzed, and pooled prevalence was calculated. Results We analyzed 1,310 patients included in 35 case series and 34 case reports. Hearing loss was present for many patients (27 studies), with sensorineural hearing loss affecting 40.3% (95% confidence interval [CI]: 17.3–63.4) and conductive affecting 22.7% (95% CI: 5.7–39.7). Recurrent acute otitis media was the most frequent infectious manifestation, with 56.5% (95% CI: 34.1–78.4) in seven studies, followed by recurrent airway infections with 44.1% (95% CI: 11.0–87.1) in five studies. Forty‐nine (49.7%) percent of patients (95% CI: 25.9–73.6) in nine studies had dysphagia, and 76.6% (95% CI: 59.8–93.3) in four studies had some degree of dysphonia. Craniofacial anomalies were reported in 30 studies, with micrognathia (53.1%; 95% CI: 34.1–72.1) and high arched palate (70.6%; 95% CI: 56.5–84.8) commonly reported. Additional physical exam abnormalities reported included those involving: lips (76.8%; 95% CI: 65.3–88.4), dentition (65.1%; 95% CI: 27.2–100), mouth (85.5%; 95% CI: 76.2–93.8), and eyelashes (87.1%; 95% CI: 77.2–96.9). Sleep‐disordered breathing or obstructive sleep apnea affected 25.8% (95% CI: 11.4–40.2) of patients (7 studies). Airway anomalies were reported in 11 case reports. Conclusion This is the first comprehensive evaluation of otolaryngologic manifestations in the CdLS literature. Most reported hearing loss and craniofacial anomalies. Sleep disorders occurred in a minority of patients, whereas airway disorders were primarily reported in case reports. These conditions should be further examined given their potential life‐threatening implications. Level of Evidence 3a Laryngoscope, 130:E122–E133, 2020

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“…The prevalence of obstructive sleep apnea (OSA) is reported to be up to 4% in children and when untreated can result in daytime somnolence and behavior problems, cardiovascular and/or metabolic disorders, and decreased quality of life . Most children with OSA are treated with adenotonsillectomy; however, persistent OSA may occur in 40% of children with some subgroups (eg, those with obesity) reported to have persistence rates as high as 75% …”

Section: Introductionmentioning

confidence: 99%

Safety and cost of drug‐induced sleep endoscopy outside the operating room

et al. 2019

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Introduction Drug‐induced sleep endoscopy (DISE) is used to assess site of obstruction for patients in a pharmacologically induced sleep‐like state. It is traditionally performed in the operating room (OR), however, no data exists regarding the feasibility of this intervention outside the OR in children. The objective is to compare the safety of DISE performed in the MRI induction room to those performed in the OR. Methods Prospective case‐series of patients undergoing DISE in the MRI induction room (study group) to those assessed in the OR (controls) in a single‐institution pediatric tertiary care center. Consecutive patients undergoing DISE examination for persistent obstructive sleep apnea (OSA) after adenotonsillectomy from September 2016 to September 2017 were included. Results Overall, 118 patients (38 study patients, 80 controls) with a mean age of 10.6 years (95% confidence interval [CI], 9.3–11.9) underwent DISE; 39.8% (47/118) were female. The most frequent comorbidity was cardiac disease (22.0%, 26/118). The mean obstructive apnea‐hypopnea index was 12.2 events/hour (95% CI, 8.8–15.6) for controls and 13.5 events/hour (95% CI, 8.7–18.3) for study patients (P = .76). No major complication or unplanned admissions occurred in either group. Induction time was similar (12 vs. 13 minutes, P = .7) as was total procedure time (12 vs. 14 minutes, P = .3) for procedures performed in both settings. Conclusion There were no significant complications for DISE performed in the OR or the MRI induction room and procedure times were similar. Further assessment of patient outcomes and resource utilization is needed. Level of Evidence 4 Laryngoscope, 130: 2076–2080, 2020

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A shared decision‐making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Abstract: 1b. Laryngoscope, 128:1007-1015, 2018.

Cited by 23 publications

References 28 publications

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

Safety and cost of drug‐induced sleep endoscopy outside the operating room

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