Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(01): e123-e128
DOI: 10.1055/s-0040-1709195
Original Research

Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

Juliana Alves Sousa Caixeta 
1   Universidade Federal de Goiás, Goiânia, GO, Brazil
,
Jessica Caixeta Silva Sampaio 
2   UniEVANGÉLICA, Anápolis, GO, Brazil
,
Vanessa Vaz Costa 
2   UniEVANGÉLICA, Anápolis, GO, Brazil
,
Isadora Milhomem Bruno da Silveira 
2   UniEVANGÉLICA, Anápolis, GO, Brazil
,
Carolina Ribeiro Fernandes de Oliveira 
2   UniEVANGÉLICA, Anápolis, GO, Brazil
,
Luiz Claudio Alves Sousa Caixeta 
3   Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
,
Melissa Ameloti Gomes Avelino 
1   Universidade Federal de Goiás, Goiânia, GO, Brazil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear.

Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB).

Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant.

Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores.

Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

Keywords

sleep-disordered breathing - quality of life - tonsillectomy - adenoidectomy - OSA-18 - child


Publication History

Received: 08 September 2019

Accepted: 25 February 2020

Article published online:
04 May 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child 1993; 68 (03) 360-366
    CrossrefPubMedGoogle Scholar
  • 2 Ehsan Z, Ishman SL. Pediatric Obstructive Sleep Apnea. Otolaryngol Clin North Am 2016; 49 (06) 1449-1464
    CrossrefPubMedGoogle Scholar
  • 3 de Serres LM, Derkay C, Astley S, Deyo RA, Rosenfeld RM, Gates GA. Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg 2000; 126 (12) 1423-1429
    CrossrefPubMedGoogle Scholar
  • 4 Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T. et al. Elevated morbidity and health care use in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2007; 175 (01) 55-61
    CrossrefPubMedGoogle Scholar
  • 5 Goldstein NA, Fatima M, Campbell TF, Rosenfeld RM. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 2002; 128 (07) 770-775
    CrossrefPubMedGoogle Scholar
  • 6 Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 2005; 115 (06) 1101-1103
    CrossrefPubMedGoogle Scholar
  • 7 Garetz SL, Mitchell RB, Parker PD. et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics 2015; 135 (02) e477-e486
    CrossrefPubMedGoogle Scholar
  • 8 Tan HL, Alonso Alvarez ML, Tsaoussoglou M, Weber S, Kaditis AG. When and why to treat the child who snores?. Pediatr Pulmonol 2017; 52 (03) 399-412
    CrossrefPubMedGoogle Scholar
  • 9 Tamay Z, Akcay A, Kilic G, Suleyman A, Ones U, Guler N. Are physicians aware of obstructive sleep apnea in children?. Sleep Med 2006; 7 (07) 580-584
    CrossrefPubMedGoogle Scholar
  • 10 Balbani APS, Weber SAT, Montovani JC, Carvalho LR. Pediatras e os distúrbios respiratórios do sono na criança. Rev Assoc Med Bras (1992) 2005; 51 (02) 80-86
    CrossrefPubMedGoogle Scholar
  • 11 Derkay CS. Pediatric otolaryngology procedures in the United States: 1977-1987. Int J Pediatr Otorhinolaryngol 1993; 25 (1-3): 1-12
    CrossrefPubMedGoogle Scholar
  • 12 Patel HH, Straight CE, Lehman EB, Tanner M, Carr MM. Indications for tonsillectomy: a 10 year retrospective review. Int J Pediatr Otorhinolaryngol 2014; 78 (12) 2151-2155
    CrossrefPubMedGoogle Scholar
  • 13 Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998; 118 (01) 61-68
    CrossrefPubMedGoogle Scholar
  • 14 Shay S, Shapiro NL, Bhattacharyya N. Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population. Laryngoscope 2015; 125 (02) 457-461
    CrossrefPubMedGoogle Scholar
  • 15 Allareddy V, Martinez-Schlurmann N, Rampa S. et al. Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010: A Population-Based Study. Clin Pediatr (Phila) 2016; 55 (07) 593-602
    CrossrefPubMedGoogle Scholar
  • 16 Paulussen C, Claes J, Claes G, Jorissen M. Adenoids and tonsils, indications for surgery and immunological consequences of surgery. Acta Otorhinolaryngol Belg 2000; 54 (03) 403-408
    PubMedGoogle Scholar
  • 17 Kaygusuz I, Gödekmerdan A, Karlidag T. et al. Early stage impacts of tonsillectomy on immune functions of children. Int J Pediatr Otorhinolaryngol 2003; 67 (12) 1311-1315
    CrossrefPubMedGoogle Scholar
  • 18 Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109 (04) 704-712
    CrossrefPubMedGoogle Scholar
  • 19 Baldassari CM, Mitchell RB, Schubert C, Rudnick EF. Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg 2008; 138 (03) 265-273
    CrossrefPubMedGoogle Scholar
  • 20 Friedman NR. Polysomnography should not be required both before and after adenotonsillectomy for childhood sleep disordered breathing. J Clin Sleep Med 2007; 3 (07) 678-680
    CrossrefPubMedGoogle Scholar
  • 21 Stewart MG, Friedman EM, Sulek M. et al. Quality of life and health status in pediatric tonsil and adenoid disease. Arch Otolaryngol Head Neck Surg 2000; 126 (01) 45-48
    CrossrefPubMedGoogle Scholar
  • 22 Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 2003; 3 (06) 329-341
    CrossrefPubMedGoogle Scholar
  • 23 Escarrá F, Vidaurreta SM. Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids. Arch Argent Pediatr 2015; 113 (01) 21-27
    PubMedGoogle Scholar
  • 24 Bergeron M, Duggins AL, Cohen AP, Ishman SL. Comparison of Patient- and Parent-Reported Quality of Life for Patients Treated for Persistent Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2018; 159 (04) 789-795
    CrossrefPubMedGoogle Scholar
  • 25 Franco Jr RA, Rosenfeld RM, Rao M. First place--resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000; 123 (1 Pt 1): 9-16
    CrossrefPubMedGoogle Scholar
  • 26 Soh HJ, Rowe K, Davey MJ, Horne RSC, Nixon GM. The OSA-5: Development and validation of a brief questionnaire screening tool for obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2018; 113: 62-66
    CrossrefPubMedGoogle Scholar
  • 27 Redline S, Amin R, Beebe D. et al. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep (Basel) 2011; 34 (11) 1509-1517
    CrossrefPubMedGoogle Scholar
  • 28 Huang YS, Hwang FM, Lin CH, Lee LA, Huang PY, Chiu ST. Clinical manifestations of pediatric obstructive sleep apnea syndrome: Clinical utility of the Chinese-version Obstructive Sleep Apnea Questionaire-18. Psychiatry Clin Neurosci 2015; 69 (12) 752-762
    CrossrefPubMedGoogle Scholar
  • 29 Mousailidis GK, Lachanas VA, Skoulakis CE. et al. Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography. Int J Pediatr Otorhinolaryngol 2014; 78 (12) 2097-2102
    CrossrefPubMedGoogle Scholar
  • 30 Fernandes FM, Teles RdaC. Application of the Portuguese version of the Obstructive Sleep Apnea-18 survey to children. Rev Bras Otorrinolaringol (Engl Ed) 2013; 79 (06) 720-726
    Google Scholar
  • 31 Todd CA, Bareiss AK, McCoul ED, Rodriguez KH. Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2017; 157 (05) 767-773
    CrossrefPubMedGoogle Scholar
  • 32 Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P. Impact of adenotonsillectomy on pediatric quality of life: review of the literature. Ital J Pediatr 2017; 43 (01) 107
    CrossrefPubMedGoogle Scholar
  • 33 Ye J, Liu H, Zhang GH. et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol 2010; 119 (08) 506-513
    CrossrefPubMedGoogle Scholar
  • 34 Jeon YJ, Song JJ, Ahn JC. et al. Immediate and Sustained Improvement in Behavior and Life Quality by Adenotonsillectomy in Children With Sleep-Disordered Breathing. Clin Exp Otorhinolaryngol 2016; 9 (02) 136-142
    CrossrefPubMedGoogle Scholar
  • 35 Bousquet J, Arnavielhe S, Bedbrook A. et al; MASK study group. MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence. Clin Transl Allergy 2018; 8: 45
    CrossrefPubMedGoogle Scholar
  • 36 Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989; 36 (06) 1551-1569
    CrossrefPubMedGoogle Scholar
  • 37 Feres MF, Hermann JS, Sallum AC, Pignatari SS. Radiographic adenoid evaluation: proposal of an objective parameter. Radiol Bras 2014; 47 (02) 79-83
    CrossrefPubMedGoogle Scholar
  • 38 Othman MN, Bee See G, Abdul Latif H. Impact of adenotonsillectomy on the quality of life in children with sleep disordered breathing. Int J Pediatr Otorhinolaryngol 2016; 91: 105-107
    CrossrefPubMedGoogle Scholar
  • 39 Ikeda FH, Horta PA, Bruscato WL, Dolci JE. Intellectual and school performance evaluation of children submitted to tonsillectomy and adenotonsillectomy before and after surgery. Rev Bras Otorrinolaringol (Engl Ed) 2012; 78 (04) 17-23
    Google Scholar
  • 40 Feng HW, Jiang T, Zhang HP. et al. Comparisons of thyroid hormone, intelligence, attention, and quality of life in children with obstructive sleep apnea hypopnea syndrome before and after endoscopic adenoidectomy. BioMed Res Int 2015; 2015: 523716
    PubMedGoogle Scholar
  • 41 Baugh RF, Archer SM, Mitchell RB. et al; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144 (01) S1-S30
    CrossrefPubMedGoogle Scholar
  • 42 Volsky PG, Woughter MA, Beydoun HA, Derkay CS, Baldassari CM. Adenotonsillectomy vs observation for management of mild obstructive sleep apnea in children. Otolaryngol Head Neck Surg 2014; 150 (01) 126-132
    CrossrefPubMedGoogle Scholar
  • 43 Lee CH, Kang KT, Weng WC, Lee PL, Hsu WC. Quality of life after adenotonsillectomy for children with sleep-disordered breathing: a linear mixed model analysis. Int J Pediatr Otorhinolaryngol 2014; 78 (08) 1374-1380
    CrossrefPubMedGoogle Scholar
  • 44 Lee CH, Kang KT, Weng WC, Lee PL, Hsu WC. Quality of life after adenotonsillectomy in children with obstructive sleep apnea: short-term and long-term results. Int J Pediatr Otorhinolaryngol 2015; 79 (02) 210-215
    CrossrefPubMedGoogle Scholar
  • 45 Randhawa PS, Cetto R, Chilvers G, Georgalas C, Narula AA. Long-term quality-of-life outcomes in children undergoing adenotonsillectomy for obstructive sleep apnoea: a longitudinal study. Clin Otolaryngol 2011; 36 (05) 475-481
    CrossrefPubMedGoogle Scholar
  • 46 Song IS, Hong SN, Joo JW. et al. Long-term results of sleep-related quality-of-life and behavioral problems after adenotonsillectomy. Laryngoscope 2020; 130 (02) 546-550
    CrossrefPubMedGoogle Scholar
  • 47 Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2011; 144 (06) 844-850
    CrossrefPubMedGoogle Scholar
  • 48 Sohn H, Rosenfeld RM. Evaluation of sleep-disordered breathing in children. Otolaryngol Head Neck Surg 2003; 128 (03) 344-352
    CrossrefPubMedGoogle Scholar
  • 49 Inoshita A, Kasai T, Matsuoka R. et al. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea. J Thorac Dis 2018; 10 (12) 6702-6710
    CrossrefPubMedGoogle Scholar
  • 50 Chan CH, Wong BM, Tang JL, Ng DK. Gender difference in snoring and how it changes with age: systematic review and meta-regression. Sleep Breath 2012; 16 (04) 977-986
    CrossrefPubMedGoogle Scholar
  • 51 Hopkins C, Almeyda R, Alreefy H. et al. Multicentre prospective clinical application of the T14 paediatric outcome tool. J Laryngol Otol 2015; 129 (10) 980-985
    CrossrefPubMedGoogle Scholar
  • 52 Ernst H, Dzioba A, Glicksman J, Paradis J, Rotenberg B, Strychowsky J. Evaluating the impact of adenotonsillectomy for pediatric sleep-disordered breathing on parental sleep. Laryngoscope 2019
    Google Scholar