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Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy
C B Croft1, M J Brockbank, A Wright
1Royal National Throat, Nose and Ear Hospital, London, UK.
Insights
Sleep screening identified sleep apnoea in children undergoing adenotonsillectomy. Breathing irregularities were key indicators, and oropharyngeal airway size significantly impacted sleep disruption severity.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Physiology
Background:
- Recurrent upper respiratory tract infections are common in children.
- Adenotonsillectomy is a frequent surgical intervention for these conditions.
- Obstructive sleep apnoea (OSA) can be associated with upper airway abnormalities.
Purpose of the Study:
- To determine the incidence of sleep apnoea in children undergoing adenotonsillectomy.
- To identify predictive factors for obstructive sleep apnoea in this pediatric population.
- To evaluate the impact of adenotonsillectomy on sleep quality.
Main Methods:
- Sleep screening was performed on 50 children scheduled for adenotonsillectomy.
- Preoperative assessments included parental history, physical examination, and lateral cephalometry.
- Children were categorized into sleep grades based on snoring and sleep disruption.
Main Results:
- A history of breathing irregularities was highly specific for identifying sleep apnoea.
- Tonsillar size and position, and oropharyngeal airway dimensions (via cephalometry) significantly correlated with sleep grade.
- Post-adenotonsillectomy, children with moderate to severe sleep disruption (grades II-IV) improved to grades 0 or I.
Conclusions:
- Adenotonsillectomy is effective in resolving sleep-related breathing issues in children with OSA.
- Oropharyngeal airway size and tonsillar status are critical factors in pediatric sleep apnoea.
- Preoperative screening for breathing irregularities aids in diagnosing sleep apnoea in children.
Abstract:
Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.