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Published on: December 6, 2016
Adenotonsillectomy for obstructive sleep apnoea in children
1Ear, Nose and Throat Department , Medway Maritime Hospital, Windmill Road, Gillingham , Kent, UK, ME7 5NY. jeromelim@doctors.org.uk
Insights
Adenotonsillectomy is a common treatment for pediatric obstructive sleep apnea (OSA). One study found no significant difference between two surgical techniques, though one allowed faster return to normal diet.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Surgical Interventions
Background:
- Obstructive sleep apnea (OSA) in children is primarily treated with surgery.
- Adenotonsillectomy is the most frequent surgical intervention for pediatric OSA.
Purpose of the Study:
- To evaluate the effectiveness of adenotonsillectomy in treating pediatric obstructive sleep apnea (OSA).
Main Methods:
- Searched the Cochrane Airways Group Specialised Register for randomized trials up to August 2008.
- Included randomized trials involving children diagnosed with obstructive sleep apnea (OSA).
- Two reviewers assessed search results and extracted data from eligible studies.
Main Results:
- One study met inclusion criteria, comparing temperature-controlled radiofrequency (TCFR&A) adenoidectomy/tonsillectomy with complete adenoidectomy/tonsillectomy (T&A).
- No significant differences were found in symptoms or respiratory disturbance index between the two surgical methods.
- Children in the TCFR&A group showed a quicker return to a normal diet at 7 days post-surgery.
Conclusions:
- A single study found no significant difference between TCFR&A and T&A for pediatric OSA, though TCFR&A facilitated faster dietary recovery.
- There is a lack of high-quality randomized controlled trials (RCTs) on adenotonsillectomy efficacy for pediatric OSA.
- Further research, including baseline sleep studies and long-term follow-up, is needed to establish treatment guidelines for pediatric OSA.
Background:
Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children.
Objectives:
To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children.
Search Strategy:
The Cochrane Airways Group Specialised Register was searched with pre-specified terms. Searches were current as of August 2008.
Selection Criteria:
Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea.
Data Collection And Analysis:
Two reviewers examined the search results and collected data from the studies in terms of their characteristics before deciding which ones would be included in the review.
Main Results:
One study met the review entry criteria. This study addressed the relative merits of two surgical techniques in treating OSA in children (temperature controlled radiofrequency tonsillectomy and adenoidectomy, and complete tonsillectomy and adenoidectomy). No significant difference was apparent for either symptoms or respiratory disturbance index. More children in the TCFR&A group were able to return to normal diet at 7 days compared with complete T&A. No significant complications were observed in the study.
Authors' Conclusions:
One small study failed to find a difference between two surgical techniques, although return to normal diet was more frequent in the group treated by temperature controlled radiofrequency tonsillectomy and adenoidectomy. At present there is still debate as to the criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of confirmed obstructive sleep apnoea with adenotonsillectomy in children. Research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated. The quality of research in this area could be improved with the use of sleep studies at baseline to determine the extent of severity of sleep apnoea in children who are recruited to studies in this area. Long-term follow up is also required in order to explore the effect of adenotonsillectomy on paediatric sleep apnoea.
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