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TABLE 4

Results of Mediation Analysis for 18 Outcomes Assessed in the CHAT

OutcomeaACMEADETotal EffectbProportion Mediatedc
Mean Estimate (95% CI)PMean Estimate (95% CI)PMean Estimate (95% CI)PMean Estimate (95% CI)P
NEPSY attention and executive function score (n = 390) −0.20 (−1.42 to 1.02) .74 2.53 (−0.41 to 5.67) .10 2.32 (−0.41 to 5.30) .10 −0.09 (−3.69 to 0.83) .76 
Conners’ Rating Scale score         
 Caregiver rating (n = 385) −0.07 (−0.78 to 0.60) .88 −2.94 (−4.73 to −1.11) .002 −3.02 (−4.62 to −1.38) <.001 0.02 (−0.19 to 0.39) .88 
 Teacher rating (n = 209) −0.68 (−2.41 to 0.97) .42 −2.40 (−6.02 to 0.75) .15 −3.08 (−5.84 to −0.48) .03 0.22 (−2.10 to 3.07) .45 
BRIEF score         
 Caregiver rating (n = 385) 0.06 (−0.66 to 0.72) .86 −3.68 (−5.43 to −1.95) <.001 −3.62 (−5.26 to −2.08) <.001 −0.02 (−0.22 to 0.19) .86 
 Teacher rating (n = 204) −0.13 (−1.65 to 1.42) .89 −2.05 (−5.49 to 1.25) .21 −2.19 (−5.22 to 0.64) .14 0.06 (−618.93 to −0.26) .90 
PSQ-SRBD (n = 389) −0.03 (−0.05 to −0.02) <.001 −0.22 (−0.25 to −0.18) <.001 −0.25 (−0.28 to −0.21) <.001 0.13 (0.07 to 0.21) <.001 
PedsQL score (n = 392) 0.78 (−0.41 to 2.05) .23 4.55 (1.21 to 7.61) .007 5.33 (2.30 to 8.10) <.001 0.15 (−0.05 to 0.63) .23 
DAS-2 GCA score (n = 390) −0.56 (−1.14 to 0.00) .05 1.27 (−0.16 to 2.63) .08 0.71 (−0.64 to 1.98) .31 −0.79 (−8.96 to 7.66) .34 
Conners’ ADHD Index T score         
 Caregiver rating (n = 385) −0.45 (−1.16 to 0.25) .21 −2.15 (−3.98 to −0.33) .02 −2.60 (−4.23 to −1.01) .002 0.17 (−0.10 to 0.70) .21 
 Teacher rating (n = 209) −0.33 (−1.83 to 1.12) .67 −3.11 (−5.98 to −0.30) .03 −3.44 (−5.90 to −1.03) .004 0.10 (−0.39 to 0.81) .67 
CBCL total problems T score (n = 374) −0.02 (−0.66 to 0.61) .94 −2.68 (−4.33 to −1.13) <.001 −2.70 (−4.31 to −1.13) <.001 0.01 (−0.32 to 0.27) .94 
OSA-18 summary score (388) −1.98 (−3.40 to −0.64) .004 −15.31 (−18.70 to −12.07) <.001 −17.29 (−20.40 to −14.24) <.001 0.11 (0.04 to 0.20) .004 
ESS (n = 393) −0.13 (−0.47 to 0.20) .44 −1.64 (−2.55 to −0.77) <.001 −1.77 (−2.60 to −0.98) <.001 0.08 (−0.11 to 0.31) .44 
BMI percentile (n = 391) −0.35 (−1.26 to 0.50) .40 2.76 (0.56 to 5.00) .01 2.42 (0.41 to 4.49) .02 −0.14 (−0.99 to 0.33) .41 
C-reactive protein, (n = 262), μg/mL −0.15 (−0.52 to 0.17) .40 0.38 (−0.53 to 1.30) .47 0.23 (−0.48 to 0.92) .60 −0.64 (−6.39 to 4.92) .54 
HOMA-IR (n = 261) 0.02 (−0.19 to 0.22) .85 0.55 (0.03 to 1.11) .03 0.57 (0.09 to 1.07) .02 0.04 (−0.51 to 0.69) .85 
Systolic blood pressure, (n = 391) mm Hg −0.12 (−0.78 to 0.54) .73 −0.13 (−1.82 to 1.60) .88 −0.25 (−1.75 to 1.32) .78 0.47 (−6.16 to 5.50) .95 
Diastolic blood pressure (n = 391), mm Hg 0.29 (−0.34 to 0.91) .35 −0.17 (−1.72 to 1.37) .85 0.12 (−1.30 to 1.53) .86 2.44 (−7.01 to 6.52) .93 
OutcomeaACMEADETotal EffectbProportion Mediatedc
Mean Estimate (95% CI)PMean Estimate (95% CI)PMean Estimate (95% CI)PMean Estimate (95% CI)P
NEPSY attention and executive function score (n = 390) −0.20 (−1.42 to 1.02) .74 2.53 (−0.41 to 5.67) .10 2.32 (−0.41 to 5.30) .10 −0.09 (−3.69 to 0.83) .76 
Conners’ Rating Scale score         
 Caregiver rating (n = 385) −0.07 (−0.78 to 0.60) .88 −2.94 (−4.73 to −1.11) .002 −3.02 (−4.62 to −1.38) <.001 0.02 (−0.19 to 0.39) .88 
 Teacher rating (n = 209) −0.68 (−2.41 to 0.97) .42 −2.40 (−6.02 to 0.75) .15 −3.08 (−5.84 to −0.48) .03 0.22 (−2.10 to 3.07) .45 
BRIEF score         
 Caregiver rating (n = 385) 0.06 (−0.66 to 0.72) .86 −3.68 (−5.43 to −1.95) <.001 −3.62 (−5.26 to −2.08) <.001 −0.02 (−0.22 to 0.19) .86 
 Teacher rating (n = 204) −0.13 (−1.65 to 1.42) .89 −2.05 (−5.49 to 1.25) .21 −2.19 (−5.22 to 0.64) .14 0.06 (−618.93 to −0.26) .90 
PSQ-SRBD (n = 389) −0.03 (−0.05 to −0.02) <.001 −0.22 (−0.25 to −0.18) <.001 −0.25 (−0.28 to −0.21) <.001 0.13 (0.07 to 0.21) <.001 
PedsQL score (n = 392) 0.78 (−0.41 to 2.05) .23 4.55 (1.21 to 7.61) .007 5.33 (2.30 to 8.10) <.001 0.15 (−0.05 to 0.63) .23 
DAS-2 GCA score (n = 390) −0.56 (−1.14 to 0.00) .05 1.27 (−0.16 to 2.63) .08 0.71 (−0.64 to 1.98) .31 −0.79 (−8.96 to 7.66) .34 
Conners’ ADHD Index T score         
 Caregiver rating (n = 385) −0.45 (−1.16 to 0.25) .21 −2.15 (−3.98 to −0.33) .02 −2.60 (−4.23 to −1.01) .002 0.17 (−0.10 to 0.70) .21 
 Teacher rating (n = 209) −0.33 (−1.83 to 1.12) .67 −3.11 (−5.98 to −0.30) .03 −3.44 (−5.90 to −1.03) .004 0.10 (−0.39 to 0.81) .67 
CBCL total problems T score (n = 374) −0.02 (−0.66 to 0.61) .94 −2.68 (−4.33 to −1.13) <.001 −2.70 (−4.31 to −1.13) <.001 0.01 (−0.32 to 0.27) .94 
OSA-18 summary score (388) −1.98 (−3.40 to −0.64) .004 −15.31 (−18.70 to −12.07) <.001 −17.29 (−20.40 to −14.24) <.001 0.11 (0.04 to 0.20) .004 
ESS (n = 393) −0.13 (−0.47 to 0.20) .44 −1.64 (−2.55 to −0.77) <.001 −1.77 (−2.60 to −0.98) <.001 0.08 (−0.11 to 0.31) .44 
BMI percentile (n = 391) −0.35 (−1.26 to 0.50) .40 2.76 (0.56 to 5.00) .01 2.42 (0.41 to 4.49) .02 −0.14 (−0.99 to 0.33) .41 
C-reactive protein, (n = 262), μg/mL −0.15 (−0.52 to 0.17) .40 0.38 (−0.53 to 1.30) .47 0.23 (−0.48 to 0.92) .60 −0.64 (−6.39 to 4.92) .54 
HOMA-IR (n = 261) 0.02 (−0.19 to 0.22) .85 0.55 (0.03 to 1.11) .03 0.57 (0.09 to 1.07) .02 0.04 (−0.51 to 0.69) .85 
Systolic blood pressure, (n = 391) mm Hg −0.12 (−0.78 to 0.54) .73 −0.13 (−1.82 to 1.60) .88 −0.25 (−1.75 to 1.32) .78 0.47 (−6.16 to 5.50) .95 
Diastolic blood pressure (n = 391), mm Hg 0.29 (−0.34 to 0.91) .35 −0.17 (−1.72 to 1.37) .85 0.12 (−1.30 to 1.53) .86 2.44 (−7.01 to 6.52) .93 

The causal mediator was polysomnographic resolution, defined by an AHI <2 and OAI <1 at follow-up. ACME, average causal mediation effect; ADE, average direct effect; ADHD, attention-deficit/hyperactivity disorder; DAS-2 GCA, Differential Ability Scales–Second Edition (General Conceptual Ability). T scores provide information about a child’s score relative to the reference sample.

a

Outcome variables included scores on the NEPSY, the Conners’ Behavior Rating Scales and the BRIEF, with summary measures obtained from the primary caregiver and the teacher, the PSQ-SRBD, and the PedsQL. These were reported in the CHAT study. Additional outcome variables included scores on the DAS-2 GCA, the Conners’ ADHD Index T scores obtained from the primary caregiver and the teacher, the CBCL, the OSA-18 inventory, and the modified ESS. Physiologic outcomes were represented by changes in BMI percentile score, C-reactive protein values, HOMA-IR, and the systolic and diastolic blood pressures. Changes in outcomes in response to early adenotonsillectomy compared to watchful waiting are shown in Table 3. Normative values are described in Table 1. The relationship between the treatment and the outcome is assessed before and after, including polysomnographic resolution of OSA as the mediating variable.

b

The total effect is decomposed into the ACME and the ADE.

c

The contribution of the mediated effect as a proportion of the total effect is also shown. Point estimates are represented by means and 95% CIs, along with P values for comparisons. The number of children is indicated by “n =” in parentheses. P < .05 was considered significant.

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