Is surgery the best answer for children with sleep apnea?

For children with obstructive sleep apnea, standard care often includes a tonsillectomy and adenoidectomy. But researchers at Saint Louis University say further research is needed to determine if surgery is the best option for these patients.

"We know surgery is associated with improvements in children with sleep apnea, but this research will be the first to allow us to investigate whether or not the surgery causes those improvements," says Ron Mitchell, M.D., professor of otolaryngology at Saint Louis University and the research study’s principal investigator.

"In the future, the information we gather from this study may help us know when to recommend surgery immediately and when it is most appropriate to wait and see whether the child will grow out of the problem. This will allow us to use healthcare resources more effectively."

Saint Louis University and SSM Cardinal Glennon Children’s Medical Center are currently participating in the ChildHood AdenoTonsillectomy (CHAT) study, the first research study to compare the outcomes of children who undergo surgery versus those who are monitored and receive medical treatment, such as nasal spray as needed.

In addition to studying the care of children with obstructive sleep apnea, the CHAT study will look at the connection sleep apnea has to learning problems, Attention Deficit Hyperactivity Disorder (ADHD), pre-diabetes, high cholesterol, slow growth, and obesity.

SLU is one of only six research sites nationwide and the only site in Missouri to participate in the study. In total, the NIH-funded study will enroll 500 children ages 5-9 years of age.

About Obstructive Sleep Apnea
In normal weight children, obstructive sleep apnea is caused by enlarged tonsils and adenoids that restrict the size of the upper airway and disrupt breathing during sleep. As many as three percent of all children and as many as 30 percent of overweight or obese children have obstructive sleep apnea.

Approximately 500,000 children undergo a tonsillectomy each year to treat the condition making this the most common major pediatric surgery.

According to Shalini Paruthi, M.D., assistant professor of pediatrics at SLU and study co-investigator, sleep problems such as obstructive sleep apnea can affect children’s daytime behavior, concentration, mood, school performance and interactions with others. Sleep problems also can mimic symptoms of ADHD.

"Treating sleep apnea can make a difference in a child’s life. For some children, school performance has improved, as have energy levels and social behaviors," Paruthi said.

Participating in the Study
To qualify for the study, children will be evaluated by an ear, nose and throat doctor and will undergo a sleep study. Once diagnosed and accepted into the study, participants will be randomly assigned to one of two groups.

The first group will undergo surgery to remove their tonsils and adenoids. The second group will be monitored for seven months. Study participants in the second group will have the option to undergo surgery after the study concludes. The time commitment for children in either group is seven months.

Study participants also will be given learning and behavioral tests at the beginning and end of the study to measure any change that may occur.

"Most parents who have children with sleep problems are concerned about behavioral issues. One of the goals of this study is to see whether surgery improves or normalizes these behaviors," Paruthi said.

In total, the study will include seven visits over one year. Participants will be reimbursed up to $500 for their time and travel.

To learn more about the CHAT study, call Casey Critchlow at 314-268-2700 ext. 1090. The study will take place at Cardinal Glennon Children’s Medical Center.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease, and heart and lung disease.

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