A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea Carole L. Marcus, M.B., B.Ch., Rene H. Moore, h.!.

, Carol L. Rosen, M.!., Bruno "iordani, h.!., Susan L. "aretz, M.!., H. "erry Taylor, h.!., Ron B. Mitchell, M.!., Raouf Amin, M.!., #liot S. $atz, M.!., Raanan Arens, M.!., Shalini aruthi, M.!., Hiren Muzumdar, M.!., !a%id "ozal, M.!., &ina Hattian'adi Thomas, h.!., (anice )are, h.!., !ean Bee*e, h.!., $aren Snyder, M.S., Lisa #lden, M.!., Ro*ert C. Sprecher, M.!., aul )ill'in', M.!., !+i'ht (ones, M.!., (ohn . Bent, M.!., Timothy Ho*an, M.!., Ronald !. Cher%in, M.!., Susan S. #llen*er', h.!., and Susan Redline, M.!., M. .H., for the Childhood Adenotonsillectomy Trial ,CHATThe authors. affiliations are listed in the Appendi/. Address reprint re0uests to !r. Redline at Bri'ham and )omen.s Hos1 pital, 223 Lon'+ood A%e., Boston, MA 42335, or at sredline6partners.or'. This article +as pu*lished on May 23, 2437, at &#(M.or'. & #n'l ( Med 2437879:;27991<9. !=>; 34.3459?&#(Moa3235::3 Copyri'ht @ 2437 Massachusetts Medical Society. ABSTR ACT BAC$"R=A&! Adenotonsillectomy is commonly performed in children +ith the o*structi%e sleep apnea syndrome, yet its usefulness in reducin' symptoms and impro%in' co'nition, *eha%ior, 0uality of life, and polysomno'raphic findin's has not *een ri'orously e%al1

uated. )e hypothesized that, in children +ith the o*structi%e sleep apnea syndrome +ithout prolon'ed o/yhemo'lo*in desaturation, early adenotonsillectomy, as com1 pared +ith +atchful +aitin' +ith supporti%e care, +ould result in impro%ed outcomes. M#TH=!S )e randomly assi'ned B9B children, 5 to C years of a'e, +ith the o*structi%e sleep apnea syndrome to early adenotonsillectomy or a strate'y of +atchful +aitin'. oly1 somno'raphic, co'niti%e, *eha%ioral, and health outcomes +ere assessed at *ase1 line and at < months. R#SALTS The a%era'e *aseline %alue for the primary outcome, the attention and e/ecuti%e1 function score on the !e%elopmental &europsycholo'ical Assessment ,+ith scores ran'in' from 54 to 354 and hi'her scores indicatin' *etter functionin'-, +as close to the population mean of 344, and the chan'e from *aseline to follo+1up did not differ si'nificantly accordin' to study 'roup ,mean DES!F impro%ement, <.3E37.C in the early1adenotonsillectomy 'roup and 5.3E37.B in the +atchful1+aitin' 'roup8 G 4.39-. >n contrast, there +ere si'nificantly 'reater impro%ements in *eha%ioral, 0uality1of1life, and polysomno'raphic findin's and si'nificantly 'reater reduction in symptoms in the early1adenotonsillectomy 'roup than in the +atchful1+aitin' 'roup. &ormalization of polysomno'raphic findin's +as o*ser%ed in a lar'er pro1 portion of children in the early1adenotonsillectomy 'roup than in the +atchful1 +aitin' 'roup ,<CH %s. B9H-. C=&CLAS>=&S As compared +ith a strate'y of +atchful +aitin', sur'ical treatment for the o*struc1 ti%e sleep apnea syndrome in school1a'e children did not si'nificantly impro%e atten1 tion or e/ecuti%e function as measured *y neuropsycholo'ical testin' *ut did reduce symptoms and impro%e secondary outcomes of *eha%ior, 0uality of life, and poly1

somno'raphic findin's, thus pro%idin' e%idence of *eneficial effects of early adeno1 tonsillectomy. ,Iunded *y the &ational >nstitutes of Health8 CHAT ClinicalTrials.'o% num*er, &CT44594:5C.The &e+ #n'land (ournal of Medicine !o+nloaded from neJm.or' on &o%em*er 3:, 2437. Ior personal use only. &o other uses +ithout permission. Copyri'ht @ 2437 Massachusetts Medical Society. All ri'hts reser%ed. A