Adenotonsillectomy for sleep-disordered breathing in a predominantly obese pediatric population

Burstein, David H.; Jackson, Alison; Weedon, Jeremy; Graw-Panzer, Katharina D.; Fahmy, Samir; Goldstein, Nira A.

doi:10.1016/j.ijporl.2012.12.029

Cited by 6 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15,17 Two retrospective cohort studies also reported results for children with obesity or other conditions. 25,32 One reported significantly greater improvement in AHI in healthy children with mild OSA undergoing tonsillectomy compared with those not undergoing tonsillectomy. 32 In subgroup analyses of obese children and those with comorbidities, such as Down syndrome, there was no significant benefit between groups in surgical and nonsurgical populations.…”

Section: Osdb-related Outcomesmentioning

confidence: 99%

“…25 Three studies reported AHI outcomes that could be combined in a fixed effects meta-analysis (the CHAT RCT 16 -23 …”

Section: Osdb-related Outcomesmentioning

confidence: 99%

“…However, outcomes were consistently better in children receiving tonsillectomy ( Table 2). One RCT and 1 retrospective cohort used the Clinical Assessment Score-15 (CAS-15), 15,25 with both reporting significantly greater improvement in sleep quality in scores in the tonsillectomy group compared with watchful waiting. In the 1 study reporting baseline data, scores in the watchful waiting group improved from baseline to the 6-month follow-up (P = not reported [NR]).…”

Section: Sleep-related Quality Of Lifementioning

confidence: 99%

“…The CHAT RCT 16, 17, 19 -23 and 1 prospective 28 and 1 retrospective cohort study 25 addressed behavioral outcomes ( Table 2). All studies had a moderate risk of bias and used different scales to assess outcomes, again limiting our ability to compare effectiveness directly across studies.…”

Section: Behavioral Outcomesmentioning

confidence: 99%

“…28 In the second study, scores were significantly better in the tonsillectomy group compared with the no tonsillectomy group at follow-up, but baseline measures were not reported. 25 CHAT investigators also used the Conners' rating scale to assess behavioral issues, including Effect size: -1.35 CGI, caregiver M-ESS, change from baseline G1: 52.5 ± 11.6 G1: -2.01 ± 4.7 G2: 52.6 ± 11.7 G2: 0.28 ± 4.1 CGI, teacher G1 versus G2: P < .01 G1: 56.4 ± 14.4…”

Section: Behavioral Outcomesmentioning

confidence: 99%

See 4 more Smart Citations

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

View full text Add to dashboard Cite

CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE:To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION:Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION:Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores. RESULTS:We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleeprelated quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months. LIMITATIONS:Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known. CONCLUSIONS:Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

show abstract

Section: Osdb-related Outcomesmentioning

confidence: 99%

“…25 Three studies reported AHI outcomes that could be combined in a fixed effects meta-analysis (the CHAT RCT 16 -23 …”

Section: Osdb-related Outcomesmentioning

confidence: 99%

Section: Sleep-related Quality Of Lifementioning

confidence: 99%

Section: Behavioral Outcomesmentioning

confidence: 99%

Section: Behavioral Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

View full text Add to dashboard Cite

show abstract

Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children

Venekamp

Hearne

Chandrasekharan

et al. 2015

Cochrane Database of Systematic Reviews

122

120

View full text Add to dashboard Cite

In otherwise healthy children, without a syndrome, of older age (five to nine years), and diagnosed with mild to moderate OSAS by PSG, there is moderate quality evidence that adenotonsillectomy provides benefit in terms of quality of life, symptoms and behaviour as rated by caregivers and high quality evidence that this procedure is beneficial in terms of PSG parameters. At the same time, high quality evidence indicates no benefit in terms of objective measures of attention and neurocognitive performance compared with watchful waiting. Furthermore, PSG recordings of almost half of the children managed non-surgically had normalised by seven months, indicating that physicians and parents should carefully weigh the benefits and risks of adenotonsillectomy against watchful waiting in these children. This is a condition that may recover spontaneously over time.For non-syndromic children classified as having oSDB on purely clinical grounds but with negative PSG recordings, the evidence on the effects of adenotonsillectomy is of very low quality and is inconclusive.Low-quality evidence suggests that adenotonsillectomy and CPAP may be equally effective in children with Down syndrome or MPS diagnosed with mild to moderate OSAS by PSG.We are unable to present data on the benefits of adenotonsillectomy in children with oSDB aged under five, despite this being a population in whom this procedure is often performed for this purpose.

show abstract

Evaluation and Management of Pediatric Obstructive Sleep Apnea

Goldstein¹

2015

Cummings Pediatric Otolaryngology

View full text Add to dashboard Cite

Adenotonsillectomy for sleep-disordered breathing in a predominantly obese pediatric population

Cited by 6 publications

References 20 publications

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children

Evaluation and Management of Pediatric Obstructive Sleep Apnea

Contact Info

Product

Resources

About