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Sleep surgery in syndromic and neurologically impaired children

Noor-E-Seher Ali1, Jennifer C Alyono1, Anisha R Kumar1

  • 1Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, United States of America.

American Journal of Otolaryngology
|June 7, 2020
PubMed

Insights

Surgery for obstructive sleep apnea (OSA) in children with comorbidities often requires additional interventions beyond adenotonsillectomy. Dissection of the pharynx (DISE) helps identify remaining obstruction sites for improved management.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Genetics and Rare Diseases

Background:

  • Obstructive sleep apnea (OSA) is prevalent in children with syndromic or neurologic conditions.
  • Management strategies for pediatric OSA with comorbidities require careful consideration.

Purpose of the Study:

  • To evaluate surgical interventions for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities.
  • To analyze the effectiveness of different surgical approaches and identify factors influencing outcomes.

Main Methods:

  • Retrospective review of 375 pediatric OSA patients with various comorbidities.
  • Analysis of surgical procedures, apnea-hypopnea index (AHI) changes, complications, and endoscopic findings.

Main Results:

  • Adenoidectomy and tonsillectomy were the most frequent surgeries, significantly reducing AHI post-tonsillectomy.
  • Tongue base and epiglottic retroflexion were common findings on DISE; lingual tonsillectomy showed limited AHI improvement.
  • 228 patients underwent 297 surgical interventions.

Conclusions:

  • Adenotonsillectomy is a primary treatment for syndromic/neurologically impaired children with OSA, especially with hypertrophy.
  • Incomplete OSA resolution often necessitates further interventions.
  • Dissection of the pharynx (DISE) is crucial for identifying residual obstruction and guiding subsequent management.
Abstract

Keywords:
NeurologicObstructive sleep apneaSyndromic

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