Assessing the need for adenotonsillectomy for sleep

disordered breathing in a community setting : A

secondary outcome measures analysis of a
randomized controlled study
Chariton E. Papadakis, Konstantinos Chaidas, Theognosia S. Chimona, Maria Zisoglou, Alexandros
Ladias, Efklidis K. Proimos, Michael Miligkos, Athanasios G. Kaditis
Pediatric Pulmonology.2019;1-7

Presented by Natalia Putri Kaigere, MD

Jakarta, November 27th 2020
 INTRODUCTION
• Numerous children globally undergo adenotonsillectomy (AT) for obstructive sleep‐disordered breathing (SDB).

Childhood Adenotonsilectomy
Trial (CHAT)
applied to demonstrate postoperative

Polysomnography improvement in respiratory disturbance

and neurobehavior morbidity
Complex Psychometric

• hypothesized that children with symptom severity exceeding a certain cut‐off level.

Postoperative changes in secondary Enuresis, somatic growth and cardiovascular system

outcomes health
 METHODS
• Observational prospective randomized controlled Study
• Chania Greece General Hospital
Criteria Inclusion

1. Children aged 4 to 10
yo,
2. history of snoring >3
nights /week for at least
6 months,
3. tonsillar hypertrophy
(tonsillar size >2+),
4. candidate for AT;
5. were otherwise healthy
AT Group
0 Months baseline 3 Months Follow- up
CHANGE
- PSQ-SRBD
- mESS
- Nocturnal Enuresis < 1 night per week
Control Group - Proportion in body weight z-score ≥ 0.5
- Proportion in BMI z-score ≥ 0.5
- Average pulse ≥ 6bpm
- Systolic and diastolic blood pressure percentile
- CRP Serum Concentration
 Table 1. baseline characteristics of participants in the two study group with
RESULT technically acceptable baseline follow up oximetry tracings
Variabel AT Group Control Group
No 68 72
Age, y 5.9 ± 1.6 6 ± 1.6
. Sex, Female (%) 33 (48,5) 34 (47,2)
Tonsillar size
3⁺ (%) 61 (89.7) 65 (90.3)
• 186 Eligible Participants 4⁺ (%) 7 (10.3) 7 (9.7)
were randomized Weight z-score 0.3 ± 1.3 0.5 ± 1.4
• 140 children had two BMI z-score 0.3 ± 1.4 0.2 ± 1.6
Obesity (%) 12 (17,6) 14 (19,4)
technically acceptable
ODI3, per h 3.4 (1- 5.7) 4.1 (1.5-9.3)
oximetries and 2/3 of Subjects with ODI3 ≥3,5/h (%) 32 (47.1) 38 (52.8)
them a PSQ-SRBD ≥0.33 Subjects with PSQ-SRBD ≥ 0,33 (%) 48 (70.6) 51 (70.8)
Subjects with PSQ-SRBD ≥ 0,33 25 (36.8) 29 (40.3)
and ODI3 ≥3,5/h (%)
Subjects with PSQ-SRBD < 0,33 13 (19.1) 12 (16.7)
and ODI3 < 3,5/h (%)
Subjects with enuresis (%) 24 (35.3) 22 (30.6)
 RESULT (2)
AT Group Control Group
Group no 68 72
Change between Change between Between group
Outcome measures 0 mo 3 and 0 mo 0 mo 3 and 0 mo Difference (95%CI) P-value

PSQ-SRBD 0,44±0.18 -0.32±0.15 0.41±0.16 -0.01±0.09 -0.31(-0.35 to-0.27) < 0.01

mESS 5.51±3,78 -2.75±3.07 4.61±3.82 0.01±2.04 -2.76(-3.63 to – 1.90) < 0.01

• The AT group experienced significantly larger improvement in PSQ-SRBD and mESS than control
 DISCUSSION

• PSQ‐ SRBD  22‐item questionnaire

• PSQ-SRBD score ≥ 0.33  high risk of moderate to severe SDB

• The observation period of 3 month not have been significant

differences in somatic growth between the two study groups to be
demonstrated.
 CONCLUSION
• Preoperative PSQ-SRBD score ≥0.33 have measureable clinical benefit
postoperatively

• PSQ‐SRBD can faciliatate treatment decisions for children with

obstructive SDB
Limitation :
Strenghts :
• Small number of children with
• Computer generated
PSQ-SRBD score ≥0.33 who had
group assignment ODI3 ≥ 3.5/h or were obese