Polysomnography has long been considered key to diagnosing obstructive sleep apnea (OSA) in children, but a new study in Pediatrics questions how helpful the technique is for determining whether a child will benefit from an adenotonsillectomy.
Researchers obtained cognitive, behavioral, quality-of-life, health, and polysomnographic outcomes at baseline and at 7 months from the Childhood Adenotonsillectomy Trial, which was a randomized trial that compared the outcomes of watchful waiting and early adenotonsillectomy in children who have OSA.
The study included 398 children aged 5 to 9 years. At follow-up, a total of 244 children (61%) saw resolution of OSA at follow-up. A polysomnographic resolution of OSA accounted for small but significant proportions of changes in disease-specific quality of life (proportion mediated 0.11 [95% confidence interval 0.04 to 0.20]; P = .004) and symptoms (proportion mediated 0.13 [95% confidence interval 0.07 to 0.21]; P < .001). A change in polysomnographic severity also showed a similar mediation in disease-specific quality-of-life outcomes (proportion mediated 0.20 [95% confidence interval 0.10 to 0.31]; P = .004). However, in the other 16 outcomes, there was no significant mediation effect identified. Adenotonsillectomy was found to return a normal polysomnography in 79% of children versus 46% who underwent watchful waiting. Obstructive sleep apnea resolved in roughly 50% of the children who underwent watchful waiting.
The researchers concluded that most of the treatment-related changes in the outcomes of OSA in school-aged children was not causally attributable to polysomnographic resolutions or changes in its severity. They said that the results illustrate the limited use of polysomnographic thresholds for managing childhood OSA.