Department of Otolaryngology, Dunedin Public Hospital and Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Biostatistics Centre, University of Otago, Dunedin, New Zealand.
Int J Pediatr Otorhinolaryngol. 2022 Feb;153:111001. doi: 10.1016/j.ijporl.2021.111001. Epub 2021 Dec 15.
Adenotonsillar hypertrophy is the main cause of childhood sleep disordered breathing (SDB) and adenotonsillectomy (TA) the most common treatment. Polysomnography (PSG) for diagnosing SDB is often difficult to obtain with Otolaryngologists usually relying on history and examination when recommending TA. Questionnaires assessing quality of life (QoL) may assist the Otolaryngologists decision making.
To explore changes in QoL tools following TA for SDB in children aged 3 to 15 with the aim of identifying whether the Pediatric Sleep Questionnaire (PSQ) or Obstructive Sleep Apnoea -18 (OSA-18) is a better predictor of outcome following TA.
QoL was assessed using OSA-18, PSQ and the Pediatric Quality of Life Inventory™ (PedsQL™). Four groups were recruited from three research databases, those with: SDB, recurrent tonsillitis (RT), SDB and RT, or no disease (controls). Children either received TA or underwent observation. QoL questionnaires were administered at recruitment and 3 months later. Test-retest reliability was assessed using Bland-Altman plots. Pre-intervention scores were plotted against changes in scores, with pre-established cut-offs and cut-offs indicated by control group variability.
There were 120 children, 25 had no intervention, and 19 were controls. All questionnaires showed test-retest reliability over time. Using the distribution of scores from the control group we estimated the 95th percentile to redefine the cut-off for OSA-18 (reduced from 60 to 46) and PSQ (unchanged from 0.33). Higher pre-operative scores predicted greater reduction following TA, with OSA-18 the most consistent predictor of QoL change. The PSQ classified 86.8% of children undergoing TA above the 0.33 cut-off; whereas OSA-18 classified 73.7% above the 46 cut-off. Of these, 71.2% and 87.5% showed improvement after TA, respectively. Using the 95% confidence interval for change in the control group to identify a 'meaningful' change in score, children with OSA-18 scores >46 had a 93% chance of a meaningful improvement, whereas PSQ scores >0.33 were associated with an 80% chance of a meaningful improvement.
OSA-18 is a better predictor of improved QoL than PSQ for TA in children with SDB. We propose a new cut off score (>46) for OSA-18. This may assist Otolaryngologists' decision making when assessing a child with SDB.
腺样体扁桃体肥大是儿童睡眠呼吸障碍（SDB）的主要原因，腺样体扁桃体切除术（TA）是最常见的治疗方法。诊断 SDB 的多导睡眠图（PSG）通常难以获得，耳鼻喉科医生通常在推荐 TA 时依赖于病史和检查。评估生活质量（QoL）的问卷可能有助于耳鼻喉科医生的决策。
探讨 3 至 15 岁儿童因 SDB 接受 TA 后 QoL 工具的变化，目的是确定阻塞性睡眠呼吸暂停 -18（OSA-18）或小儿睡眠问卷（PSQ）是否是 TA 后结局的更好预测指标。
使用 OSA-18、PSQ 和儿科生活质量量表™（PedsQL™）评估 QoL。从三个研究数据库招募了四个组，分别为：SDB、复发性扁桃体炎（RT）、SDB 和 RT 或无疾病（对照组）。儿童要么接受 TA，要么接受观察。在招募时和 3 个月后进行 QoL 问卷调查。使用 Bland-Altman 图评估测试-再测试可靠性。将干预前的分数与分数变化进行比较，采用预先设定的截止值和对照组变异性指示的截止值。
共有 120 名儿童，25 名未接受干预，19 名是对照组。所有问卷在一段时间内均显示出测试-再测试的可靠性。使用对照组的分数分布，我们估计了 95%的百分位数来重新定义 OSA-18（从 60 降低到 46）和 PSQ（不变为 0.33）的截止值。术前较高的分数预示着 TA 后更大的降低，OSA-18 是 QoL 变化最一致的预测指标。PSQ 将 86.8%接受 TA 的儿童分类为 0.33 截止值以上；而 OSA-18 将 73.7%分类为 46 截止值以上。其中，71.2%和 87.5%在 TA 后分别显示出改善。使用对照组中分数变化的 95%置信区间来确定分数的“有意义”变化，OSA-18 评分>46 的儿童有 93%的可能性有明显改善，而 PSQ 评分>0.33 与 80%的可能性有明显改善相关。
对于因 SDB 接受 TA 的儿童，OSA-18 是比 PSQ 更好的预测 QoL 改善的指标。我们提出了一个新的 OSA-18 截止值（>46）。这可能有助于耳鼻喉科医生在评估 SDB 儿童时做出决策。
