Polysomnography and Treatment-Related Outcomes of Childhood Sleep Apnea.

BACKGROUND

Polysomnography is central to the diagnosis and management of childhood obstructive sleep apnea (OSA). However, it is not known whether the treatment-related outcomes of OSA are causally associated with its resolution or changes in severity as determined by polysomnography.

METHODS

Polysomnographic, cognitive, behavioral, quality-of life, and health outcomes at baseline and at 7 months were obtained from the Childhood Adenotonsillectomy Trial, a randomized trial comparing the outcomes of early adenotonsillectomy to watchful waiting in children with OSA. We used causal mediation analysis to measure the changes in 18 outcomes independently attributable to polysomnographic resolution or changes in severity after adjusting for confounding variables.

RESULTS

A total of 398 children aged 5 to 9 years were included. A total of 244 (61%) experienced resolution of OSA at follow-up. Polysomnographic resolution of the condition accounted for small but significant proportions of changes in symptoms (proportion mediated [95% confidence interval] 0.13 [0.07 to 0.21]; < .001) and disease-specific quality of life (0.11 [0.04 to 0.20]; = .004). Changes in polysomnographic severity similarly mediated symptom score (proportion mediated 0.18 [0.11 to 0.26]; < .001) and disease-specific quality-of-life outcomes (0.20 [0.10 to 0.31]; = .004). Importantly, significant mediation effects were not identified for any of the other 16 outcomes. No significant interactions were observed between the trial arms.

CONCLUSIONS

The majority of the treatment-related changes in outcomes of OSA in school-aged children are not causally attributable to polysomnographic resolution or changes in its severity. These results underscore the limited utility of polysomnographic thresholds in the management of childhood OSA.