• Ronald D Chervin, Susan S Ellenberg, Xiaoling Hou, Carole L Marcus, Susan L Garetz, Eliot S Katz, Elise K Hodges, Ron B Mitchell, Dwight T Jones, Raanan Arens, Raouf Amin, Susan Redline, Carol L Rosen, and Childhood Adenotonsillectomy Trial.
• Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI. Electronic address: chervin@umich.edu.
• Chest. 2015 Nov 1; 148 (5): 1204-1213.

BackgroundAdenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment.MethodsThe Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline.ResultsAfter 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors.ConclusionsMany candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT.Trial RegistryClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

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