Risk Factors, Symptom Burden, and Treatment Response in Pediatric REM ‐Predominant OSA : Evidence From the Childhood Adenotonsillectomy Trial

Objective

To evaluate whether children with rapid eye movement (REM)–predominant obstructive sleep apnea (OSA) are less likely to achieve disease resolution following different management strategies compared with those with non–REM‐predominant OSA.

Methods

We performed a secondary analysis of the Childhood Adenotonsillectomy Trial. Children aged 5.0–9.9 years with OSA were randomized to adenotonsillectomy (AT) or watchful waiting. REM‐predominant OSA was defined as a REM‐AHI to NREM‐AHI ratio of ≥ 2. The primary outcome was OSA resolution at 7‐month follow‐up.

Results

Among 382 children (48.2% male; median age 6.75 years), 55.8% had REM‐predominant OSA. Black race and obesity were associated with a higher prevalence of this subtype. REM‐predominant OSA group exhibited increased daytime sleepiness (difference, 10%; 95% CI, 1%–17%), higher AHI (difference, 1.37; 95% CI, 0.67–2.22), and lower oxygen saturation nadirs (difference, −2.00; 95% CI, −3.00 to −2.00) compared with the non–REM‐predominant OSA group. However, PSQ‐defined symptom burden (difference, −1%; 95% CI, −9% to 7%) and OSA‐18‐defined quality‐of‐life impairment (difference, 3%; 95% CI, −6% to 12%) did not differ significantly between groups. At the 7‐month follow‐up, children in the REM‐predominant OSA group who underwent watchful waiting were significantly less likely to experience spontaneous resolution than those in the non–REM‐predominant OSA group (aOR, 0.52; 95% CI, 0.28–0.97). However, no significant difference was observed in the OSA resolution rate between the two groups who underwent AT (aOR, 0.75; 95% CI, 0.34–1.66).

Conclusions

REM‐predominant OSA was associated with greater daytime sleepiness and PSG severity but was not associated with significantly greater parent‐reported symptom burden or worse disease‐specific quality of life. Children with REM‐predominant OSA were less likely to experience spontaneous resolution after watchful waiting, underscoring the prioritization of AT.

Level of Evidence

3.

Trial Registration: ClinicalTrials.gov Identifier: NCT00560859