A randomized trial of adenotonsillectomy for childhood sleep apnea

Carole L. Marcus, Reneé H. Moore, Carol L. Rosen, Bruno Giordani, Susan L. Garetz, H. Gerry Taylor, Ron B. Mitchell, Raouf Amin, Eliot S. Katz, Raanan Arens, Shalini Paruthi, Hiren Muzumdar, David Gozal, Nina Hattiangadi Thomas, Dean Beebe Janice Ware, Karen Snyder, Lisa Elden, Robert C. Sprecher, Paul Willging, Dwight Jones & 5 others John P. Bent, Timothy Hoban, Ronald D. Chervin, Susan S. Ellenberg, Susan Redline

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS: The average baseline value for the primary outcome, the attention and executivefunction score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%). CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.)

Original languageEnglish (US)
Pages (from-to)2366-2376
Number of pages11
JournalNew England Journal of Medicine
Volume368
Issue number25
DOIs
StatePublished - 2013

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Watchful Waiting
Sleep Apnea Syndromes
Obstructive Sleep Apnea
Quality of Life
Oxyhemoglobins
Executive Function
National Institutes of Health (U.S.)
Cognition
Health
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Marcus, C. L., Moore, R. H., Rosen, C. L., Giordani, B., Garetz, S. L., Taylor, H. G., ... Redline, S. (2013). A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine, 368(25), 2366-2376. https://doi.org/10.1056/NEJMoa1215881

A randomized trial of adenotonsillectomy for childhood sleep apnea. / Marcus, Carole L.; Moore, Reneé H.; Rosen, Carol L.; Giordani, Bruno; Garetz, Susan L.; Taylor, H. Gerry; Mitchell, Ron B.; Amin, Raouf; Katz, Eliot S.; Arens, Raanan; Paruthi, Shalini; Muzumdar, Hiren; Gozal, David; Thomas, Nina Hattiangadi; Janice Ware, Dean Beebe; Snyder, Karen; Elden, Lisa; Sprecher, Robert C.; Willging, Paul; Jones, Dwight; Bent, John P.; Hoban, Timothy; Chervin, Ronald D.; Ellenberg, Susan S.; Redline, Susan.

In: New England Journal of Medicine, Vol. 368, No. 25, 2013, p. 2366-2376.

Research output: Contribution to journalArticle

Marcus, CL, Moore, RH, Rosen, CL, Giordani, B, Garetz, SL, Taylor, HG, Mitchell, RB, Amin, R, Katz, ES, Arens, R, Paruthi, S, Muzumdar, H, Gozal, D, Thomas, NH, Janice Ware, DB, Snyder, K, Elden, L, Sprecher, RC, Willging, P, Jones, D, Bent, JP, Hoban, T, Chervin, RD, Ellenberg, SS & Redline, S 2013, 'A randomized trial of adenotonsillectomy for childhood sleep apnea', New England Journal of Medicine, vol. 368, no. 25, pp. 2366-2376. https://doi.org/10.1056/NEJMoa1215881
Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine. 2013;368(25):2366-2376. https://doi.org/10.1056/NEJMoa1215881
Marcus, Carole L. ; Moore, Reneé H. ; Rosen, Carol L. ; Giordani, Bruno ; Garetz, Susan L. ; Taylor, H. Gerry ; Mitchell, Ron B. ; Amin, Raouf ; Katz, Eliot S. ; Arens, Raanan ; Paruthi, Shalini ; Muzumdar, Hiren ; Gozal, David ; Thomas, Nina Hattiangadi ; Janice Ware, Dean Beebe ; Snyder, Karen ; Elden, Lisa ; Sprecher, Robert C. ; Willging, Paul ; Jones, Dwight ; Bent, John P. ; Hoban, Timothy ; Chervin, Ronald D. ; Ellenberg, Susan S. ; Redline, Susan. / A randomized trial of adenotonsillectomy for childhood sleep apnea. In: New England Journal of Medicine. 2013 ; Vol. 368, No. 25. pp. 2366-2376.
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abstract = "BACKGROUND: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS: The average baseline value for the primary outcome, the attention and executivefunction score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79{\%} vs. 46{\%}). CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.)",
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T1 - A randomized trial of adenotonsillectomy for childhood sleep apnea

AU - Marcus, Carole L.

AU - Moore, Reneé H.

AU - Rosen, Carol L.

AU - Giordani, Bruno

AU - Garetz, Susan L.

AU - Taylor, H. Gerry

AU - Mitchell, Ron B.

AU - Amin, Raouf

AU - Katz, Eliot S.

AU - Arens, Raanan

AU - Paruthi, Shalini

AU - Muzumdar, Hiren

AU - Gozal, David

AU - Thomas, Nina Hattiangadi

AU - Janice Ware, Dean Beebe

AU - Snyder, Karen

AU - Elden, Lisa

AU - Sprecher, Robert C.

AU - Willging, Paul

AU - Jones, Dwight

AU - Bent, John P.

AU - Hoban, Timothy

AU - Chervin, Ronald D.

AU - Ellenberg, Susan S.

AU - Redline, Susan

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS: The average baseline value for the primary outcome, the attention and executivefunction score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%). CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.)

AB - BACKGROUND: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS: The average baseline value for the primary outcome, the attention and executivefunction score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%). CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.)

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