Surgical
versus non-surgical management of obstructive sleep-disordered breathing in
children: meta-analysis
A.A.
Afifi, A. Askoura, M. Shehata, M.F. Allam and D.M. Marzouk
From
the Family Medicine Department, Faculty of Medicine, Ain Shams University
QJM: An
International Journal of Medicine, Volume 111, Issue suppl 1, 1 December
2018, hcy200.050, https://doi.org/10.1093/qjmed/hcy200.050
Published: 13 December 2018
Background: Obstructive sleep
disordered breathing (OSDB) includes a wide spectrum of clinical entities with
variable severity of recurrent partial or complete upper airway obstruction. OSDB
is common in children, adenotonsillar hypertrophy account for most cases in
children. Adenotonsillectomy is widely considered an effective treatment for
obstructive sleep disordered breathing in children.
Objectives: To compare effectiveness
of surgical versus nonsurgical treatment of Obstructive sleep-disordered
breathing in children in randomized controlled trials through a meta-analysis study.
Search methods: The Cochrane
Central Register of Controlled Trials, PubMed, EMBASE, Google Scholar, Web of
Science, were searched for available trials till August 2017.
Selection criteria: Clinical trials
concerned in treatment of Obstructive sleep-disordered breathing in children
aged 2 to 16 years.
Outcome measured: Apnea/Hypopnea
Index, behavioral outcomes, neurocognitive performance, executive functions, health
care utilization, disease specific quality of life and adverse events of
treatment.
Results: Seven trials met the
inclusion criteria. As regard disease- specific quality of life Four studies
evaluated this outcome there was significant clinical improvement in the
surgical group (REM: SMD = -1.013, 95% CI = -1.584 to -0.441, P-value = 0.001),
while Only one study measures health care utilization which states that Adenotonsillectomy
significantly reduces health care utilization. As regard Apnea/Hypopnea Index,
three studies present their data as continuous data evaluated the change in AHI
among children with OSDB by pooling of these three studies there is no
statistically significant difference between both management strategies
surgical and non-surgical (REM: SMD = -0.248, 95% CI = -0.701 to 0.205, P-value
= 0.283), Two other studies present their data as dichotomous data by pooling
of these two studies there is no statistically significant difference between
both management strategies (FEM: Odds ratio = 0.881, 95%
CI = 0.304 to 2.557, P-value = 0.816). Regarding behavioral out comes two
studies evaluated the change in behavior by pooling of these 2 studies there
was no difference between both management strategies (REM: SMD = -0.514, 95% CI
= -2.145 to 1.117, P-value = 0.537). Two studies evaluated the changes in executive
functions by pooling these 2 studies there was no statistically significant
difference between surgical and non-surgical management (REM: SMD = 0.151, 95%
CI = -0.037 to 0.340, P-value
= 0.116). Two studies evaluated adverse events that occurred among children by
pooling these 2 studies there was no difference between both management
strategies (FEM: Odds ratio = 0.834, 95% CI = 0.317 to 2.193, P-value = 0.713).
Only one study measures neurocognitive outcome, no inference on neurocognitive outcome
can be elicited.
Conclusion: the current meta-analysis
reported significant clinical improvement in the surgical group as compared
with the non-surgical group, in terms of disease specific quality of life, Health
care utilization. However, there were no significant changes in other outcomes.
