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Early adenotonsillectomy for obstructive sleep apnoea improved quality of life and symptoms but not attention or executive function
watchful waiting. Primary outcome analysis recorded in 194 assigned to early adenotonsillectomy and 203 to watchful waiting.
Design: Multicentre, single-blind randomised trial. Allocation: Concealed (web-based randomisation) Blinding: Study investigators (other than surgeons) were blinded. Families were not blinded.
MAIN RESULTS Executive and attention scores improved in both groups, early adenotonsillectomy significantly improved teacher and caregiver reported behaviour. The unblinded assessments by caregivers showed greater improvement than the unblinded assessments by teachers. Symptoms of OSAS, and quality of life were improved in the early adenotonsillectomy (see table 1).
STUDY QUESTION Setting: Seven academic sleep centres in the USA. Patients: Children 5–9 years with obstructive sleep apnoea syndrome (OSAS). Without recurrent tonsillitis, body mass index z-score >3 and medication for attention-deficit hyperactivity disorder. Intervention: Tonsillectomy within 4 weeks or watchful waiting. Outcomes: Change in attention and executive-function score caregiver and teacher rating of behaviour; symptoms of OSAS global quality of life; intellectual functioning and polysomno-graphic indices. Follow-up period: 7 months. Patient follow-up: 464 children randomised—226 assigned to early adenotonsillectomy and 227 to
CONCLUSION In children with obstructive sleep apnoea symptoms (but not prolonged periods of desaturation), early adenotonsillectomy compared with watchful waiting did not improve attention or executive function but improved behaviour, quality of life and polysomnographic findings. Abstracted from: Marcus CL, Moore RH, Rosen CL, et al. Childhood Adenotonsillectomy Trial (CHAT). A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea. N Engl J Med 2013;368:2366–76.
Table 1 Outcome measures Watchful waiting (n=203) Change at 7 months
Outcome
Blinding
Baseline
BRIEF Caregiver
Unblinded
50.1 (48.5 to 51.7)
Blinded
56.4 (54.1 to 58.7)
Teacher
Early adenotonsillectomy (n=194)
0.4 (−0.83 to 1.63) −1.0 (−3.2 to 1.2)
Baseline
Effect size†
p Value
50.1 (48.5 to 51.7)
−3.3 (−4.5 to 2.1)
Small
Early adenotonsillectomy for obstructive sleep apnoea improved quality of life and symptoms but not attention or executive function
watchful waiting. Primary outcome analysis recorded in 194 assigned to early adenotonsillectomy and 203 to watchful waiting.
Design: Multicentre, single-blind randomised trial. Allocation: Concealed (web-based randomisation) Blinding: Study investigators (other than surgeons) were blinded. Families were not blinded.
MAIN RESULTS Executive and attention scores improved in both groups, early adenotonsillectomy significantly improved teacher and caregiver reported behaviour. The unblinded assessments by caregivers showed greater improvement than the unblinded assessments by teachers. Symptoms of OSAS, and quality of life were improved in the early adenotonsillectomy (see table 1).
STUDY QUESTION Setting: Seven academic sleep centres in the USA. Patients: Children 5–9 years with obstructive sleep apnoea syndrome (OSAS). Without recurrent tonsillitis, body mass index z-score >3 and medication for attention-deficit hyperactivity disorder. Intervention: Tonsillectomy within 4 weeks or watchful waiting. Outcomes: Change in attention and executive-function score caregiver and teacher rating of behaviour; symptoms of OSAS global quality of life; intellectual functioning and polysomno-graphic indices. Follow-up period: 7 months. Patient follow-up: 464 children randomised—226 assigned to early adenotonsillectomy and 227 to
CONCLUSION In children with obstructive sleep apnoea symptoms (but not prolonged periods of desaturation), early adenotonsillectomy compared with watchful waiting did not improve attention or executive function but improved behaviour, quality of life and polysomnographic findings. Abstracted from: Marcus CL, Moore RH, Rosen CL, et al. Childhood Adenotonsillectomy Trial (CHAT). A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea. N Engl J Med 2013;368:2366–76.
Table 1 Outcome measures Watchful waiting (n=203) Change at 7 months
Outcome
Blinding
Baseline
BRIEF Caregiver
Unblinded
50.1 (48.5 to 51.7)
Blinded
56.4 (54.1 to 58.7)
Teacher
Early adenotonsillectomy (n=194)
0.4 (−0.83 to 1.63) −1.0 (−3.2 to 1.2)
Baseline
Effect size†
p Value
50.1 (48.5 to 51.7)
−3.3 (−4.5 to 2.1)
Small
