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Published on: December 6, 2016
Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study
Yu-Shu Huang1, Christian Guilleminault2, Li-Ang Lee3
1Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan ; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Insights
Adenotonsillectomy improves obstructive sleep apnea (OSA) in children, but resolution is often incomplete. Recurrence is common, with 68% experiencing worsening symptoms over time.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Adenotonsillectomy (AT) is a primary treatment for pediatric OSA.
Purpose of the Study:
- To evaluate the long-term efficacy of AT in treating pediatric OSA.
- To identify risk factors for OSA recurrence after AT.
Main Methods:
- A 3-year prospective longitudinal study of 135 children (6-12 years) with OSA.
- Children underwent polysomnography, examinations, and questionnaires post-AT at 6, 12, 24, and 36 months.
- Statistical analyses included multivariate generalized linear modeling and hierarchical linear models.
Main Results:
- Adenotonsillectomy significantly improved the apnea-hypopnea index (AHI) initially.
- However, incomplete resolution was observed, with 53.4% still having AHI > 1 at 6 months.
- A progressive worsening of AHI was noted, reaching 68% with AHI > 1 at 36 months.
Conclusions:
- Adenotonsillectomy provides significant short-term improvement in pediatric OSA.
- Long-term resolution is often incomplete, with a high rate of worsening symptoms and recurrence.
- Factors like BMI, enuresis, allergic rhinitis, and postsurgery AHI severity predict recurrence.
Objective:
To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA.
Study Design:
An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence.
Results:
Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m(2)) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight.
Conclusions:
Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.
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