Prognosis for Spontaneous Resolution of Obstructive Sleep Apnea in Children.

Adenotonsillectomy (AT) is commonly performed for childhood obstructive sleep apnea syndrome (OSAS), but little is known about prognosis without treatment.The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1, and by an OSAS symptom score (Pediatric Sleep Questionnaire, PSQ) <0.33 with ≥25% improvement from baseline.After 194 children aged 5-9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-African-American race (each p<.05). Among these, the independent predictors were lower AHI and waist circumference percentile <90%. Among 167 children with baseline PSQ scores ≥0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer Attention-Deficit/Hyperactivity Disorder symptoms; and female gender. Only lower PSQ and snoring scores were independent predictors.Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid adenotonsillectomy.Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTRials.gov Identifier #NCT00560859.