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The Effect of Tonsillectomy and Adenoidectomy on Isolated Sleep Associated Hypoventilation in Children

Charles Saadeh1, Seckin O Ulualp1,2

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

The Laryngoscope
|September 3, 2020
PubMed

Insights

Surgical treatment for isolated sleep-associated hypoventilation (SAH) in children effectively normalized hypercapnia in most cases. Further research is needed to identify risk factors for persistent SAH after surgery.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Otolaryngology

Background:

  • Sleep-associated hypoventilation (SAH) is defined by elevated end-tidal carbon dioxide (EtCO2) during sleep.
  • SAH in children can be an isolated condition or coexist with obstructive sleep apnea (OSA).
  • Outcomes of surgical intervention for isolated SAH in pediatric populations remain largely unreported.

Purpose of the Study:

  • To evaluate the effectiveness of surgical treatment for isolated sleep-associated hypoventilation in children.
  • To report on the resolution rates and potential risk factors for residual SAH post-surgery.

Main Methods:

  • A retrospective review of medical charts for children diagnosed with isolated SAH without OSA was conducted.
  • Data included patient demographics, comorbidities, polysomnography (PSG) findings, and surgical management details.
  • Post-surgical PSG was used to assess the resolution of hypercapnia.

Main Results:

  • Seventeen children (3-14 years) with isolated SAH were identified; common comorbidities included asthma and obesity.
  • Eighteen percent of children had persistent SAH post-surgery.
  • Normal weight children achieved SAH resolution, while some overweight and obese children had residual SAH.
  • Upper airway surgery significantly reduced %TST with EtCO2 > 50 mmHg (59.1% to 3.4%).

Conclusions:

  • Surgical intervention, particularly upper airway surgery, leads to normalization of hypercapnia in the majority of children with isolated SAH.
  • Weight status may influence SAH resolution post-surgery.
  • Larger cohort studies are warranted to identify predictors of residual isolated SAH after surgical treatment.
Abstract

Keywords:
Hypoventilationadenoidectomychildrenobstructive sleep apneatonsillectomy

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