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Published on: December 6, 2016
Outcome of adenotonsillectomy for children with sleep apnea
Jagdish Chander Suri1, Manas K Sen1, V P Venkatachalam2
1Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjang Hospital, New Delhi, India.
Insights
Adenotonsillectomy (AT) significantly improved obstructive sleep apnea (OSA) indicators like RDI and AHI in children. However, complete resolution of pediatric OSA after AT was limited, particularly in severe cases.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea syndrome (OSAS) affects 1%-4.9% of children aged 2-18 years.
- Adenotonsillar hypertrophy is a common cause of pediatric OSAS.
Purpose of the Study:
- To prospectively evaluate the effectiveness of adenotonsillectomy (AT) in treating pediatric obstructive sleep apnea (OSA).
- To assess changes in polysomnographic parameters post-AT.
Main Methods:
- Fifty children under 15 with snoring, mouth breathing, and adenotonsillar hypertrophy underwent AT.
- Polysomnography (Level I) was performed pre-operatively and 3-6 months post-AT.
- Evaluated parameters included BMI z-score, Mallampati score, respiratory distress index (RDI), and apnea-hypopnea index (AHI).
Main Results:
- AT significantly improved BMI z-score (p<0.001) and reduced RDI (16.2 to 6.46, p<0.001) and AHI (8.5 to 1.3, p<0.001).
- Pre-operative RDI correlated negatively with BMI z-score.
- Complete OSA resolution occurred in only 6.7% of patients, primarily those with mild disease. Factors like disease severity, Mallampati scores III-IV, high-arched palate, and age >8 years predicted residual disease.
Conclusions:
- Adenotonsillectomy leads to significant improvements in RDI and AHI for pediatric OSA.
- Complete resolution of OSA post-AT is limited, especially in moderate to severe cases.
- Factors such as initial disease severity influence treatment outcomes.
Background And Objectives:
The prevalence of obstructive sleep apnea syndrome is about 1%-4.9% in children aged 2-18 years. This is a prospective study carried out to evaluate the role of adenotonsillectomy (AT) in pediatric sleep apnea.
Methods:
Fifty children aged less than 15 years presenting with the chief complaints of snoring, mouth breathing, recurrent upper respiratory infections, and adenotonsillar hypertrophy were included in the study. Physical examination included body mass index (BMI) z-score, orodental and nasal examination, modified Mallampati scoring; whole-night level I polysomnography was conducted and repeated after three to six months of AT.
Results:
The mean preoperative BMI z-score was -0.76, which improved significantly to -0.15 (p < 0.001) after AT. A negative correlation was seen between respiratory distress index (RDI) and pre surgery BMI z-score. As per pre-operative RDI, OSA was classified mild in 6.7% children (31.1% as per apnea-hypopnea index [AHI]), moderate in 35.6% (31.1% as per AHI), and severe in 57.8% (37.8% as per AHI). The average RDI value reduced significantly from 16.2 ± 10.7 to 6.46 ± 4.8 (p < 0.001) and AHI from 8.5 (SD ± 5.7) to 1.3 (SD ± 1) post-operatively. Only 6.7% children could be cured with surgery, of whom none belonged to moderate or severe category. Multivariate analysis shows that initial severity of disease, modified Mallampati scores III and IV, high-arched palate, and age above eight years were associated with significant residual disease after AT.
Conclusion:
AT was associated with a statistically significant change in RDI and AHI. However, complete resolution of OSA could be seen in a small percentage of patients with a mild degree of disease.
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