Surgical versus non-surgical management of obstructive sleep-disordered breathing in children: meta-analysis

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.