Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta‐analysis

Abstract

Objective To determine the impact of adenotonsillectomy on the quality of life of pediatric patients with obstructive sleep apnea (OSA) and to identify gaps in the current research. Data Sources The MEDLINE, EMBASE, and Cochrane databases were systematically searched via the Ovid portal on June 18, 2016, for English-language articles. Review Methods Full-text articles were selected that studied boys and girls <18 years of age who underwent adenotonsillectomy for OSA or sleep-disordered breathing and that recorded validated, quantitative quality-of-life outcomes. Studies that lacked such measures, performed adenotonsillectomy for indications other than OSA or sleep-disordered breathing, or grouped adenotonsillectomy with other procedures were excluded. Results Of the 328 articles initially identified, 37 were included for qualitative analysis. The level of evidence was generally low. All studies involving short-term follow-up (≤6 months) showed improvement in quality-of-life scores after adenotonsillectomy as compared with preoperative values. Studies involving long-term follow-up (>6 months) showed mixed results. Modifications to and concurrent procedures with conventional adenotonsillectomy were also identified that showed quality-of-life improvements. Three studies were identified for meta-analysis that compared pre- and postoperative Obstructive Sleep Apnea-18 scores. Short- and long-term follow-up versus preoperative scores showed significant improvement ( P < .001). Short- and long-term scores showed no significant difference. Conclusion This systematic review and meta-analysis demonstrate adenotonsillectomy's effectiveness in improving the quality of life of pediatric patients with OSA. This is well demonstrated in the short term and has strong indications in the long term.

Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

“…3,21 The OSA-18 is an evaluative, discriminative, and validated instrument to assess QoL in children with SDB, and it is the most widely used evaluation tool worldwide. 19,25,31 An analysis of the literature revealed that AT is the treatment of choice for children with SDB caused by adenotonsillar hypertrophy. As a result, most of the studies that evaluate QoL in this group of patients do not have a control group.…”

“…It has been validated in a variety of languages. [28][29][30][31] Most of the studies evaluated children for 6 months or less and rarely the patients were reassessed over 1 year after AT. 19,[32][33][34] Objective The present study aimed to describe the QoL in children with SDB and the long-term impact of AT on this disease.…”

Influencia del exceso de peso en el éxito de la adenoamigdalectomía en pacientes con hiperplasia adenoamigdalina sintomática

“…En la etiopatogenia de estos trastornos, se ha demostrado la asociación entre HAA y la presencia de sintomatología durante el sueño 3 . En consecuencia, existe evidencia que ha reportado efectos beneficiosos de la AA sobre las manifestaciones clínicas de estos trastornos, como también posibles efectos positivos en reducir las consecuencias cognitivas asociadas a dichos trastornos y en la calidad de vida de los pacientes intervenidos [6][7][8][9][10][11] . Sin embargo, la mayoría de estos estudios son no controlados y no poseen un seguimiento a largo plazo.…”

Risk Stratification of Paediatric Obstructive Sleep Apnoea (OSA) for Adenotonsillectomy: How we do it at a UK District General Hospital

“…There are various studies in literature which have shown improvement in the quality of life (QoL) of both the child and the caregivers following adenotonsillectomy [6]. Daytime sleepiness tends to be less of a problem in children than in adults; however, hyperactivity and inattention may be more characteristic features.…”