Quality of Life and Behavioural Assessment in Post-adenotonsillectomy Cases of Paediatric Age Group

Abstract

Adenotonsillectomy is a widely practiced surgical intervention to manage obstructive sleep apnoea syndrome (OSAS) in the paediatric age group. We conducted a prospective, non randomised, interventional study among 40 patients in paediatric age group (2–18 years) suffering from adenotonsillar hypertrophy with an indication of adenotonsillectomy based on American Academy of Otolaryngology-Head and Neck Surgery criteria. Care givers completed the obstructive sleep apnoea 18 (OSA 18) quality of life (QoL) survey and Rutter Children’s Behaviour Questionnaire (RCBQ) before adenotonsillectomy as well as 6 months after surgery. We found that mean score of OSA 18 and total RCBQ decreased significantly 6 months after surgery. The mean score of OSA 18 (4.12 ± 1.4) and total RCBQ score (20.5 ± 2) significantly reduced to 1.19 ± 0.12 and 7.4 ± 2.55 (p < 0.0001), respectively, after surgery. There was significant improvement in all the domains of OSA 18 score after intervention including sleep disturbance (mean score change 2.56, p < 0.0001), physical suffering (2.99, p < 0.0001), emotional distress (2.71, p < 0.0001), daytime problems (2.56, p < 0.0001), caregiver concerns (3.76, p < 0.0001). We also observed that QoL as well as behaviour was independent of age and gender of patients. This study demonstrates significant score changes across all questionnaire domains, comparing pre and post operative data indicating an improvement in their quality of life and behaviour. Hence, we advocate that adenotonsillectomy may be considered as an effective treatment in properly selected patients with OSAS.

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References

  1. 1.

    Seden A, Tami T (2002) Fundamentals of the ear, nose and throat, 12th edn. Lippincott & Wilkins, Philadelphia, pp 457–466

    Google Scholar 

  2. 2.

    Amin RS, Kimball TR, Bean JA, Jeffries J, Willging JP, Cotton RT et al (2002) Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med 165:1395–1399

    Article  Google Scholar 

  3. 3.

    Gozal D (1998) Sleep-disordered breathing and school performance in children. Pediatrics 102:616–620

    CAS  Article  Google Scholar 

  4. 4.

    Tran KD, Nguyen CD, Weedon J et al (2005) Child behavior and quality of life in pediatric obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 131(1):52–57

    Article  Google Scholar 

  5. 5.

    Chervin RD, Archbold KH, Dillon JE et al (2002) Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 109(3):449–456

    Article  Google Scholar 

  6. 6.

    Gottlieb DJ, Vezina RM, Chase C et al (2003) Symptoms of sleep-disordered breathing in 5-year old children are associated with sleepiness and problem behaviours. Pediatrics 112(4):870–877

    Article  Google Scholar 

  7. 7.

    de Serres LM, Derkay C, Astley S, Deyo RA, Rosenfeld RM, Gates GA (2000) Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg 26:1423–1429

    Article  Google Scholar 

  8. 8.

    Marcus CL, Greene MG, Carroll JL (1998) Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med 157:1098–1103

    CAS  Article  Google Scholar 

  9. 9.

    Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med 163:19–25

    CAS  Article  Google Scholar 

  10. 10.

    Sohn H, Rosenfeld RM (2003) Evaluation of sleep-disordered breathing in children. Otolaryngol Head Neck Surg 128:344–352

    Article  Google Scholar 

  11. 11.

    Rutter M (1967) A children’s behavior questionnaire for compilation by teachers: preliminary findings. J Child Psychol Psychiatr 8(1):1–11

    CAS  Article  Google Scholar 

  12. 12.

    Watkinson CJ (2018) Scott–Brown’s otolaryngology and head neck surgery, vol 2, 8th edn. Taylor and Francis, New York, pp 294–310

    Google Scholar 

  13. 13.

    Li HY, Huang YS, Chen NH, Fang TJ, Lee LA (2006) Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing. Laryngoscope 116(7):1142–1147

    Article  Google Scholar 

  14. 14.

    Wei JL, Mayo MS, Smith HJ, Reese M, Weatherly RA (2007) Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 133(10):974–979

    Article  Google Scholar 

  15. 15.

    Flanary VA (2003) Long term effect of adenotonsillectomy on quality of life in pediatric patients. Laryngoscope 113:1639–1644

    Article  Google Scholar 

  16. 16.

    Giordani B, Hodges EK, Guire KE, Ruzicka DL, Dillon JE, Weatherly RA, Garetz SL, Chervin RD (2012) Changes in neuropsychological and behavioural functioning in children with and without obstructive sleep apnea following tonsillectomy. J Int Neuropsychol Soc 18:212–222

    Article  Google Scholar 

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Correspondence to Manaswita Roy.

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Sarmah, U., Mandal, S. & Roy, M. Quality of Life and Behavioural Assessment in Post-adenotonsillectomy Cases of Paediatric Age Group. Indian J Otolaryngol Head Neck Surg 71, 221–229 (2019). https://doi.org/10.1007/s12070-018-01569-8

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Keywords

  • Obstructive sleep apnoea syndrome
  • Adenotonsillar hypertrophy
  • Quality of life