Fehrm J, et al. - Experts ascertained if adenopharyngoplasty (APP) had greater efficacy vs adenotonsillectomy (ATE) for treating severe obstructive sleep apnea (OSA) in otherwise healthy children. According to the findings from this study, APP was not more effective than ATE alone in these children, and ATE should remain the primary treatment.

Methods

• Authors conducted a blinded randomized clinical trial at the otorhinolaryngology department at Karolinska University Hospital, Stockholm, Sweden.
• They randomized 83 children, aged 2 to 4 years, with an obstructive apnea-hypopnea index (OAHI) score of 10 or higher, to APP (n = 36) or ATE (n = 47).
• They recruited the participants from December 1, 2014, through November 31, 2016.
• In all 83 patients in both groups, adenotonsillectomy was performed by the cold steel technique, with the APP group also undergoing closure of the tonsillar pillars with two inverted sutures on each side.
• The difference between the groups in OAHI score change before and after surgery was the primary outcome, with worse problems indicated by a higher score, and a score of 10 or higher defined as severe OSA.
• Researchers assessed the outcome per protocol and with intention-to-treat analysis.
• Other polysomnography variables and the Obstructive Sleep Apnea-18 (OSA-18) questionnaire (possible total symptom score range, 18-126; higher scores indicate worse quality of life) were the secondary outcomes.
• They performed polysomnography and completed the OSA-18 questionnaire preoperatively and 6 months postoperatively.

Results

• Of 83 children in the study, 49 (59%) were boys, and the mean (SD) age was 36.6 (9.2) months.
• A total of 74 (89%) (APP, n = 30; ATE, n = 44) of these completed the study.
• Results suggested that the mean (SD) preoperative OAHI score was 23.8 (11.8) for APP and 23.8 (11.5) for ATE.
• A significant decrease in mean OAHI score after surgery was seen in both the APP and ATE groups (-21.7; 95% CI, -26.3 to -17.2; and -21.1; 95% CI, -24.5 to -17.7, respectively), but there was no significant difference between the groups (0.7; 95% CI, -4.8 to 6.1).
• Also, findings revealed no significant differences between the groups regarding other polysomnography variables (eg, respiratory distress index: mean, 0.6; 95% CI, -5.0 to 6.3) or the OSA-18 questionnaire (eg, total symptom score: -0.5; 95% CI, -13 to 12).
• One patient from each group was readmitted due to postoperative bleeding, but no other complications were seen.