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Impact of Adenotonsillectomy on Quality of Life in Children With Obstructive Sleep Disorders
Lianne M. de Serres, MD;
Craig Derkay, MD;
Kathleen Sie, MD;
Michael Biavati, MD;
Jacqueline Jones, MD;
David Tunkel, MD;
Scott Manning, MD;
Andrew F. Inglis, MD;
Joseph Haddad, Jr, MD;
Dimitra Tampakopoulou, MD;
Alan D. Weinberg, MS
Arch Otolaryngol Head Neck Surg. 2002;128:489-496.
Objectives To determine the impact of adenotonsillectomy on quality of life (QOL)
in children with obstructive sleep disorders (OSDs) before and after surgery.
Design Prospective, observational, before-and-after trial.
Setting Seven tertiary pediatric otolaryngology practices.
Patients Convenience sample of 101 children (mean age, 6.2 years) with adenotonsillar
hypertrophy and OSD scheduled for adenotonsillectomy.
Intervention Adenotonsillectomy was performed in children for OSDs. Quality of life
was assessed using the Obstructive Sleep Disorders–6 survey, a validated
instrument for detecting QOL change in children with OSDs. Surveys were completed
at the initial office visit (visit 1), the day of surgery (visit 2), and at
the postoperative office visit (visit 3). Physical characteristics were assessed
using tonsillar and orocraniofacial scales (visit 1). Satisfaction with health
care decisions was assessed using the Satisfaction With Decision and Satisfaction
With Office Visit scales (visit 1).
Main Outcome Measures Short-term changes in QOL before (visits 1 and 2) and after (visits
2 and 3) surgery.
Results Changes in QOL before surgery were trivial or small, and smaller than
changes after surgery (mean change score, 0.18 vs 2.3; P<.001). Large, moderate, and small improvements in QOL were seen
in 74.5%, 6.1%, and 7.1% of children, respectively. Sleep disturbance, caregiver
concern, and physical suffering were the most improved domains, although significant
changes also occurred for speech and swallowing problems, emotional disturbance,
and activity limitations. Five percent of children had poorer QOL after surgery,
but no predictive factors were identified.
Conclusion Adenotonsillectomy produces large improvements in at least short-term
QOL in most children with OSDs.
From the Division of Pediatric Otolaryngology, The Children's Hospital
of New York, NY Presbyterian Hospital, Columbia University, New York (Drs
de Serres, Haddad, and Tampakopoulou); the Department of Otolaryngology–Head
and Neck Surgery, Children's Hospital of the King's Daughter, Eastern Virginia
Medical School, Norfolk (Dr Derkay); the Division of Pediatric Otolaryngology,
Children's Hospital and Regional Medical Center, Department of Otolaryngology–Head
and Neck Surgery, University of Washington, Seattle (Drs Sie, Manning, and
Inglis); the Division of Pediatric Otolaryngology, Children's Hospital of
Dallas, Dallas, Tex (Dr Biavati); the Division of Pediatric Otolaryngology,
New York Weill Cornell Medical Center, NY Presbyterian Hospital, Cornell University,
New York (Dr Jones); the Department of Otolaryngology–Head and Neck
Surgery, Johns Hopkins University, Baltimore, Md (Dr Tunkel); and the Department
of Surgery, NY Presbyterian Hospital, Columbia University, New York (Mr Weinberg).
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