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Persistent respiratory effort after adenotonsillectomy in children with sleep-disordered breathing

Jean-Benoît Martinot1, N Nam Le-Dong2, Stéphane Denison1

  • 1CHU UCL Namur, Namur, Belgium.

The Laryngoscope
|August 24, 2017
PubMed

Insights

Adenotonsillectomy improves sleep-disordered breathing but may not fully resolve respiratory effort. Mandibular movement monitoring effectively identifies persistent effort after surgery, aiding in follow-up care for children.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Respiratory Physiology

Background:

  • Adenotonsillectomy (AT) is a primary treatment for sleep-disordered breathing (SDB) in children with adenotonsillar hypertrophy.
  • While AT improves polysomnography (PSG) findings, it may not fully normalize them, particularly respiratory effort (RE).
  • Evaluating persistent RE post-AT using traditional PSG can be challenging, necessitating innovative monitoring techniques.

Purpose of the Study:

  • To investigate the efficacy of mandibular movement (MMas) monitoring in assessing persistent respiratory effort (RE) after adenotonsillectomy (AT) in children with SDB.
  • To compare MMas indices with polysomnography (PSG) findings before and after AT.
  • To determine if MMas can reliably identify children with persistent RE post-AT.

Main Methods:

  • A prospective cohort study involving 25 children (3-12 years) with SDB.
  • Polysomnography (PSG) was conducted before and >3 months after AT.
  • Midsagittal movement magnetic sensors were used to measure mandibular movements (MMas) during each respiratory cycle.

Main Results:

  • AT significantly improved PSG indices like the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI).
  • However, respiratory effort-related arousals (RERA) persisted in a significant proportion of children.
  • MMas indices correlated significantly with AHI and ODI, and MMas duration was associated with RERA duration and index, indicating its sensitivity to respiratory effort.

Conclusions:

  • Adenotonsillectomy effectively reduces SDB severity but may not eliminate all respiratory effort.
  • Persistent RERA after AT is common and can be identified by abnormal MMas patterns.
  • Mandibular movement monitoring is a valuable, readily achievable tool for follow-up assessment of persistent respiratory effort in children post-AT.
Abstract

Keywords:
Adenotonsillectomymandibular movementsobstructive sleep apnearespiratory effort

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