Utility of symptoms to predict treatment outcomes in obstructive sleep apnea syndrome

Carol L. Rosen, Rui Wang, H. Gerry Taylor, Carole L. Marcus, Eliot S. Katz, Shalini Paruthi, Raanan Arens, Hiren Muzumdar, Susan L. Garetz, Ron B. Mitchell, Dwight Jones, Jia Weng, Susan Ellenberg, Susan Redline, Ronald D. Chervin

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: Polysomnography defines the pathophysiology of obstructive sleep apnea syndrome (OSAS) but does not predict some important comorbidities or their response to adenotonsillectomy. We assessed whether OSAS symptoms, as reflected on the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ), may offer clinical predictive value. METHODS: Baseline and 7-month follow-up data were analyzed from 185 participants (aged 5-9 years with polysomnographically confirmed OSAS) in the surgical treatment arm of the multicenter Childhood Adenotonsillectomy Trial. Associations were assessed between baseline PSQ or polysomnographic data and baseline morbidity (executive dysfunction, behavior, quality of life, sleepiness) or postsurgical improvement. RESULTS: At baseline, each 1-SD increase in baseline PSQ score was associated with an adjusted odds ratio that was ~3 to 4 times higher for behavioral morbidity, 2 times higher for reduced global quality of life, 6 times higher for reduced disease-specific quality of life, and 2 times higher for sleepiness. Higher baseline PSQ scores (greater symptom burden) also predicted postsurgical improvement in parent ratings of executive functioning, behavior, quality of life, and sleepiness. In contrast, baseline polysomnographic data did not independently predict these morbidities or their postsurgical improvement. Neither PSQ nor polysomnographic data were associated with objectively assessed executive dysfunction or improvement at follow-up. CONCLUSIONS: PSQ symptom items, in contrast to polysomnographic results, reflect subjective measures of OSAS-related impairment of behavior, quality of life, and sleepiness and predict their improvement after adenotonsillectomy. Although objective polysomnography is needed to diagnose OSAS, the symptoms obtained during an office visit can offer adjunctive insight into important comorbidities and likely surgical responses.

Original languageEnglish (US)
Pages (from-to)e662-e671
JournalPediatrics
Volume135
Issue number3
DOIs
StatePublished - Mar 1 2015

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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