Qualidade de vida em crianças com distúrbios obstrutivos do sono: avaliação pelo OSA-18

Impact of Chronic Adenoid Hypertrophy on Quality of Life Index in Children and Role of Adenoidectomy

Objectives: To analyze the effects of chronic adenoid hypertrophy on quality of life (QOL) of children and caregivers and compare quality of life of child before and after adenoidectomy. Materials & Methods: Prospective, observational before and after questionnaire based assessment study at a pediatric otorhinolaryngology specialty center in a metropolitan quaternary care hospital. Children aged between 2 and 12 years undergoing adenoidectomy were included. Parents were asked to fill the Obstructive Sleep Apnea-18 (OSA-18) Quality of Life Index Questionnaire one day before surgery and after one month of surgery during their scheduled follow-up visit. The study was conducted over a period of 1 year and total of 40 children's assessment was done. Results were tabulated and analyzed. Results: The mean age of presentation was 6 years. Based on OSA-18 quality of life assessment scoring the total pre-operative mean score was 73.3 and post-operative was 40.5. There was significant change in OSA-18 total score and individual domain scores post-operatively indicating significant improvement in QOL post adenoidectomy. The domains most affected due to chronic adenoid hypertrophy were physical suffering, caregiver concerns and sleep disturbance (p value < 0.001).Conclusion: Chronic adenoid hypertrophy has major impact on quality of life of a child along with caregiver concern and they show significant improvement after adenoidectomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04000-z.

Quality of life related to residual snoring after adenotonsillectomy: a pilot study

INTRODUCTION

Few studies have addressed long-term quality of life related to residual snoring after adenotonsillectomy. The aim of this study was to compare scores from the OSA-18 questionnaire between children with residual snoring and non-snoring children two or more years after adenotonsillectomy.

MATERIAL AND METHODS

The sample comprised 25 children divided into two groups, a group of 14 snoring children, and a control group of 11 non-snoring children. The OSA-18 questionnaire was applied to the volunteers. In the control group, it was completed by the caregivers of the children, while in individuals with residual snoring it was completed by the caregivers of children in the presence of a doctor or dentist. A statistical comparison was made using a generalized linear model.

RESULTS

The snorer group had a higher total OSA-18 score, and a higher score in all five domains compared to the control group.

CONCLUSION

Children with residual snoring two or more years after adenotonsillectomy may have a worse quality of life compared to the control group.

Qualidade de vida de crianças e adolescentes: uma revisão bibliográfica

O presente artigo tem como objetivo analisar as produções científicas nacionais, que abordam a temática da qualidade de vida ligada à saúde da criança e do adolescente. As bases de dados consultadas foram a SciELO e Bireme totalizando 30 artigos publicados no período de 1990 a 2008. Revelou-se uma predominância da abordagem quantitativa (70%) e um alto índice de aplicações de instrumentos de avaliações de qualidade de vida ligada à saúde (66,7%) e genéricos (28,6%). O conceito de qualidade de vida foi usado em duas vertentes: no contexto da pesquisa científica e como parte dos resultados desejados das práticas assistenciais e políticas públicas. O referido construto é apresentado através de uma perspectiva multidimensional, incluindo no mínimo as dimensões física, psicológica e social e de uma perspectiva subjetiva, o que implica no pressuposto de que a própria pessoa deve avaliar sua qualidade de vida. Observou-se ainda um movimento de valorização da perspectiva da criança e do adolescente como relator de sua experiência de vida. Conclui-se pela necessidade de criação e utilização de instrumentos de avaliação de qualidade de vida que valorizem a perspectiva de crianças e adolescentes e adequados a sua fase de desenvolvimento. A avaliação de qualidade de vida deve ser incorporada à avaliação clínica uma vez que a doença crônica repercute nas diversas dimensões da vida dos mesmos.

Reliability and validity of the obstructive sleep apnea-18 survey in healthy children and children with syndromic craniosynostosis

OBJECTIVE

Obstructive sleep apnea (OSA) affects a person's quality of life. A questionnaire, the OSA-18, is available to measure quality of life in children with OSA not caused by specific craniofacial syndromes. We assessed the internal consistency, test-retest reliability, and discriminative validity of the OSA-18 in children with syndromic and complex craniosynostosis; we also applied the OSA-18 in healthy children to obtain reference values.

METHOD

The OSA-18 was translated in the Dutch language using the procedure of multiple forward and backward translations. Test-retest reliability and internal consistency were examined. In a prospective study, the craniosynostosis patients underwent an ambulatory polysomnography to diagnose OSA. The ability of the OSA-18 to discriminate between subgroups of patients with or without OSA was evaluated. We compared OSA-18 scores of children with syndromic or complex craniosynostosis with scores in healthy children.

RESULTS

The Cronbach's alpha was ≥ 0.70 for the total OSA-18 score and for most of the domains in both the craniosynostosis and general population. In the craniosynostosis group, the test-retest intraclass correlation coefficients were ≥ 0.70, except for the domain physical suffering at 0.69. The discriminative validity of the domains sleep disturbance, physical suffering, caregiver concerns, and total OSA-18 score was significant between the general and craniosynostosis population.

CONCLUSION

This study supports the reliability and validity of the OSA-18 in children with syndromic or complex craniosynostosis.

Gastroesophageal reflux and obstructive sleep apnea in childhood

OBJECTIVES

To examine the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS) with polysomnographic alterations and symptom severity.

PATIENTS AND METHODS

Eighteen children aged from 6 to 12 years (8.14+/-1.75) with adenotonsillar hypertrophy and OSAS were evaluated with the OSA-18 questionnaire nasofibrolaringoscopy and full overnight polysomnography performed simultaneously with esophageal pH monitoring.

RESULTS

OSAS (Apnea-index (AI)>or=1/hour) was present in all cases. Reflux parameters did not correlate to OSAS severity and a temporal relationship between GER and apnea-hypopnea events was not observed. Body mass index was lower than 18 in 9 cases (52.9%) and 7 children (41.1%) presented a history of abnormal behavior during sleep. In most cases oxygen desaturation and reduction of sleep efficiency were mild. Sleep architecture was similar to the young adult pattern. Seven children (41.1%) presented pH monitoring values below 4 during more than 10% of total sleep time. pH monitoring values were correlated to emotional distress (p=0.008) and to daytime problems (p=0.03) as evaluated by the OSA-18.

CONCLUSIONS

GER is frequent and should be assessed in children from 6 to 12 years with OSAS. Emotional distress and daytime problems are correlated to increased GER severity.

Long term results in the life quality of children with obstructive sleep disorders

Obstructive Sleep Disorders (OSD) affect mostly the pediatric population. Within this group, its main etiology is adenotonsillar hyperplasia, being adenoidectomy or adenotonsillectomy the best treatment option for quality of life improvement.

Aim

To asses quality of life of children with OSD after adenoidectomy/adenotonsillectomy.

Method

A prospective study was carried out with 48 children, between 2 and 11 years, with clinical manifestations of OSD and obstructive adenotonsillar hyperplasia. The OSA18 questionnaire was answered by the parents to evaluate their children’s quality of life before surgery; at about thirty days and at least eleven months after the procedure. A higher score meant a worse quality of life.

Results

Before surgery, the average OSA18 score was 82.83(SD=12.57), with an average global score for quality of life of 6.04(SD=1.66). Within thirty days after surgery, the average OSA18 score was 34.3 (SD=9.95) with an average global score of 9.6(SD=0.81), both showing significant reduction (p< 0.001). Thirty-four children (70.83%) were re-evaluated between 11 and 30 months (average=16.85; SD=5.16). The average OSA18 score was 35.44 (SD=19.95) with an average global score of 9.28 (SD=1.78). The postoperative evaluations weren’t significantly different.

Conclusion

surgery improves the quality of life of children with OSD, and such improvement maintains for the long run.