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Published on: December 6, 2016
A prospective study on the surgical outcomes of children with sleep-disordered breathing
Christian Guilleminault1, Kasey Li, Stacey Quo
1Stanford University Sleep Disorders Clinic, CA 94305, USA. cguil@leland.stanford.edu
Insights
Multidisciplinary team evaluations for pediatric sleep-disordered breathing (SDB) show that treatment adherence is low when referred to outside specialists, impacting outcomes. Better understanding of SDB
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Multidisciplinary Care
Background:
- Sleep-disordered breathing (SDB) affects children, with surgical interventions often considered.
- The rationale for surgical treatment of pediatric SDB is not fully understood by all medical communities.
- Understanding the interplay between mouth breathing, maxillofacial growth, and SDB symptoms is crucial.
Purpose of the Study:
- To prospectively assess the effectiveness of surgical treatment decisions for pediatric SDB made by a multidisciplinary team.
- To compare the clinical outcomes of recommended treatments versus actual treatments performed for children with SDB.
Main Methods:
- A multidisciplinary team evaluated 56 children (18 months to 12 years) with suspected SDB using polysomnography, questionnaires, and clinical assessments.
- Treatment suggestions (surgical, medical, orthodontic) were provided to referring physicians.
- Follow-up evaluations, including repeat testing, were conducted 3 months post-treatment.
Main Results:
- Only 11 children received treatments aligned with the multidisciplinary team's recommendations.
- Of the 45 children referred to other specialists, only 1 had the recommended treatment implemented.
- 28.6% of children required a second surgical procedure, and many experienced residual symptoms or polysomnographic abnormalities.
Conclusions:
- There are significant misconceptions regarding the surgical treatment of pediatric SDB.
- Effective management of pediatric SDB requires better understanding of anatomical factors and their link to symptoms.
- Multidisciplinary evaluation of anatomical abnormalities is key to improving SDB treatment outcomes in children.
Study Objective:
To prospectively evaluate the outcome of surgical treatment decisions made by a multidisciplinary team for children aged 18 months to 12 years with sleep-disordered breathing (SDB).
Design And Setting:
A multidisciplinary team evaluated children referred to a sleep clinic for suspicion of SDB using polysomnography, questionnaires, and clinical evaluations. Suggestions for treatment (surgical, medical, or orthodontic) were made and sent to referring providers. A follow-up evaluation, which included a repeat of all of the tests performed at baseline, was performed 3 months after treatment (and at 6 months for a subgroup of subjects). The clinical outcome of the recommended versus the performed treatment was compared.
Patients:
56 successively evaluated children.
Results:
Based on insurance plans, 11 children were treated by a surgeon on the multidisciplinary team, who followed all treatment recommendations. After treatment, 1 of the 11 children still had SDB. Forty-five children were referred to other specialists. Only 1 of these children had the team's treatment recommendations implemented. Twenty-six of the 45 children had residual symptoms. Twelve children had polysomnographic abnormalities with or without symptoms or snoring. Sixteen children (28.6%) underwent a second surgical procedure.
Conclusion:
There are misconceptions in the pediatric and otolaryngologic communities about the rationale for the surgical treatment of SDB. Interactions between mouth breathing, maxillofacial growth, and clinical symptoms associated with SDB are not well understood. Multidisciplinary evaluations of the anatomic abnormalities of children with SDB lead to better overall treatment.