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Adenotonsillectomy for obstructive sleep apnea in children with cerebral palsy: Risks and benefits

Nikolaus E Wolter1, Patrick Scheffler2, Chantal Li1

  • 1Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

International Journal of Pediatric Otorhinolaryngology
|September 25, 2023
PubMed

Insights

Adenotonsillectomy improves obstructive sleep apnea (OSA) in children with Cerebral Palsy (CP), but they face higher complication risks. Motor and swallowing impairments increase respiratory issues post-surgery.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Pulmonology
  • Pediatric Neurology

Background:

  • Obstructive sleep apnea (OSA) is prevalent in children with Cerebral Palsy (CP).
  • Adenotonsillectomy is a common treatment for OSA, but outcomes in CP populations require further investigation.
  • Motor and swallowing impairments in CP may influence surgical outcomes and complication rates.

Purpose of the Study:

  • To evaluate the effectiveness of adenotonsillectomy in treating OSA in children with CP.
  • To assess the impact of motor and swallowing dysfunction on respiratory complications following adenotonsillectomy in children with CP.
  • To compare outcomes between children with CP and age-matched controls without CP.

Main Methods:

  • Retrospective review of children with CP and sleep-disordered breathing (SDB) who underwent adenotonsillectomy between 2003-2021.
  • Age-matching of CP patients with a control group without CP.
  • Assessment of motor function using the Gross Motor Functional Classification System (GMFCS) and swallowing function using the Eating and Drinking Ability Classification System (EDACS).

Main Results:

  • 49% of children with CP assessed had moderate to severe OSA; 30% underwent adenotonsillectomy.
  • Adenotonsillectomy led to an initial significant reduction in the obstructive apnea-hypopnea index (OAHI) in all children with CP.
  • Children with CP showed higher rates of postoperative complications (43.5%) and respiratory complications (OR 8.9) compared to controls.
  • Severe motor (GMFCS 5) and swallowing (EDACS 3-5) impairments were associated with increased respiratory complications post-surgery.

Conclusions:

  • Adenotonsillectomy improves OAHI in children with CP, but they experience higher complication rates.
  • Respiratory complications are more frequent in children with CP who have significant motor and swallowing impairments.
  • These findings aid in preoperative planning and risk stratification for caregivers and clinicians.
Abstract

Keywords:
AdenoidectomyCerebral palsyObstructive sleep apneaTonsillectomy

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