Impact of Adenotonsillectomy on Quality of Life in Pediatric Obstructive Sleep Apnoea (OSA): Insights from the OSA-18 Questionnaire

Montaha Al-Iede,1,2 Zaina Alhelou,2 Nour Hamdan,2 Basil Alramahi,2 Shada Algharibeh,2 Ahmad Qarajeh,2 Sara Ishtaieh,2 Ahmad Al Nsour,3 Mai AlAdwan,2 Abdulrahman Alhanbali,2 Rima A Sinan,2 Lubna Khreesha3 1Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Jordan University Hospital, Amman, Jordan; 2The School of Medicine, the University of Jordan, Amman, Jordan; 3The Ear, Nose and Throat Department, The University of Jordan, Amman, JordanCorrespondence: Montaha Al-Iede, The School of Medicine, The University of Jordan, Amman, Jordan, Email [email protected]: Hypertrophy of the adenoids and tonsils is a common cause of obstructive sleep apnoea (OSA) in children, with adenotonsillectomy as the primary treatment. This study aimed to assess the efficacy of surgical options (adenotonsillectomy, adenoidectomy, and tonsillectomy) in managing pediatric OSA and their impact on quality of life, using the OSA-18 questionnaire.Methods: This retrospective cohort study analyzed data from parents of 196 children who underwent adenoidectomy, tonsillectomy, or both. The OSA-18 questionnaire was administered online via Google Form to assess quality-of-life issues. Data collection occurred between November 4 and December 25, 2022. Statistical analysis included paired t-tests, ANOVA, Pearson’s correlation, and stepwise linear regression to evaluate pre- and post-surgery differences and associated factors.Results: A significant improvement in quality of life was observed following adenotonsillectomy, with a mean reduction of 15.14 points in OSA-18 scores. The greatest improvements were noted in the domains of physical symptoms and sleep disturbance, particularly among children with severe OSA. Most participants were male (63%), with an average pre-surgery weight of 25.5 kg. Prior to surgery, 34.18% used CPAP and 56.12% nasal steroids. Post-surgery, 83.16% were hospitalized for 1– 2 days, with 4.08% requiring ICU care, and 26.53% experienced postoperative complications.Conclusion: Surgical interventions, particularly adenotonsillectomy, significantly improved quality of life in pediatric OSA patients, with marked benefits in severe cases.Plain Language Summary: This study assessed the effectiveness of surgical treatments for obstructive sleep apnea (OSA) in children and their impact on quality of life using OSA-18 questionnaire. OSA in children is commonly caused by enlarged adenoids and tonsils, and surgery—either removing the adenoids, tonsils, or both (adenotonsillectomy)—is the first line treatment.Parents of 196 children who had undergone one of these surgeries were surveyed, using a questionnaire (OSA-18) to evaluate improvements in quality of life. Data was gathered online over a two-month period. Most of the children were boys, and some were using pre-surgery treatments like CPAP machines or nasal steroids to manage symptoms.The findings showed that most children only stayed in the hospital for 1-2 days, though a few needed ICU care. Around a quarter experienced post-surgery complications, but overall, there were significant improvements in symptoms, especially among children with more severe OSA. Adenotonsillectomy, in particular, was associated with meaningful gains in physical well-being and sleep quality.Keywords: adenoids, adenotonsillectomy, OSA, OSA-18, quality of life, Tonsillectomy