TABLE 2.

Key OSDB-Related Outcomes in Studies Comparing Tonsillectomy With Watchful Waiting in Children With OSDB

Author, Year, Study Type, ROB	Comparison Groups (n)	Baseline Outcomes	Follow-Up AHI Scores Outcomes
Trosman et al, 2016,32 retrospective cohort, moderate ROB	G1: Tonsillectomy (18)	AHI, mean ± SD	AHI, mean ± SD; 16-mo follow-up (IQR)
	G1a: Tonsillectomy – obese children (8)	G1: 3.5 ± 1.1
	G1b: Tonsillectomy – syndromic children (6)	G1a: 3.83	G1: 2.69 (1.48 to 3.9)
	G2: WWSC (44)	G1b: 3.08	G1a: 3.08
	G2a: WWSC – obese children (11)	G2: 3.09 ± 1.1	G1b: 2.03
	G2b: WWSC – syndromic children (9)	G2a: 3.2	G2: 5.18 (2.46 to 7.9)
		G2b: 3.31	G2a: 3.4
			G2b: 2.84
			G1 vs G2: P = .03
			G1a versus G2a: P = .25
			G1b versus G2b: P = .36
Marcus et al, 2013,16–23,29 RCT, moderate ROB	G1: Tonsillectomy (193)	AHI, events per hour, median (IQR)	AHI, events per hour, change from baseline to 7 mo (IQR)
	G2: WWSC (208)	G1: 4.8 (2.7–8.8)	G1: –3.5 (–7.1 to –1.8)
		G2: 4.5 (2.5–8.9)	G2: –1.6 (–3.7 to 0.5)
		OSA-18 total score	G1 versus G2: P < .001
		G1: 53.1 ± 18.3	Effect size: 0.57
		G2: 54.1 ± 18.8	OSA-18 total score, change from baseline
		PSQ	G1: –21 ± 16.5
		G1: 0.5 ± 0.2	G2: –4.5 ± 19.3
		G2: 0.5 ± 0.2	G1 versus G2: P ≤ .01
		M-ESS	Effect size: –0.93
		G1: 7.1 ± 4.7	PSQ, change from baseline
		G2: 7.5 ± 5.2	G1: –0.3 ± 0.2
		PedsQL	G2: –0.0 ± 0.2
		G1: 77.3 ± 15.3	G1 versus G2: P ≤ .01
		G2: 76.5 ± 15.7	Effect size: –1.35
		CGI, caregiver	M-ESS, change from baseline
		G1: 52.5 ± 11.6	G1: –2.01 ± 4.7
		G2: 52.6 ± 11.7	G2: 0.28 ± 4.1
		CGI, teacher	G1 versus G2: P < .01
		G1: 56.4 ± 14.4	Effect size: –0.42
		G2: 55.1 ± 12.8	PedsQL, change from baseline to 7 mo
		NEPSYa	G1: 5.9 ± 13.6
		G1: 101.5 ± 15.9	G2: 0.9 ± 13.3
		G2: 101.1 ± 15	G1 versus G2: P ≤ .001
		BRIEF (GEC), caregiver	Effect size: 0.37
		G1: 50.1 ± 11.2	CGI, caregiver, change from baseline to 7 mo
		G2: 50.1 ± 11.5	G1: –2.9 ± 9.9
		BRIEF (GEC), teacher	G2: –0.2 ± 9.4
		G1: 57.2 ± 14.1	G1 versus G2: P = .01
		G2: 56.4 ± 11.7	CGI, teacher, change from baseline to 7 mo
			G1: –4.9 ± 12.9
			G2: –1.5 ± 10.7
			G1 versus G2: P = .04
			NEPSY,a change from baseline to 7 mo
			G1: 7.1 ± 13.9
			G2: 5.1 ± 13.4
			G1 versus G2: P = NS
			Effect size: 0.15
			BRIEF (GEC), caregiver
			G1: –3.3 ± 8.5
			G2: 0.4 ± 8.8
			G1 versus G2: P < .001
			Effect size: 0.28
			BRIEF (GEC), teacher
			G1: –3.1 ± 12.6
			G2: –1.0 ± 11.2
			G1 versus G2: P = NS
			Effect size: 0.18
Biggs et al, 2014,28 prospective cohort, moderate ROB	G1: Tonsillectomy or nasal steroids (12)	AHI, events per hour	AHI, events per hour (4 y posttonsillectomy)
	G2: WWSC (27)	G1: 9.4 ± 9.9	G1: 1.8 ± 5.2
		G2: 1.0 ± 1.2	G2: 1.7 ± 6.0
		CBC, total problem	G1 versus G2: P = NS
		G1: 64 ± 9	CBC, total problem (4 y posttonsillectomy)
		G2: 59 ± 10	G1: 61 ± 15
		BRIEF (GEC), caregiver	G2: 57 ± 12
		G1: 62 ± 11	G1 versus G2: P = NS
		G2: 58 ± 11	BRIEF (GEC) caregiver (4 y posttonsillectomy)
		WASI full-scale IQ	G1: 58 ± 16
		G1:102 ± 13	G2: 57 ± 12
		G2: 106 ± 14	G1 versus G2: P < .05
			WASI full-scale IQ (4 y posttonsillectomy)
			G1: 101 ± 12
			G2: 104 ± 15
			G1 versus G2: P = NS
Burstein et al, 2013,25 retrospective cohort,b moderate ROB	G1: Tonsillectomy (16)	AHI, median	AHI, median
	G2: WWSC (16)	G1: 14.4	G1: 1.1, median change = 10.3
		G2: 9.3	G2: 3.7, median change = 6.5
		CAS-15	G1 versus G2, median change: P = .04
		G1: NR	CAS-15
		G2: NR	G1: 8.9 ± 6.1
		CBC, total problem	G2: 29.4 ± 16.2
		G1: NR	G1 versus G2: P < .001
		G2: NR	CBC total problem (1.66–1.97 y posttonsillectomy)
			G1: 43.9
			G2: 58.9
			G1 versus G2: P < .001
Goldstein et al, 2004,15 RCT, moderate ROB	G1: PSG+ plus Tonsillectomy (21)	AHI, median	AHI, median (6-mo follow-up)
	G2: PSG– plus Tonsillectomy (11)	G1: 6.2 (median)	G1: 0.9 (median)
	G3: PSG– plus WWSC (9)	G2: 0.5 (median)	G2: 0.4 (median)
		G3: 0.6 (median)	G3: 0
		CAS-15 (median)	G2 versus G3: P = NS
		G1: 77	CAS-15 (median)
		G2: 64	G1: 59
		G3: 50	G2: 49
			G3: 8
			G2 versus G3: P = .001
Volksy et al, 2014,31 nonrandomized trial, moderate ROB	G1: Tonsillectomy (30)	OSA-18, total score	OSA-18 total score, 3 mo follow-up
	G2: WWSC (34)	G1: 72.3 ± 20	G1: 33.9 ± 14.6
		G2: 58.5 ± 21.5	G2: 58.2 ± 24.5
			G1 versus G2: P = .0001
			OSA-18 total score, 8 mo follow-up
			G1: 33.6 ± 8.6
			G2: 45.1 ± 21.9
			G1 versus G2: P = NS
Tarasiuk et al, 2004,24 prospective cohort, moderate ROB	G1: Tonsillectomy (130)	Health care utilization	No. of new admissions, mean ± SE per patient per year, mean
	G2: WWSC (90)	G1 + G2: NR	Year 1
			G1: 0.15 ± 0.04
			G2: 0.08 ± 0.03
			Year 2
			G1: 0.06 ± 0.02
			G2: 0.25 ± 0.07
			No. of emergency department visits, mean ± SE per patient per year, mean
			Year 1
			G1: 0.57 ± 0.09
			G2: 0.52 ± 0.09
			Year 2
			G1: 0.35 ± 0.05
			G2: 0.37 ± 0.10
			No. of consultations, mean ± SE per patient per year, mean
			Year 1
			G1: 3.6 ± 0.37
			G2: 4.4 ± 0.40
			G1 versus G2: P = NR
			Year 2
			G1: 1.9 ± 0.26
			G2: 3.5 ± 0.46
			G1 versus G2: P = NR

CGI, Connors’ Global Index; G, group; GEC, Global Executive Composite; IQR, interquartile range; NA, not applicable; NS, not significant; ROB, risk of bias; WASI, Wechsler Abbreviated Scale of Intelligence; WWSC, watchful waiting with supportive care.

^aNEPSY attention and executive function.

^bFollow-up periods differed in this study: the mean was 1.4 years in the tonsillectomy group and 2.0 years in the no surgery group; P = .02.²⁵