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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 33-43

Clinical Assessment of Pediatric Obstructive Sleep Apnea

Nira A. Goldstein, MD^*, Vasanthi Pugazhendhi, MD, Sudha M. Rao, MD, Jeremy Weedon, PhD^||, Thomas F. Campbell, PhD^¶, Andrew C. Goldman, MD^*, J. Christopher Post, MD, PhD^# and Madu Rao, MD

^* Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York
Division of Pediatric Pulmonology, State University of New York Downstate Medical Center, Brooklyn, New York
Division of Pediatric Cardiology, State University of New York Downstate Medical Center, Brooklyn, New York
^|| Scientific Computing Center, State University of New York Downstate Medical Center, Brooklyn, New York
^¶ Department of Communication Science and Disorders, University of Pittsburgh and the Department of Audiology and Communication Disorders, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
^# Department of Pediatric Otolaryngology, Allegheny General Hospital, Pittsburgh, Pennsylvania

Objective. To determine whether children with a clinical assessment suggestive of obstructive sleep apnea (OSA) but with negative polysomnography (PSG) have improvement in their clinical assessment score after tonsillectomy and adenoidectomy (T&A) as compared with similar children who do not undergo surgery.

Methods. In a prospective, randomized, investigator-blinded, controlled trial, 59 otherwise healthy children (mean age: 6.3 years [3.0]; 31 boys, 28 girls) with a clinical diagnosis of OSA (clinical assessment score 40) were recruited from the pediatric otolaryngology and pediatric pulmonary private offices and clinics of a tertiary care, academic medical center. A standardized assessment was performed on all patients, including history, physical examination, voice recording, tape recording of breathing during sleep, lateral neck radiograph, echocardiogram, and PSG. A clinical assessment score was assigned. Children with positive PSG (n = 27) were scheduled for T&A, whereas children with negative PSG (n = 29) were randomized to T&A (n = 15) or no surgery (n = 14). Children were reassessed in an identical manner at a planned 6-month follow-up.

Results. Follow-up was available for 21 patients with positive PSG, 11 patients with negative PSG randomized to T&A, and 9 nonsurgery patients. In the randomized subjects, the median reduction in clinical assessment score was 49 (range: 32–61) for the T&A patients as compared with 8 (range: –9 to 29) for the nonsurgery patients. Nine (82%) of the T&A patients were asymptomatic (clinical assessment score <20) compared with 2 (22%) of the nonsurgery patients.

Conclusion. Children with a positive clinical assessment of OSA but negative PSG have significant improvement after T&A as compared with observation alone, thus validating the clinician’s role in diagnosing upper airway obstruction.

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Key Words: obstructive sleep apnea • polysomnography • tonsillectomy • adenoidectomy • sleep-disordered breathing • snoring

Abbreviations: OSA, obstructive sleep apnea • PSG, polysomnography • UARS, upper airway resistance syndrome • T&A, tonsillectomy and adenoidectomy • BMI, body mass index • RDI, respiratory disturbance index • ROC, receiver operating characteristic • AI, apnea index

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Received for publication May 27, 2003; Accepted Oct 23, 2003.

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