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Impact of adenotonsillectomy in children with severe obstructive sleep apnea: A systematic review
Francesca Galluzzi1, Werner Garavello2
1Department of Otorhinolaryngology, San Gerardo Hospital, Via Pergolesi, 33, 20052 Monza, MI, Italy.
Insights
Adenotonsillectomy partially treats severe obstructive sleep apnea (OSA) in children without other health issues. While it significantly reduces OSA severity, persistent apnea requires ongoing monitoring and management.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Outcomes Research
Background:
- Severe obstructive sleep apnea (OSA) in children necessitates effective treatment.
- Adenotonsillectomy is a common surgical intervention for pediatric OSA.
- The efficacy of adenotonsillectomy in otherwise healthy children with severe OSA requires further elucidation.
Purpose of the Study:
- To evaluate the impact of adenotonsillectomy on severe obstructive sleep apnea (OSA) in children lacking comorbidities.
- To synthesize evidence on the effectiveness of adenotonsillectomy for pediatric severe OSA.
Main Methods:
- Systematic review of nine studies (five prospective, four retrospective) on adenotonsillectomy for severe pediatric OSA.
- Polysomnographic parameters (AHI/RDI) used as primary outcome measures.
- Quality assessment using OCEBM and MINORS scores.
Main Results:
- Adenotonsillectomy led to a statistically significant reduction in postoperative AHI/RDI values across all included studies.
- Improvement in AHI/RDI ranged from 57.7% to 93.3%.
- Persistent OSA was documented in all studies, with residual OSA rates varying from 30% to 90.6% depending on the severity criteria (AHI≥5 or AHI≥1).
Conclusions:
- Adenotonsillectomy demonstrates partial effectiveness in treating severe OSA in children without comorbidities.
- The surgery significantly reduces OSA severity, indicated by improved polysomnographic parameters.
- Postoperative clinical and polysomnographic follow-up is crucial for managing residual mild to moderate OSA.
Objectives:
To determine the impact of adenotonsillectomy for treatment of severe obstructive sleep apnea (OSA) in children without comorbidities.
Methods:
A systematic review was performed to identify studies regarding adenotonsillectomy for treatment of children with severe sleep apnea. Polysomnographic parameters were considered as metric of cure and the number of patients of persistent apnea was calculated. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.
Results:
The systematic review included nine studies. Five studies were prospective and four retrospectives. No one was controlled. The number of subjects with severe OSA included was 499 with a prevalence of male. The mean age varied from 4.3 to 8.2. The follow-up period ranges from 1 to 23 months. The criteria for considering severe OSA ranges from AHI or RDI ≥10 to ≥30. All the trials have found a statistically significant reduction of postoperative AHI or RDI values in patients who had undergone adenotonsillectomy for severe OSA. The AHI and RDI improving varied from 57.7% to 93.3%. All the studies documented persistent OSA after adenotonsillectomy. The number of residual OSA considering AHI≥5 varied from 30 to 55.5%, in case of AHI ≥1 from 60 to 90.6%.
Conclusion:
To the best of our knowledge, this is the first review regarding the effectiveness of adenotonsillectomy for severe OSA in otherwise healthy children. Adenotonsillectomy is partially effective in the treatment of severe OSA in children without comorbidities. However, it reduces the severity of OSA determining a significant reduction of polysomnographic parameters. These results suggest a clinical and polysomnographic follow-up after surgery in order to manage the residual mild and moderate OSA.
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