Clinical assessment of pediatric obstructive sleep apnea.
Pediatrics, 2004/7;114(1):33-43.
Goldstein NA[1], Pugazhendhi V, Rao SM, Weedon J, Campbell TF, Goldman AC, Post JC, Rao M
Affiliations
PMID: 15231905
Impact factor: 9.703
Abstract
objective: To determine whether children with a clinical assessment suggestive of obstructive sleep apnea (OSA) but with negative polysomnography (PSG) have improvement in their clinical assessment score after tonsillectomy and adenoidectomy (T&A) as compared with similar children who do not undergo surgery.
methods: In a prospective, randomized, investigator-blinded, controlled trial, 59 otherwise healthy children (mean age: 6.3 years [3.0]; 31 boys, 28 girls) with a clinical diagnosis of OSA (clinical assessment score 40) were recruited from the pediatric otolaryngology and pediatric pulmonary private offices and clinics of a tertiary care, academic medical center. A standardized assessment was performed on all patients, including history, physical examination, voice recording, tape recording of breathing during sleep, lateral neck radiograph, echocardiogram, and PSG. A clinical assessment score was assigned. Children with positive PSG (n = 27) were scheduled for T&A, whereas children with negative PSG (n = 29) were randomized to T&A (n = 15) or no surgery (n = 14). Children were reassessed in an identical manner at a planned 6-month follow-up.
results: Follow-up was available for 21 patients with positive PSG, 11 patients with negative PSG randomized to T&A, and 9 nonsurgery patients. In the randomized subjects, the median reduction in clinical assessment score was 49 (range: 32-61) for the T&A patients as compared with 8 (range: -9 to 29) for the nonsurgery patients. Nine (82%) of the T&A patients were asymptomatic (clinical assessment score <20) compared with 2 (22%) of the nonsurgery patients.
conclusion: Children with a positive clinical assessment of OSA but negative PSG have significant improvement after T&A as compared with observation alone, thus validating the clinician's role in diagnosing upper airway obstruction.
MeSH terms
Adenoidectomy; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Logistic Models; Male; Observer Variation; Polysomnography; Predictive Value of Tests; Prospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Single-Blind Method; Sleep Apnea, Obstructive; Tonsillectomy
More resources
EndNote: Download