Dysphagia Outcomes Before and After Adenotonsillectomy in Children With Obstructive Sleep Apnea A Secondary Analysis of a Randomized Clinical Trial

IMPORTANCE Obstructive sleep apnea (OSA) and tonsil hypertrophymay be associated with dysphagia. However, randomized clinical trials assessing dysphagia outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting with supportive care (WWSC) are lacking. OBJECTIVE To assess dysphagia outcomes in children with OSA and tonsil hypertrophy managed with AT or WWSC. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a multicenter randomized clinical trial, the Childhood Adenotonsillectomy Trial (CHAT), was conducted at tertiary children's hospitals from October 2007 to June 2012. Children aged 5.0 to 9.9 years with OSA were randomized to AT orWWSC and underwent polysomnography at baseline and 7 months. Caregivers completed the OSA-18 questionnaire, which includes an item on difficulty in swallowing at baseline and 7 months. The current secondary analysis was conducted from December 1, 2022, to January 10, 2023. INTERVENTIONS AT vs WWSC. MAIN OUTCOMES AND MEASURES Prevalence of dysphagia, based on parental responses to the difficulty in swallowing item on the OSA-18 questionnaire, was redefined as a binary outcome at baseline and 7-month follow-up. RESULTS In total, 386 children were included (199 female [51.6%]; median [IQR] age, 6.0 [5.0-8.0] years). Of the total, 207 children were Black (53.6%). At baseline, the number of children with dysphagia was similar (4.0%; 95% CI, -4.9% to 12.9%) between the AT group (56 [29.8%]) and theWWSC group (51 [25.8%]). Following AT, a decrease was observed (21.3%; 95% CI, 13.5%-28.9%) in the prevalence of dysphagia among the children. In contrast, the prevalence of dysphagia did not change significantly (1.0%; 95% CI, -7.6% to 9.6%) in theWWSC group. Children in the AT group were more likely to experience a resolution of dysphagia than those in theWWSC group (adjusted odds ratio, 4.84; 95% CI, 1.91-12.25). Higher baseline AHI was associated with a lower resolution of dysphagia (AOR, 0.91; 95% CI, 0.83-0.98). CONCLUSIONS AND RELEVANCE This secondary analysis of the CHAT randomized clinical trial suggested that children with dysphagia and OSA undergoing ATmay experience dysphagia improvement. A prospective randomized trial that uses a validated dysphagia survey is needed to verify the effectiveness of AT in treating dysphagia.