Childhood Adenotonsillectomy Study for Children With OSAS (CHAT)

This study has been completed.
Sponsor:
Collaborators:
Harvard University
University of Michigan
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
University of Pennsylvania
ClinicalTrials.gov Identifier:
NCT00560859
First received: November 19, 2007
Last updated: November 10, 2015
Last verified: November 2015

November 19, 2007
November 10, 2015
October 2007
March 2012   (final data collection date for primary outcome measure)
Improvements in Attention/Executive Domain Index of the Developmental Neuropsychological Assessment (NEPSY) From Baseline to 7 Months. [ Time Frame: The primary endpoint measure will occur at 7 months following the baseline visit. ] [ Designated as safety issue: No ]
The primary outcome was the change in the attention and executive function score on the NEPSY. The change from baseline in Attention/Executive Domain Index of the Developmental Neuropsychological Assessment (NEPSY) was compared to 7 months were compared. Scores on the attention and executive-function domain of the Developmental Neuropsychological Assessment (NEPSY) range from 50 to 150, with higher scores indicating better functioning.
To determine improvements in neurocognitive functioning post surgery, the Attention/Executive Domain Index of the Developmental Neuropsychological Assessment (NEPSY), will be compared between the two arms. [ Time Frame: The primary endpoint measure will occur at 7 months following the baseline visit. ]
Complete list of historical versions of study NCT00560859 on ClinicalTrials.gov Archive Site
  • Change in Apnea Hypopnea Index (AHI) Score From Baseline to 7 Months [ Time Frame: 7 months following the baseline visit. ] [ Designated as safety issue: No ]
    The outcome measure was the change in AHI from baseline to 7 months to determine if there was an improvement in score is associated with improved OSAS (i.e reduction in AHI). The AHI is calculated by dividing the number of apnea events by the number of hours of sleep. The obstructive sleep apnea syndrome was defined as an AHI score of 2 or more events per hour or an obstructive apnea index (OAI) score of 1 or more events per hour.
  • Change in Score of Pediatric Sleep Questionnaire Sleep-related Breathing Disorder Scale [ Time Frame: 7 months following baseline. ] [ Designated as safety issue: No ]
    Scores on the Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD) range from 0 to 1, with higher scores indicating greater severity.
  • The Apnea Hypopnea Index (AHI) score will be compared between the two groups to determine whether an improvement in score is associated with improved OSAS (i.e. reduction in AHI). [ Time Frame: 7 months following the baseline visit. ]
  • To determine the effects of AT surgery on subgroups by race and weight. [ Time Frame: 7 months following baseline. ]
Not Provided
Not Provided
 
Childhood Adenotonsillectomy Study for Children With OSAS
A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome
The purpose of this research is to determine the effect of adenotonsillectomy surgery (removal of tonsils and adenoids) on obstructive sleep apnea syndrome (OSAS) in children. OSAS can cause health problems including poor growth, high blood pressure, diabetes and behavioral and learning difficulties. Although adenotonsillectomy is the usual treatment for children with OSAS, it is not known with any certainty if the child's OSAS symptoms improve afterwards. This study will help determine if improvement occurs or if it does not. It will also look at whether certain groups, such as children who are overweight or of different ethnicities, are helped by the surgery.

Because adenotonsillectomy is the usual treatment for OSAS, all children in the study will get surgery. However, in order to assess the extent to which adenotonsillectomy surgery improves breathing disturbances and sleep quality in children with OSAS, two groups will be studied. One group will get surgery early (one month after enrollment) and the other group will be re-evaluated for surgery within 7 months of enrollment.

Children in both groups will be closely monitored through the 7-8 month study period and sleep and health educational materials will be provided to assist in establishing healthy habits.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
  • Obstructive Sleep Apnea
  • Snoring
  • Procedure: Adenotonsillectomy (AT) - removal of adenoids and tonsils
    Standard surgical intervention for treatment of Obstructive Sleep Apnea Syndrome which includes removal of adenoids and tonsils
    Other Name: EAT
  • Other: Watchful Waiting
    Children will reevaluated for adenotonsillectomy (AT) after a 7 month primary monitoring period.
    Other Name: Watchful Waiting with Supportive Care (WWSC)
  • Active Comparator: Early AT Surgery
    There will be removal of tonsils and adenoids that will be performed within 4 weeks of the baseline visit.
    Intervention: Procedure: Adenotonsillectomy (AT) - removal of adenoids and tonsils
  • Watchful Waiting
    Children will be closely monitored and re-evaluated for AT by an otolaryngologist after the primary 7 month monitoring period.
    Intervention: Other: Watchful Waiting

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
453
June 2012
March 2012   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Ages 5.0 to 9.99 years at time of screening.
  2. Diagnosed with Obstructive Sleep Apnea defined as: Obstructive Apnea Index (OAI) ≥ 1 or Apnea Hypopnea Index (AHI) ≥ 2, confirmed on nocturnal, laboratory-based PSG and Parental report of habitual snoring (on average occurring >3 nights per week).
  3. Tonsillar hypertrophy ≥ 1 based on a standardized scale of 0-4: 0 = surgically absent, 1 = taking up < 25% of the airway, 2 = 25 - 50 % of the airway,3 = 50 - 75 % of the airway, 4 = > 75% of the airway
  4. Deemed to be a surgical candidate for AT by Ear, Nose and Throat specialist (ENT) evaluation.

Exclusion Criteria:

  1. Recurrent tonsillitis defined as: >3 episodes in each of 3 years, 5 episodes in each of 2 years, or 7 episodes in one year
  2. Craniofacial anomalies, including cleft lip and palate or sub-mucosal cleft palate or any anatomic or systemic condition which would interfere with general anesthesia or removal of tonsils and adenoid tissue in the standard fashion
  3. Obstructive breathing while awake that merits prompt AT in the opinion of the child's physician
  4. Severe OSAS or significant hypoxemia requiring immediate AT as defined by: OAI>20 or AHI>30, desaturation defined as oxygen saturation (SaO2) <90% for more than 2% sleep time
  5. Apnea hypopnea indices in the normal range (OAI < 1 and AHI <2)
  6. Evidence of clinically significant cardiac arrhythmia on PSG: Non-sustained ventricular tachycardia Atrial fibrillation, Second degree atrioventricular (AV) block: Sustained bradycardia < 40 bpm (> 2 minutes, Sustained tachycardia > 140 bpm (> 2 minutes)
  7. Extremely overweight defined as: body mass index > 2.99 age group and sex-z-score
  8. Severe health problems that could be exacerbated by delayed treatment for OSAS Including: Doctor-diagnosed heart disease or cor pulmonale, history of Stage II Hypertension (HTN) defined as > 99% percentile plus 5 mmHg for either systolic or diastolic, based on the age, gender, and height and/or requiring medication, therapy for failure to thrive or short stature, psychiatric or behavioral disorders requiring or likely to require initiation of new medication, therapy, or other specific treatment. School aged children, parental report of excessive daytime sleepiness defined as unable to maintain wakefulness, at least three times per week, in routine activities in school or home, despite adequate opportunity to sleep.
  9. Severe chronic health conditions that might hamper participation including: severe cardiopulmonary disorders, sickle cell anemia, poorly controlled asthma, epilepsy requiring medication, diabetes (type I or type II) requiring medication, conditions likely to preclude accurate polysomnography (e.g. severe uncontrolled pain),mental retardation or enrollment in a formal school Individual Educational Plan (IEP) and assigned to a self-contained classroom for all academic subjects, history of inability to complete cognitive testing and/or score on the Differential Ability Scale (DAS) II of ≤ 55, chronic infection or HIV
  10. Known genetic, craniofacial, neurological or psychiatric conditions likely to affect the airway, cognition, or behavior
  11. Current use of one or more of the following medications: psychotropics, hypnotics,hypoglycemic agents or insulin,antihypertensives,growth hormone, anticonvulsants,anti-coagulants,daily oral corticosteroids, daily medications for pain
  12. Previous upper airway surgery on the nose, pharynx or larynx, including tonsillectomy. Ear surgery and/or pressure equalizing (PE) tubes are not exclusion criteria
  13. Receives Continuous Positive Airway Pressure (CPAP) treatment
  14. A parent or guardian who cannot accompany the child on the night of polysomnogram (PSG)
  15. A family planning to move out of the area within the year
  16. Female participants only: Parental report that child has reached menarche
Both
5 Years to 9 Years   (Child)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00560859
804695, 5U01HL083129-05
Yes
Not Provided
Not Provided
University of Pennsylvania
University of Pennsylvania
  • Harvard University
  • University of Michigan
  • National Heart, Lung, and Blood Institute (NHLBI)
Study Chair: Susan Redline, MD, MPH Harvard University
Study Director: Susan Ellenberg, Ph.D. University of Pennsylvania
Principal Investigator: Ron Chervin, MD, MS University of Michigan
Study Director: Bruno Giordani, PH.D. Univeristy of Michigan
Study Director: Susan Garetz, MD University of Michigan
Principal Investigator: Raouf Amin, MD Cincinnati Children's Hopsital Medical Center (CCHMC)
Principal Investigator: Carole Marcus, MBB Ch. Children's Hospital of Philadelphia
Principal Investigator: Carol Rosen, MD Case University School of Medicine; Rainbow Babies & Children's Hospital
Principal Investigator: Ron Mitchell, MD Cardinal Glennon Children's Medical Center, St. Louis MO
Principal Investigator: Raanan Arens, MD Montefiore Children's Hospital Albert Einstein Med Ctr, NY NY
Principal Investigator: Hiren Muzumdar, MD Montefiore Chilren's Hospital Albert Einstein Med Ctr, NY NY
Principal Investigator: Eliot Katz, MD Boston Children's Hospital, Boston MA
University of Pennsylvania
November 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP