(JOURNAL READING)

A RANDOMIZED TRIAL OF
ADENOTONSILLECTOMY
FOR CHILDHOOD SLEEP APNEA

DIANA ANGGRAINI ASMARAPUTRI

30101206758
 ABOUT JOURNAL

Title :
A Randomized Published date Published
Author : : by :
Trial of
Adenotonsillec Carole L. This journal N Engl J
tomy Marcus, M.B., was published Med
for Childhood B.Ch., Rene on May 21, 2013;368:23
Sleep Apnea H. Moore, 2013, 66-76.
Ph.D., .
at NEJM.org.
 BACKGROUND

The most commonly

identified risk factor for
there has
the childhood
been no controlled
Obstructive
study evaluating the
Sleep apnea syndrome is
benefits
adenotonsillar
and risks of
hypertrophy. Thus, the
adenotonsillectomy, as
primary treatment is
compared
adenotonsillectomy,
with watchful waiting,
Which accounts for more
for the management of
than 500,000 procedures
the obstructive sleep
annually in the
apnea syndrome.
United States alone.
 This study was
conducted in an aim to
investigate A
Randomized Trial of
Adenotonsillectomy
for Childhood Sleep
Apnea

to evaluate the efficacy of early

adenotonsillectomy versus watchful
waiting with supportive care, with
respect to cognitive,
behavioral,quality-of-life, and sleep
factors and evaluated whether the
relative efficacy of the
treatment differed according to
race, weight, or
baseline severity of the syndrome.
 METHOD

DESAIN
randomized controlled clinical trial
SAMPLE
A total of 464 children underwent randomization. 5 to 9
years of age, with theobstructive sleep apnea syndrome
The current randomized controlled clinical trial was
conducted at seven academic sleep centers
 Main
outcome
Assessment
s Follow up

Partici
pants

Statistical analisys
 PARTICIPANTS

Inclusion :
Eligible children were 5 to 9 years of age, had the
obstructive sleep apnea syndrome without
prolonged oxyhemoglobin desaturation, and were
considered to be suitable candidates
for adenotonsillectomy. The obstructive sleep
apnea syndrome was defined as an obstructive
apneahypopnea index (AHI)
 ASSESSMENTS

Children underwent standardized polysomnographic

testing
with scoring at a centralized sleep reading center,
cognitive and
behavioral testing, and other clinical and laboratory
evaluations
at baseline and 7 Months after randomization. 6 At both
examinations, caregivers were asked to complete survey
instruments, and teachers were mailed behavioral
assessments
(see the Supplementary Appendix).
 RESULT
The baseline attention and executive function score on
the
NEPSY was close to the population mean of 100 in both
groups. Average scores increased in both groups; the
difference
Between the groups favored early adenotonsillectomy but
was not significant (P = 0.16).
There was a significantly greater improvement on the
caregiver-reported Conners Rating Scale among children
randomly assigned to early adenotonsillectomy than
among
those assigned to watchful waiting.
 Symptoms of the obstructive sleep apnea
syndrome were
measured with the use of the PSQ-SRBD and the
Epworth
Sleepiness Scale, and generic and disease-specific
measures of
quality of life were assessed by means of the PedsQL
and
OSA-18, respectively. All these instruments showed a
Significantly greater reduction in symptoms In the
early-
Adenotonsillectomy group than in the watchful-waiting
group.
The AHI score improved in both groups but significantly
more
so in the early-adenotonsillectomy group
 CRITICAL APRAISAL

Consist of 8 words
Title Describes the main contents of study

Informatif, There are background, methods, results,

conclusions, there are keyword of the journal, < 250
abstract words

There is inclusion and exclusion criteria are mentioned,

The current randomized controlled clinical trial were
Contents endroll in this study, There is place and time of study
 Pediatric patients 5 to 9 years of age, with the obstructive
sleep apnea syndrome to early adenotonsillectomy or a
Populati
strategy of watchful waiting
on

In this study, randomly assigned 464 children, 5 to 9 years

Interven of age, with theobstructive sleep apnea syndrome to
si: early adenotonsillectomy or a strategy of watchful waiting

the study were compared with a strategy of watchful

waiting, surgical treatment for the obstructive sleep apnea
Compar
syndrome in school-age children
e:

compared with a strategy of watchful waiting, surgical

treatment for the obstructive sleep apnea syndrome in
school-age children did not significantly improve attention or
executive function as measured by neuropsychological
Outcom testing but did reduce symptoms and improve secondary
e: outcomes of behavior
 VALIDITY
Questions Answers
Wheter the allocation of patients Yes
on this study was done randomly?

Wheter the patients were Yes

sufficiently long observation?

Wheter all the patients in the Yes

randomized, analyzed?

Wheter patients and physicians Yes

remain blind to therapy, other
therapies tested?

Is the treatment and control groups Yes

alike?
 APLICABLE

Questions Answers

Is there difference in our patients No

when compared to those of
previous study?

May the such of therapy be aplied Yes

to our patients?

Has the patient the potensial Potensial beneficial

beneficial or detrimental if the
therapy is applied?
CONCLUSIONS

Validity

Applicable