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Adenotonsillectomy for obstructive sleep apnea in children with syndromic craniosynostosis

Stephanie O Zandieh1, Bonnie L Padwa, Eliot S Katz

  • 1New York, N.Y.; and Boston, Mass. From the Department of Pediatric Pulmonology, New York University Langone Medical Center, New York University School of Medicine, and the Department of Plastic and Oral Surgery and the Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Harvard Medical School.

Plastic and Reconstructive Surgery
|April 2, 2013
PubMed

Insights

Adenotonsillectomy often fails to improve obstructive sleep apnea (OSA) in children with craniosynostosis. This condition is common in these patients and requires complex airway management beyond tonsil removal.

Area of Science:

  • Pediatric Surgery
  • Sleep Medicine
  • Craniofacial Surgery

Background:

  • Obstructive sleep apnea (OSA) is a frequent complication in children with syndromic craniosynostosis.
  • The effectiveness of adenotonsillectomy for OSA in this specific patient population remains unclear.

Purpose of the Study:

  • To evaluate the role of adenotonsillectomy in managing obstructive sleep apnea (OSA) in children with syndromic craniosynostosis.
  • To determine if adenotonsillectomy leads to significant improvements in the apnea/hypopnea index (AHI) in this cohort.

Main Methods:

  • Retrospective review of pediatric patients with Apert, Crouzon, and Pfeiffer syndromes.
  • Analysis of apnea/hypopnea index (AHI) from polysomnography before and after adenotonsillectomy.

Main Results:

  • 83% of patients with syndromic craniosynostosis presented with obstructive sleep apnea (OSA).
  • Adenotonsillectomy was performed in 62% of patients, with 45% having pre- and post-operative polysomnography.
  • No significant change in the mean apnea/hypopnea index (AHI) was observed post-adenotonsillectomy, with persistent OSA in most cases.

Conclusions:

  • Obstructive sleep apnea (OSA) is highly prevalent and complex in children with syndromic craniosynostosis.
  • Adenotonsillectomy is frequently ineffective in improving OSA severity in this patient group.
  • Airway obstruction in these patients often involves multiple levels, necessitating comprehensive management strategies.
Abstract

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