Standardizing OSA-18 Instrument for Use as Metric in Pediatric Otolaryngology

Abstract

Objectives:

(1) Determine whether the change in obstructive sleep apnea (OSA)-18 pre- and posttonsillectomy could serve as a measure of surgical success. (2) Determine the practicality of administering pre- and posttonsillectomy OSA to a valid patient sample. Obstructive Sleep Apnea 18 (OSA-18), a validated instrument, assesses quality of life (QOL) relative to severity of sleep-related problems. Higher OSA-18 scores are associated with poorer QOL.

Methods:

Prospective, case series methodology at a tertiary pediatric hospital. Patients undergoing tonsillectomy ± adenoidectomy for sleep-disordered breathing (SBD). Two distribution-collection methods were trialed attempting to systemize the process. In phase one (14 months) we collected pre-intervention scores during the ambulatory clinic visit. In phase 2 (8 months) a single provider distributed pre-intervention instruments to parents on the day of surgery. Both methods sent post-tonsillectomy instruments using a web-based tool.

Results:

In phase 1, 348 pre-intervention instruments were collected. Fifty-eight (16%) met inclusion criteria, and of these, 22 (38%) completed the postintervention instrument. In phase 2, 11 pretonsillectomy scores were collected, and 6 (55%) of these completed the posttonsillectomy instrument. In both groups, the average change in OSA-18 was 33 points (1: 65 pre, 31 post; 2: 61 pre, 29 post, respectively).

Conclusions:

The OSA-18 instrument demonstrates tonsillectomy +/- adenoidectomy is very successful at improving pediatric OSA-related QOL. These data could document the value of the procedure. However, collecting pre- and post-intervention scores from busy parents is operationally burdensome and only modestly successful. Use of change in OSA-18 as an outcome metric will require a yet-to-be-determined strategy to reliably collect pre-and post-surgery scores.