The trial—the Childhood Adenotonsillectomy Trial (CHAT)—enrolled children ages 5 to 9.9 years and spanned seven sites across the country. It randomized 464 children with sleep apnea to either early adenotonsillectomy or watchful waiting with supportive care, evaluating a wide variety of outcomes such as cognition, behavior, blood pressure and improvement in nighttime breathing.
Explore This IssueNovember 2012
The results of the trial are not yet published but are likely to shed light on the efficacy of adenotonsillectomy for sleep-disordered breathing in children, said Dr. Mitchell, a principal investigator for this trial at Saint Louis University-affiliated SSM Cardinal Glennon Children’s Hospital.
Another CHAT principal investigator, Susan Redline, MD, MPH, Peter C. Farrell professor of sleep medicine at Harvard Medical School in Boston, added, “There have been wide fluctuations in the use of tonsillectomy over the last several decades. In part, this reflects the lack of high-level research to properly inform decision making.” She also noted that the increase in the procedure’s usage is likely attributable to a combination of factors: increased awareness of adverse health and behavioral outcomes associated with sleep apnea and an increase in childhood obesity.
The Larger Picture
Dr. Rosenfeld further advised keeping the rise in tonsillectomies in perspective. “You have to take the big picture of where we were a half-century ago (for tonsillectomy rates) and also how the indications have changed and our knowledge of the effects of sleep-disordered breathing,” he said. “When you look at it that way, we’re probably doing just the right number of tonsillectomies. It may continue to evolve and change, but we’re getting closer to the right number.”