Abstract
OBJECTIVE: To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA). METHODS: A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO(2)) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5-9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHI(Obstructive) < 1.0) and high-sleep quality (SQI ≥ 75) after 7-months were compared with children that showed residual OSA. RESULTS: Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 (n = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI(95%) 75.05, 84.86] vs. 72.44 [CI(95%) 69.50, 75.39], p = 0.005, mild OSA AHI(Obstructive) 4.01 [CI(95%) 2.34, 5.68] vs. 6.52 [CI(95%) 5.47, 7.57], p= 0.005, higher NEPSY-attention-executive function score 106.22 [CI(95%) 101.67, 110.77] vs. 101.14 [CI(95%) 98.58, 103.72], p = 0.038 and better quality of life according to parents 83.74 [CI(95%) 78.95, 88.54] vs. 77.51 [74.49, 80.53], p = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires. CONCLUSIONS: Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.