Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB

Arshed Ali, Jasif Nisar, Ihsan Ali, Rauf Ahmad


Background: SDB is an important cause of morbidity in children. SDB has been associated with decreased quality of life (QOL). In this study, we tried to determine The impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB.

Methods: A total of 112 pediatric patients were included with SDB, who visited our OPD. Diagnostic methods include history and physical examination, audiotaping or videotaping, pulse oximetry. OSA 18 questionnaire was used to assess the quality of life with conservative treatment (pre and post-treatment) and after surgical intervention-before and after adenoidectomy or adenotonsillectomy.  

Results: We had 112 patients with majority being males 69 (61.60%) and females 43 (38.30%), majority of patients were in the age group of 5-7 yrs (49.10%). In 47 patients (who underwent adenotonsillectomy/tonsillectomy), OSA-18 questionnaire was used pre-operatively, at 2 and 6 months. OSA-18 when used pre-operatively showed majority of patients 33 (70.21%) having score >80, and 14 (29.79%) patients having score between 60-80. No patient was below 60 score. Mean OSA-18 score pre-operatively was 84.15. OSA-18 score at 2 months and at 6 months were 30.06 and 26.40 respectively, which showed a lot of improvement in post-operative score and hence the post –operative quality of life. In 65 patients (conservative treatment) OSA-18 was used pre-conservative, at 2 and 6 months of treatment. OSA-18 when used before conservative treatment showed majority of patients 44 (67.6 9%) having score 60-80, and 21 (32.30%) patients having score between >80. No patient was below 60 score. OSA-18 score at 2 months showed improvement in 69.23% patients (<40), OSA-18 at 6 months showed recurrence in 12.33% patients.

Conclusions: SDB substantially impact QOL in pediatric patients. QOL significantly improves following adenotonsillectomy. There is subset of patients 12.33% with SDB in whom there was recurrence of symptoms after conservative treatment. Thus showing that conservative management is inferior to surgical management in the treatment of SDB. SDB improved after an observation period. Thus, observation with close follow-up is another treatment option.



SDB, OSA-18, Quality of life

Full Text:



Mitchell RB, Kelly J. Behavior, neurocognition and quality-of-life in childrenwith sleep-disordered breathing. Int J Pediatr Otorhinolaryngol. 2006;70:395–406.

Goldstein NA, Pugazhendhi V, Rao SM, et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics. 2004;114:33–43.

Kotagal S. Sleep disorders in childhood. Neurol Clin. 2003;21:961–81.

Baldassari CM, Mitchell RB, Schubert C, Rudnick EF.Pediatric obstructive sleep apnea and quality of life: a metaanalysis. Otolaryngol Head Neck Surg. 2008;138:265-73.

Darrow DH. Surgery for pediatric sleep apnea. Otolaryngol Clin North Am. 2007;40:855-75.

Katz ES, D’Ambrosio CM. Pediatric obstructive sleep apnea syndrome. Clin Chest Med. 2010;31:221-34.

Li AM, Au CT, Ng SK, Abdullah VJ, Ho C, Fok TF, et al. Natural history and predictors for progression of mild childhood obstructive sleep apnoea. Thorax. 2010;65:27-31.

Durr ML, Meyer AK, Kezirian EJ, Mamlouk MD, Frieden IJ, Rosbe KW. Sleep-Disordered Breathing in Pediatric Head and Neck Vascular Malformations. Laryngoscope. 2017;127(9):2159-64.

Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung. 1981;159:275–87.

Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr. 1984;105:10–4.

Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest. 1995;108:610–8.

Lewandowski AS, Toliver-Sokol M, Palermo TM. Evidence-based review of subjective pediatric sleep measures. J Pediatr Psychol. 2011;36(7):780-93.

Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J. 1996;9:2127–31.

Shouldice RB, O’Brien LM, O’Brien C, de Chazal P, Gozal D, Heneghan C. Detection of obstructive sleep apnea in pediatric subjects using surface lead electrocardiogram features. Sleep. 2004;27:784–92.

Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline:diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704–12.

Goldbart AD, Tal A. Inflammation and sleep disordered breathing in children:a state-of-the-art review. Pediatr Pulmonol. 2008;43:1151–60.

Cardiorespiratory sleep studies in children. Establishment of normative data and polysomnographic predictors of morbidity. American Thoracic Society. Am J Respir Crit Care Med. 1999;160:1381.

Jose Mario de Lima Junior, Vivane Carvalho da Silva, Marcos Rabelo de Freitas Long term results in the life quality of children with obstructive sleep disorders Rev Bras Otorrinolaringol. 2008;74(5):718-24.

Ron B. Mitchell James Kelly. Outcomes and Quality of life following Adenotonsillectomy for sleep-disordered breathing in children. ORL. 2007;69:345-8.

Flanary VA. Long-Term Effect of Adenotonsillectomy on Quality of Life in Pediatric Patients. Laryngoscope. 2003;113:1639-44.

Leach J, Olson J, Hermann J, Manning S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992;118(7):741-4.

Reilly JS. Apnéia obstrutiva do sono e ronco em crianças:noções gerais. Em:Sih T, Chinski A, Eavey R, editores. III Manual de Otor¬rinolaringologia Pediátrica da IAPO. 2003: 59-66.

Messner AH, Pelayo R. Pediatric sleep-related breathing disorders. Am J Otolaryngol. 2000;21(2):98-107.

Weckx LLM, Weckx LY. Respirador bucal:causas e conseqüências. Rev Bras Med. 1995;52(8):863-74.

Brooks LJ. Treatment of otherwise normal children with obstructive sleep apnea. Ear Nose Throat J. 1993;72(1):77-9.

Potsic WP, Pasquariello PS, Baranak CC, Marsh RR, Miller LM. Relief of upper airway obstruction by adenotonsillectomy. Otolaryngol Head Neck Surg. 1986;94(4):476-80.

Shintani T, Asakura K, Kataura A. The effect of adenotonsillectomy in children with OSA. Int J Pediatr Otorhinolaringol. 1998;44(1):51-8.

Stradling JR, Thomas G, Warley AR, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance and symptoms in snoring children. Lancet. 1990;335(8684):249-53.

Franco RA Jr, Rosenfeld RM, Rao M. First place resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;123(1):9-16.

Stewart MG, Friedman EM, Sulek M, Hulka GF, Kuppersmith RB, Harrill WC, et al. Quality of life and health status in pediatric tonsil and adenoid disease. Arch Otolaryngol Head Neck Surg. 2000;126(1):458.

De Serres LM, Derkay C, Astley S, Deyo RA, Rosenfeld RM, Gates GA. Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg. 2000;126(12):1423-9.

De Serres LM, Derkay C, Sie K, Biavati M, Jones J, Tunkel D, et al. Impact of adenotonsillectomy on quality of life in children with obstructive sleep disorders. Arch Otolaryngology Head Neck Surg. 2002;128(5):489-96.

Goldstein NA, Fatima M, Campbell TF, Rosenfeld RM. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):770-5.

Sohn H, Rosenfeld RM. Evaluation of sleep-disordered breathing in children. Otolaryngol Head Neck Surg. 2003;128(3):344-52.

Goldstein NA, Stefanov DG, Graw-Panzer KD, Fahmy SA, Fishkin S, Jackson A, et al. Validation of a Clinical Assessment Score for Pediatric Sleep-Disordered Breathing.. Laryngoscope. 2014;122:2096–104.

Ishman SL. The role of sleep studies in children who snore. JAMA Otolaryngol Head Neck Surg. 2014.

Franco RA, Rosenfeld RM, Rao M. Quality-of-life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;123:9–16.