Sleep experts have conducted the first multicenter clinical trial of obstructive sleep apnea in children and have found that those who underwent surgery to remove their adenoids and tonsils had notable improvements in behavior, quality of life and other symptoms compared to those treated with “watchful waiting” and supportive care.
However, the researchers found no difference between both groups in attention and executive functioning, as measured by formal neuropsychological tests.
“This was the first randomized clinical trial of surgery for obstructive sleep apnea in children,” said first author Carole L. Marcus, MD, who directs the Sleep Center at The Children’s Hospital of Philadelphia. “Some previous, smaller studies had found this condition associated with cognitive and behavioral problems, including ADHD, so it was important to do a controlled trial to evaluate the benefits of surgery, which is a common treatment.”
The findings are the result of the Childhood Adenotonsillectomy Trial (CHAT) that involved 464 children, aged 5 to 9, at seven academic sleep centers. The CHAT researchers published their findings in the New England Journal of Medicine, in conjunction with a presentation at the American Thoracic Society annual meeting. Susan Redline, MD, MPH, of Brigham and Women’s Hospital, Boston, is the study’s principal investigator.
Obstructive sleep apnea syndrome, or OSAS, is a condition of interrupted breathing caused by a narrowing in the throat or upper airway, resulting from enlarged tonsils and adenoid, obesity or other medical problems. Occurring in both adults and children, OSAS has a higher prevalence in African-American and obese patients. Adenotonsillectomy, the surgical removal of adenoid and tonsils, is the primary treatment for OSAS in children. More than half a million U.S. children undergo the surgery each year.
The primary outcome of the CHAT trial was the Attention/Executive Function Domain score in a formal test, the Developmental Neuropsychological Assessment. The study found no significant difference between the treatment groups in these test results. The secondary outcomes included ratings from parents and teachers who completed questionnaires rating a child’s behavior, sleepiness, quality of life, and executive functioning, including details about activities of daily living.
The researchers found that the children who had surgery had significantly greater improvements, compared to children in the watchful waiting group, in the secondary outcomes.
Overall, both surgery and watchful waiting were safe in this clinical trial, the researchers noted. Dr. Marcus said that watchful waiting was a reasonable option for parents of children with less severe OSAS who opt not to have surgery, but that clinicians should carefully monitor these children to ensure their condition does not worsen.
More research is needed to determine, among other things, the most effective treatments for younger children with OSAS and if the condition recurs as children enter puberty.
“Sleep medicine is a very new field, with many unanswered questions,” concluded Dr. Marcus. “For instance, we go to sleep each night, yet we don’t even know truly understand the true purpose of sleep. But this study is a great first step in finding some of the answers.”