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Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Anna Borgström1, Pia Nerfeldt2, Danielle Friberg2

  • 1Department of Otorhinolaryngology, Karolinska University Hospital, and Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden anna.borgstrom@karolinska.se.

Pediatrics
|March 22, 2017
PubMed

Insights

Adenotonsillotomy (ATT) is as effective as adenotonsillectomy (ATE) for treating pediatric obstructive sleep apnea (OSA) after one year. However, ATT carries a risk of OSA recurrence, requiring careful consideration for surgical method selection.

Area of Science:

  • Otolaryngology
  • Pediatric Sleep Medicine
  • Surgical Outcomes

Background:

  • Adenotonsillectomy (ATE) is a standard treatment for pediatric obstructive sleep apnea (OSA).
  • Adenotonsillotomy (ATT) is a less invasive alternative gaining popularity due to reduced morbidity.
  • Previous studies lacked randomized comparisons of ATT and ATE using polysomnographic data.

Purpose of the Study:

  • To compare the effectiveness of ATT versus ATE in treating pediatric OSA.
  • To determine if ATT is noninferior to ATE based on polysomnographic outcomes after one year.
  • To evaluate changes in Apnea-Hypopnea Index (AHI) and OSA-18 scores post-surgery.

Main Methods:

  • A randomized controlled trial involving 79 children (aged 2-6 years) with mild to moderate OSA (AHI 5-30).
  • Participants were randomized to either ATT (n=40) or ATE (n=39).
  • Polysomnography (PSG) and OSA-18 questionnaires were administered at baseline and one year post-surgery.

Main Results:

  • The mean difference in AHI change between ATT and ATE was 0.83, which did not exceed the noninferiority margin of 5.
  • Both ATT and ATE groups showed significant improvements in PSG and OSA-18 scores, with no statistically significant differences between the groups.
  • Five children (13%) in the ATT group required repeat surgery due to tonsil regrowth and OSA recurrence.

Conclusions:

  • Adenotonsillotomy (ATT) is noninferior to adenotonsillectomy (ATE) for treating pediatric obstructive sleep apnea (OSA) based on polysomnographic outcomes at one year.
  • ATT can be considered a viable alternative to ATE for pediatric OSA treatment.
  • The risk of OSA recurrence after ATT necessitates careful patient selection and consideration of potential re-intervention.
Abstract

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