ATT Compared With ATE in OSAS Children (RCT ATE/ATT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01676181
Recruitment Status : Active, not recruiting
First Posted : August 30, 2012
Last Update Posted : February 26, 2016
Information provided by (Responsible Party):
Danielle Friberg, Karolinska University Hospital

Brief Summary:
Non-inferiority hypothesis; adenotonsillotomy is equally good as adenotonsillectomy in treating obstructive sleep apnea syndrome (OSAS) in children after one, three and ten years.

Condition or disease Intervention/treatment Phase
Obstructive Sleep Apnea Syndrome in Children Procedure: Adenotonsillectomy Procedure: Adenotonsillotomy Not Applicable

Detailed Description:

Background: Children with obstructive sleep apnea syndrome (OSAS) have apneas and disturbed sleep, which causes daytime symptoms such as neurobehavioral problems. OSAS is a significant cause of morbidity among children with an incidence of 1-3%, and a peak prevalence at 2-5 years of age. If left untreated it can cause severe complications including failure to thrive, cardiovascular complications, metabolic conditions and neurobehavioral disturbances (eg hyperactivity, inattention).

Golden standard to diagnose OSA in children is full-night polysomnography (PSG) at a sleep laboratory including EEG, EOG, EMG, video-audiometry and respiratory recordings. At the Department of Otorhinolaryngology at Karolinska University Hospital, we have a sleep laboratory performing in-lab full-night polysomnography.

The cause of OSAS in children is usually adenotonsillar hypertrophy, and the treatment of choice is surgical removal of tonsils and adenoid. Traditionally total adenotonsillectomy (ATE) has been performed, but in the last decade an alternative surgical method with partial adenotonsillotomy (ATT) is developed, where only the medial portion of the tonsil is removed. The newer method ATT is not fully evaluated in comparison with traditional ATE. There are studies comparing evaluating post-operative pain and bleeding showing a slight advantage for the TT-method. Very few studies are performed using objectively measured PSG-parameters to evaluate the effect of surgery on the sleep fragmentation and the sleep apneas. There is a need for such studies in the field of surgical treatment of pediatric OSA. This was also stated in a Cochrane database review from 2009, in which the conclusion was that there is a need for high quality randomised controlled trials to be carried out investigating the efficacy of surgical treatment of OSA in children. This makes this study important and of high clinical interest.

Aims: To increase the knowledge of pediatric OSA and its treatment and to optimize the surgical treatment for children with OSA.

To through a blinded randomized controlled trial compare the efficacy of ATT and ATE in treating OSA in children, including long-term follow-up after one, three and ten years.

To evaluate postoperative pain after ATE and ATT. To evaluate quality of life after ATE and ATT.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 70 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Randomised Surgical Intervention Study Between Adenotonsillectomy and Adenotonsillotomy in Children With Obstructive Sleep Apnea Syndrome
Study Start Date : November 2011
Actual Primary Completion Date : August 2014
Estimated Study Completion Date : August 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Sleep Apnea

Arm Intervention/treatment
Active Comparator: Adenotonsillectomy
Total removal of tonsils and adenoids with cold steel
Procedure: Adenotonsillectomy
Total removal of tonsils and adenoid tissue with cold-steel

Active Comparator: Adenotonsillotomy
Partial removal of tonsils with coblation and total removal of adenoids with cold steel
Procedure: Adenotonsillotomy
Partial removal of tonsils with coblation and total removal of adenoids with cold steel

Primary Outcome Measures :
  1. Changes in polysomnographic parameter AHI (Apnea Hypopnea Index) [ Time Frame: One, three and ten years ]
    AHI; the number of apneas and hypopneas per sleep hour, is measured through polysomnography before and after surgery.

Secondary Outcome Measures :
  1. Changes in quality of life questionnaires (OSA18 and SDQ) [ Time Frame: One, three and ten Years ]
    Parents answering to quality of life-questionnaire OSA18 and SDQ (Strengths and Difficulties Questionnaire) before and after surgical intervention

Other Outcome Measures:
  1. Per- and postoperative bleeding [ Time Frame: One year ]
    The two groups (ATT and ATE) will be compared concerning per- and postoperative bleeding.

  2. changes in polysomnographic parameters other than AHI [ Time Frame: one, three and ten years ]
    Polysomnograhic parameters, for example; the oxygen desaturation index (ODI), lowest oxygen saturation, the respiratory disturbance index (RDI), AHI in REM, total sleep time, time in REM, deep sleep, supine position etc.

  3. Differences in postoperative pain [ Time Frame: One year ]
    The two groups will be compared with questionnaires and consumption of analgetics concerning the degree of postoperative pain.

  4. Number of patients who need reoperations [ Time Frame: One, three and ten years ]
    The patient may need reoperations, either because of postoperative bleeding or because the tonsils have regrowth

  5. Abnormalities in DNA analysis of blood and tonsil tissue [ Time Frame: one year ]
    Blood and tissue samples will be frozen for future analysis of DNA. We have not yet decided which method we will use. There are other studies suggesting abnormalities in certain enzymes in children with tonsillar hypertrophy

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Ages Eligible for Study:   2 Years to 6 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Children aged 2-6 years
  • Clinical symptoms of OSAS (apneas, snoring, disturbed sleep)
  • Tonsil size 3-4 with the Brodsky scale (obstructing at least 50% of the oro-pharyngeal space)
  • Apnea-Hypopnea Index (AHI) 5-30 (moderate- severe OSA)

Exclusion Criteria:

  • Clinical signs of craniofacial anomalies or neuromuscular disorders
  • Obesity
  • Earlier having had surgery of tonsils or adenoid
  • Bleeding disorder
  • Cardiopulmonary disorder

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01676181

Karolinska University Hospital, ORL dep
Stockholm, Sweden, 141 86
Sponsors and Collaborators
Karolinska University Hospital
Principal Investigator: Danielle Friberg, MD, PhD Karolinska University Hospital, ORL dep

Responsible Party: Danielle Friberg, Associate Professor, senior surgeon, Karolinska University Hospital Identifier: NCT01676181     History of Changes
Other Study ID Numbers: 2011/333-31/4
First Posted: August 30, 2012    Key Record Dates
Last Update Posted: February 26, 2016
Last Verified: February 2016

Keywords provided by Danielle Friberg, Karolinska University Hospital:
Obstructive sleep apnea syndrome

Additional relevant MeSH terms:
Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Pathologic Processes
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Signs and Symptoms
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nervous System Diseases