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Pediatric Adenotonsillectomy for Snoring (PATS)

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ClinicalTrials.gov Identifier: NCT02562040
Recruitment Status : Recruiting
First Posted : September 29, 2015
Last Update Posted : July 2, 2018
Sponsor:
Collaborators:
Children's Hospital of Philadelphia
University Hospitals Cleveland Medical Center
Children's Hospital Medical Center, Cincinnati
University of Michigan
University of Texas Southwestern Medical Center
University of Rochester
Boston Children’s Hospital
Children's Hospital of The King's Daughters
Information provided by (Responsible Party):
Susan Redline, Brigham and Women's Hospital

Brief Summary:
The purpose of this study is to evaluate the effects of early adenotonsillectomy (eAT) on the behavior, sleep-disordered breathing symptoms and quality of life for children who snore, but do not have obstructive sleep apnea, as well as identify factors that moderate responses to the surgery. Half of participants will receive eAT, while the other half will be observed with watchful waiting and supportive care.

Condition or disease Intervention/treatment Phase
Sleep-Disordered Breathing Procedure: Early Adenotonsillectomy (eAT) Behavioral: Watchful Waiting with Supportive Care (WWSC) Not Applicable

Detailed Description:

Adenotonsillectomies are performed more than 500,000 times per year in the United States, and is the most common surgery performed under general anesthesia in children. The majority of surgeries are performed for obstructed breathing rather than for infection or other indications.

The role of adenotonsillectomy (AT) in improving the 7-month neurocognitive, behavioral and health outcomes of children with frank obstructive sleep apnea (OSA) was recently addressed in the Childhood Adenotonsillectomy Trial (CHAT). The results of this rigorous, multicenter, randomized controlled trial provided critically important data indicating that adenotonsillectomy compared to watchful waiting resulted in improved behavior, quality of life, sleep-disordered breathing (SDB) symptoms and polysomnographic parameters.

However, the Childhood Adenotonsillectomy Trial addressed the role of surgery in the minority of operative candidates who have frank obstructive sleep apnea, only one form of sleep disordered breathing on a spectrum that includes a more common phenotype, primary snoring (also termed mild sleep disordered breathing (MSDB)). Mild sleep disordered breathing is characterized by snoring without frank obstruction or gas exchange abnormalities, and has a population prevalence of about 10% in children. Since most surgeries for obstructed breathing are performed for mild sleep disordered breathing rather than obstructive sleep apnea, the next logical question is whether surgery is also effective in improving symptoms and health outcomes in this large group of children.

The Pediatric Adenotonsillectomy Trial for Snoring (PATS) intends to take advantage of a successful collaboration of leaders in sleep medicine, otolaryngology and clinical trials to efficiently leverage experiences from the CHAT trial to evaluate the role of adenotonsillectomy in children with mild sleep disordered breathing while also aiming to resolve uncertainties regarding management approaches for pediatric mild sleep disordered breathing by addressing several critical issues:

  1. Assess outcomes important to children and their families, particularly patient-reported outcomes such as behavior, quality of life, and sleep disturbances.
  2. Examine differences in treatment responses among children who are at increased risk for mild sleep disordered breathing, such as pre-school children, minorities, and children with asthma or obesity.
  3. Evaluate health care utilization of children with mild sleep disordered breathing.
  4. Assess moderating influences such as second hand smoke, insufficient sleep, socioeconomic status and family functioning
  5. Examine longer term (12 month) outcomes that were not feasible in the Childhood Adenotonsillectomy Trial (CHAT).

These aims have substantial public health significance given the high morbidity of sleep disordered breathing in children.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 460 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Impact of Treatment of Mild Sleep-Disordered Breathing on Children's Health
Actual Study Start Date : June 2016
Estimated Primary Completion Date : July 2019
Estimated Study Completion Date : October 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Snoring

Arm Intervention/treatment
Active Comparator: Watchful Waiting with Supportive Care
All Watchful Waiting with Supportive Care (WWSC) participants will receive information about healthy sleep habits for children and appropriate clinical referrals for management of co-morbidities.
Behavioral: Watchful Waiting with Supportive Care (WWSC)
Information about healthy sleep habits for children and appropriate clinical referrals for management of co-morbidities.

Experimental: Early Adenotonsillectomy
All Early Adenotonsillectomy (eAT) participants will receive information about healthy sleep habits for children, undergo adenotonsillectomy within 4 weeks of randomization and receive appropriate clinical referrals for management of co-morbidities
Procedure: Early Adenotonsillectomy (eAT)
Standard clinical adenotonsillectomy within 4 weeks post randomization in addition to information about healthy sleep habits for children and appropriate clinical referrals for management of co-morbidities.




Primary Outcome Measures :
  1. Change from baseline in Behavior Rating Inventory of Executive Function (BRIEF) Global Composite Score. [ Time Frame: 12 months ]
    Change from baseline in executive behavior relating to self-regulation and organizational skills (as measured by the Behavior Rating Inventory of Executive Function (BRIEF) Global Composite Score.

  2. Change from baseline in Go-No-Go (GNG) signal detection parameter (d'). [ Time Frame: 12 months ]
    Change from baseline in vigilance as measured on the Go-No-Go (GNG) signal detection parameter (d').



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Ages Eligible for Study:   3 Years to 12 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of mild sleep-disordered breathing (MSDB) defined as meeting all of the following criteria:

    • Caregiver report of habitual snoring that occurs most of the night on at least three nights per week, and has been present for at least three months (on average occurring > 3 nights per week or more half of sleep time) and
    • Centrally-scored polysomnogram (PSG) confirming an obstructive apnea index (OAI) <1/hour and apnea-hypopnea index (AHI) ≤3/hour and no oxygen saturation (SpO2) desaturation < 90% in conjunction with obstructive events, confirmed on PSG.
  • Tonsillar hypertrophy ≥2 based on a standardized scale of 0-4.
  • Deemed to be a candidate for AT by otolaryngologist (ENT) evaluation (i.e., no technical issues that would be a contraindication for surgery such as submucous cleft palate.)
  • Primary indication for AT is nocturnal obstructive symptoms (i.e., not recurrent infections or other indications).

Exclusion Criteria:

  • Previous tonsillectomy, including partial tonsillectomy
  • Recurrent tonsillitis that merits prompt adenotonsillectomy (AT) per the American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines (i.e., ≥7 episodes/yr in the past year; ≥5 episodes/year over the past 2 years or ≥3 episodes/yr over the past 3 years.)
  • Severe obesity (body mass index (BMI) z-score ≥3).
  • Failure to thrive, defined as either height or weight being below the 5th percentile for age and gender.
  • Severe chronic health conditions that might hamper participation or confound key variables under study, including but not limited to:

    • Severe cardiopulmonary disorders such as cystic fibrosis, and congenital heart disease.
    • Bleeding disorders
    • Sickle Cell Disease
    • Epilepsy requiring medication
    • Significant cardiac arrhythmia noted on PSG including: non-sustained ventricular tachycardia, atrial fibrillation, second degree atrioventricular block, sustained bradycardia, or sustained tachycardia.
    • Other severe chronic health problems such as diabetes, narcolepsy, and poorly controlled asthma.
    • Known genetic, craniofacial, neurological or psychiatric conditions likely to affect the airway, cognition or behavior;
    • Current use of psychotropic medication (other than medications for attention deficit hyperactivity disorder, hypnotics, antihypertensives, hypoglycemic agents including insulin, anticonvulsants, anticoagulants, or growth hormone.
    • Diagnosis of autism spectrum disorder.
    • Intellectual deficit or assigned to a self-contained classroom for all academic subjects.
    • History of severe developmental disability or Adaptive Behavior Assessment System (ABAS-3) score ≤60.
  • Children/caregivers planning to move out of the area within the year.
  • Children in foster care.
  • Children/caregivers who do not speak English or Spanish well enough to complete the neurobehavioral measures.

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 ClinicalTrials.gov identifier (NCT number): NCT02562040


Contacts
Contact: Michael G Morrical 8573070332 mmorrical@partners.org
Contact: Jessie P Bakker, PhD 6177325987 jpbakker@partners.org

Locations
United States, Massachusetts
Boston Children's Hospital Recruiting
Boston, Massachusetts, United States, 02115
Principal Investigator: Judith A Owens, MD, MPH         
Sub-Investigator: Eliot S Katz, MD         
Sub-Investigator: Greg R Licameli, MD         
United States, Michigan
University of Michigan Health System Recruiting
Ann Arbor, Michigan, United States, 48109
Principal Investigator: Ronald D Chervin, MD         
Sub-Investigator: Fauziya Hassan, MBBS, MS         
Sub-Investigator: Susan L Garetz, MD         
Sub-Investigator: David A Zopf, MD         
United States, Ohio
Cincinnati Children's Hospital Medical Center Recruiting
Cincinnati, Ohio, United States, 45229
Principal Investigator: Raouf S Amin, MD         
Sub-Investigator: Stacey L Ishman, MD, MPH         
University Hospitals-Case Medical Center Recruiting
Cleveland, Ohio, United States, 44106
Principal Investigator: Carol L Rosen, MD         
Sub-Investigator: Kristie R Ross, MD         
Sub-Investigator: Hudson G Taylor, PhD         
Sub-Investigator: Jay Shah, MD         
United States, Pennsylvania
Children's Hospital of Philadelphia Recruiting
Philadelphia, Pennsylvania, United States, 19104
Principal Investigator: Ignacio E Tapia, MD         
Sub-Investigator: Jerilynn Radcliffe, PhD         
Sub-Investigator: Lisa M Elden, MD MS FRCSC         
United States, Texas
University of Texas Southwestern Medical Center Recruiting
Dallas, Texas, United States, 75390
Principal Investigator: Ronald B Mitchell, MD         
Sub-Investigator: Kamal M Naqvi, MD         
United States, Virginia
Children's Hospital of the King's Daughters Recruiting
Norfolk, Virginia, United States, 23507
Principal Investigator: Christina M Baldassari, MD         
Sub-Investigator: Michael J Strunc, MD         
Sub-Investigator: Jennifer L Wiebke, MD         
Sponsors and Collaborators
Brigham and Women's Hospital
Children's Hospital of Philadelphia
University Hospitals Cleveland Medical Center
Children's Hospital Medical Center, Cincinnati
University of Michigan
University of Texas Southwestern Medical Center
University of Rochester
Boston Children’s Hospital
Children's Hospital of The King's Daughters
Investigators
Principal Investigator: Susan S Redline, MD, MPH Brigham and Women's Hospital
Principal Investigator: Rui Wang, PhD Brigham and Women's Hospital
Principal Investigator: Susan L. Furth, MD, PhD Children's Hospital of Philadelphia

Publications:
Responsible Party: Susan Redline, Professor, Brigham and Women's Hospital
ClinicalTrials.gov Identifier: NCT02562040     History of Changes
Other Study ID Numbers: 1U011HL125307-O1A1
First Posted: September 29, 2015    Key Record Dates
Last Update Posted: July 2, 2018
Last Verified: June 2018

Keywords provided by Susan Redline, Brigham and Women's Hospital:
Pediatrics
Primary Snoring
Adenotonsillectomy

Additional relevant MeSH terms:
Respiratory Aspiration
Respiration Disorders
Respiratory Tract Diseases
Pathologic Processes