OSA 18 Questionnaire: Tool to Evaluate Quality of Life and Efficacy of Treatment Modalities in Pediatric Sleep Disordered Breathing Due to Adenotonsillar Hypertrophy

  • Srinivas Kishore Sistla
  • Vaibhav LahaneEmail author
Original Article


Aims to evaluate quality of life in paediatric SDB due to adenotonsillar hypertrophy and efficacy of treatment modalities (medical and surgical) by using OSA-18 questionnaire. Prospective study, conducted from April 2019 to June 2019, including 42 patients with clinical features suggestive of SDB due to adenotonsillar hypertrophy, in age group of 3–15 years. Nasopharyngoscopy was done to grade adenoid hypertrophy. OSA-18 QOL questionnaire was recorded in all patients and depending upon the severity of impact of QOL and grades of adenoid hypertrophy, patients were categorized into two groups. Group 1 received medical treatment and group 2 underwent adenotonsillectomy. Questionnaire was again recorded after 4 weeks. Pretreatment and post-treatment total mean and individual domain scores were compared. Paired t tests was used to evaluate results. Group 1 included 16 children with mild to moderate impact and received medical management. Pretreatment mean OSA-18 score of 70.31 was improved to 33.5. Group 2 enrolled 26 patients with severe impact, were subjected to adenotonsillectomy. Pretreatment and post-treatment mean score were 95.88 and 24.92 respectively. Both groups showed statistically significant improvement in all individual domains and total mean OSA-18 scores indicating improvement in QOL after treatment and efficacy of medical management for mild-moderate SDB and surgery for severe cases. OSA-18 questionnaire is self-administered and disease specific screening tool for early diagnosis and evaluation of QOL before and after treatment. It also helps to categorize patients for advocating appropriate treatment and to evaluate efficacy of treatment modalities.


Sleep disordered breathing Obstructive sleep apnea Quality of life OSA 18 questionnaire Adenotonsillectomy Montelukast Mometasone nasal spray 



No funding sources.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


This work has never been published and is not currently under evaluation in any other peer reviewed publication.

Ethical Approval

The study was approved by the Institutional Ethics Committee.

Informed Consent

Informed consent was obtained from parents’ caregivers all individual participants included in the study.


  1. 1.
    Mitchell RB, Pereira KD, Friedman NR (2006) Sleep-disordered breathing in children: survey of current practice. Laryngoscope 116(6):956–958PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Bixler EO, Vgontzas AN, Lin H-M et al (2009) Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 32(6):731PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Goldstein NA, Abramowitz T, Weedon J et al (2011) Racial/ethnic differences in the prevalence of snoring and sleep disordered breathing in young children. J Clin Sleep Med 7(2):163PubMedPubMedCentralGoogle Scholar
  4. 4.
    Brockmann PE, Urschitz MS, Schlaud M et al (2012) Primary snoring in school children: prevalence and neurocognitive impairments. Sleep Breath 16(1):23–29PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5(2):242–252PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Loughlin G, Brouillette R, Brooke L et al (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153(2):866–878CrossRefGoogle Scholar
  7. 7.
    Jennum P, Ibsen R, Kjellberg J (2013) Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax 68:949–954PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Tarasiuk A, Simon T, Tal A et al (2004) Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization. Pediatrics 113(2):351–356PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Mitchell R, Kelly J, Call E et al (2004) Quality of life after adenotonsillectomy for obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 130:190–194PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Flanary V (2003) Long-term effect of adenotonsillectomy on quality of life in pediatric patients. Laryngoscope 113:1639–1644PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Goldstein N, Fatima M, Campbell T et al (2002) Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 128:770–775PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Sohn H, Rosenfeld R (2003) Evaluation of sleep-disordered breathing in children. Otolaryngol Head Neck Surg 128:344–352PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Mitchell R, Kelly J (2005) Quality of life after adenotonsillectomy for SDB in children. Otolaryngol Head Neck Surg 133:569–572PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Goldbart AD, Greenberg-Dotan S, Tal A (2012) Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics 130(3):e575–e580PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Tan HL, Gozal D, Kheirandish-Gozal L (2013) Obstructive sleep apnea in children: a critical update. Nat Sci Sleep 5:109–123PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kheirandish-Gozal L, Gozal D (2008) Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics 122:e149–e155PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Berlucchi M, Salsi D, Valetti L et al (2007) The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 119:e1392–e1397PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Goldbart AD, Greenberg-Dotan S, Tal A (2012) Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics 130:e575–e580PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Kohn JL, Cohen MB, Patel P, Levi JR (2019) Outcomes of children with mild obstructive sleep apnea treated nonsurgically: a retrospective review. Otolaryngol Head Neck Surg 160(6):1101–1105PubMedCrossRefGoogle Scholar
  20. 20.
    Franco RA, Rosenfeld RM, Rao M (2000) First place—resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 123(1):9–16PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Silva VC, Leite AJM (2006) Quality of life in children with sleep-disordered breathing: evaluation by OSA-18. Braz J Otorhinolaryngol 72(6):747–756PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Hasukic Begzada (2013) OSA-18 survey in evaluation of sleep-disordered breathing in children with adenotonsillar hypertrophy. Med Arch 67(2):111–114PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    de Machado Gomes A, dos Santos OM, Pimentel K, Marambaia PP, Gomes LM, Pradella-Hallinan M, Lima MG (2012) Quality of life in children with sleep-disordered breathing. Braz J Otorhinolaryngol 78(5):12–21CrossRefGoogle Scholar
  24. 24.
    Kang KT, Weng WC, Yeh TH, Lee PL, Hsu WC (2014) Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea. J Formos Med Assoc 113:454–462PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Dayyat E, Kheirandish-Gozal L, Sans Capdevila O, Maarafeya MM, Gozal D (2009) Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest 136:137–144PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Tagaya M, Nakata S, Yasuma F, Miyazaki S, Sasaki F, Morinaga M et al (2012) Relationship between adenoid size and severity of obstructive sleep apnea in preschool children. Int J Pediatr Otorhinolaryngol 76:1827–1830PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Marcus CL, Brooks LJ, Ward SD, Draper KA, Gozal D, Halbower AC, Jones J, Lehmann C, Schechter MS, Sheldon S, Shiffman RN (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:576PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin North Am 36(6):1551–1569PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Verhulst SL, Schrauwen N, Haentjens D et al (2007) Sleep-disordered breathing and the metabolic syndrome in overweight and obese children and adolescents. J Pediatr 150(6):608–612PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Gozal D, Serpero LD, Sans CO, Kheirandish- Gozal L (2008) Systemic inflammation in nonobese children with obstructive sleep apnea. Sleep Med 9(3):254–259PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Gozal D (1998) Sleep-disordered breathing and school performance in children. Pediatrics 102(3 pt 1):616–620PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Amin RS, Kimball TR, Kalra M et al (2005) Left ventricular function in children with sleep disordered breathing. Am J Cardiol 95(6):801–804PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Amin RS, Kimball TR, Bean JA et al (2002) Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med 165(10):1395–1399PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Suratt PM, Barth JT, Diamond R et al (2007) Reduced time in bed and obstructive sleep-disordered breathing in children are associated with cognitive impairment. Pediatrics 119(2):320–329PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Weatherly RA, Mai EF, Ruzicka DL et al (2003) Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns. Sleep Med 4(4):297–307PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Wang RC, Elkins TP, Keech D et al (1998) Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 118(1):69–73PubMedCrossRefGoogle Scholar
  37. 37.
    Montgomery-Downs HE, O’Brien LM, Holbrook CR et al (2004) Snoring and sleep disordered breathing in young children: subjective and objective correlates. Sleep 27(1):87–94PubMedCrossRefGoogle Scholar
  38. 38.
    Chervin RD, Ruzicka DL, Archbold KH et al (2005) Snoring predicts hyperactivity four years later. Sleep 28(7):885–890PubMedCrossRefGoogle Scholar
  39. 39.
    Mitchell RB, Kelly J, Call E, Yao O (2004) Long- term changes in quality of life after surgery for pediatric obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 130(4):409–412PubMedCrossRefGoogle Scholar
  40. 40.
    Mitchell RB, Kelly J (2004) Adenotonsillectomy for obstructive sleep apnea in obese children. Otolaryngol Head Neck Surg 131(1):104–108PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Kljajica Z, Roje Z, Becic K, Capkun V (2019) Obstructive sleep apnea in children: how it affects parental psychological status? Int J Pediatr Otorhinolaryngol 117:157–162CrossRefGoogle Scholar
  42. 42.
    Tran KD, Nguyen CD, Weedon J, Goldstein NA (2005) Child behavior and quality of life in pediatric obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 131(1):52–57PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Brouillette RT, Manoukian JJ, Ducharme FM et al (2001) Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 138(6):838–844CrossRefGoogle Scholar
  44. 44.
    Alexopoulos EI, Kaditis AG, Kalampouka E et al (2004) Nasal corticosteroids for children with snoring. Pediatr Pulmonol 38(2):161–166PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Liming Bryan J, Ryan Matthew, Mack Douglas, Ahmad Iram, Camacho Macario (2019) Montelukast and nasal corticosteroids to treat pediatric obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 160(4):594–602PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Weissbach A, Leiberman A, Tarasiuk A, Goldbart A, Tal A (2006) Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 70(8):1351–1356PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of ENT and Head Neck SurgeryStar HospitalHyderabadIndia

Personalised recommendations