Effect of Adenotonsillectomy on Parent-Reported Sleepiness in Children with Obstructive Sleep Apnea

Abstract

Study objectives: To describe parental reports of sleepiness and sleep duration in children with polysomnography (PSG)-confirmed obstructive sleep apnea (OSA) randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC) in the ChildHood Adenotonsillectomy Trial (CHAT). We hypothesized children with OSA would have a larger improvement in sleepiness 6 mo following eAT compared to WWSC.

Methods: Parents of children aged 5.0-9.9 y completed the Epworth Sleepiness Scale modified for children (mESS) and the Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). PSG was performed at baseline and at 7-mo endpoint. Children underwent early adenotonsillectomy or WWSC.

Results: The mESS and PSQ-SS classified 24% and 53% of the sample as excessively sleepy, respectively. At baseline, mean mESS score was 7.4 ± 5.0 (SD) and mean PSQ-SS score was 0.44 ± 0.30. Sleepiness scores were higher in African American children; children with shorter sleep duration; older children; and overweight children. At endpoint, mean mESS score decreased by 2.0 ± 4.2 in the eAT group versus 0.3 ± 4.0 in the WWSC group (P < 0.0001); mean PSQ-SS score decreased 0.29 ± 0.40 in eAT versus 0.08 ± 0.40 in the WWSC group (P < 0.0001). Despite higher baseline sleepiness, African American children experienced similar improvement with adenotonsillectomy than other children. Improvement in sleepiness was weakly associated with improved apnea-hypopnea index or oxygen desaturation indices, but not with change in other polysomnographic measures.

Conclusions: Sleepiness assessed by parent report was prevalent; improved more after eAT than after WWSC; and was not strongly predicted by sleep disturbances identified by PSG.

Clinical trial registration: Childhood Adenotonsillectomy Study for Children with OSA (CHAT). ClinicalTrials.gov Identifier #NCT00560859.

Keywords: Epworth Sleepiness Scale; OSA; OSAS; Pediatric Sleep Questionnaire; adenotonsillectomy; apnea-hypopnea index; pediatric; polysomnogram; sleepiness.

© 2016 Associated Professional Sleep Societies, LLC.

Figures

Figure 1

Change in modified Epworth Sleepiness Scale scores for early adenotonsillectomy and watchful waiting with supportive care groups. a Paired t-test. b Analysis of variance two-way interaction. There was a significant change in baseline and endpoint mESS scores in the eAT group. In addition, there was a significant difference in change between groups over time (P = 0.01; analysis of variance). eAT, early adenotonsillectomy group; mESS, modified Epworth Sleepiness Scale; WWSC, watchful waiting with supportive care group.

Figure 2

Change in Pediatric Sleep Questionnaire - Sleepiness Subscale scores for early adenotonsillectomy and watchful waiting with supportive care groups. a Paired t-test. b Analysis of variance two-way interaction. There was a significant change in baseline and endpoint modified Epworth Sleepiness Scale scores in the eAT group (n = 198) and in the WWSC group (n = 204). In addition, there was a significant difference in change between groups over time (P < 0.0001; analysis of variance). eAT, early adenotonsillectomy group; PSQ-SS, Pediatric Sleep Questionnaire - Sleepiness Subscale; WWSC, watchful waiting with supportive care group.