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Published on: November 6, 2019
Outcome of tonsillotomy in children with obstructive sleep-disordered breathing
Tina Kissow Lildal1, An Boudewyns2, Konstantinos Kamperis3
1Department of Otorhinolaryngology, Head & Neck Surgery, University Clinic for Flavor, Balance and Sleep, Gødstrup Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Denmark.
Insights
Adeno-tonsillotomy (ATO) effectively reduced obstructive sleep disordered breathing (oSDB) symptoms in children. The procedure significantly improved sleep apnea severity, particularly in moderate-to-severe cases, with high success rates.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Obstructive sleep disordered breathing (oSDB) in children often lacks systematic pre-surgical assessment.
- Adeno-tonsillotomy (ATO) is a common surgical intervention for pediatric oSDB.
- Current standards of care in Denmark do not always include polysomnography (PSG) or structured symptom quantification before surgery.
Purpose of the Study:
- To evaluate the impact of adeno-tonsillotomy (ATO) on symptom burden and polysomnography (PSG) parameters in children with oSDB.
- To assess the effectiveness of ATO in improving obstructive sleep apnea (OSA) severity.
- To determine the correlation between baseline OSA severity and symptom burden/relief post-surgery.
Main Methods:
- A cohort of 52 children aged 2-10 years with oSDB underwent standardized assessment before and 3 months after ATO.
- Assessments included PSG to measure obstructive apnea-hypopnea index (oAHI), tonsil size evaluation, and the Pediatric Sleep Questionnaire (PSQ) for symptom burden.
- OSA was defined as oAHI ≥2/h; successful treatment as post-surgery oAHI ≤5/h; complete cure as oAHI ≤2/h.
Main Results:
- Significant improvement in OSA severity was observed in children with moderate-to-severe OSA (oAHI decreased from 15.7/h to 2.6/h, p < 0.001).
- Treatment success was achieved in 85% of children, with a 42% cure rate.
- The PSQ score significantly improved, indicating reduced symptom burden (0.52 to 0.26, p < 0.001).
- No significant correlation was found between baseline OSA severity and symptom burden or relief.
Conclusions:
- Adeno-tonsillotomy significantly reduces symptom burden in otherwise healthy children with oSDB.
- Improvement in oAHI was most pronounced in children with moderate-to-severe OSA.
- Combining clinical evaluation with PSQ and oAHI is recommended for comprehensive assessment and treatment planning.
Objective/Background:
Most children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters.
Methods:
Children aged 2-10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire -Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h.
Results:
Fifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47-0.56) to 0.26 (CI 0.21-0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events.
Conclusions:
Adeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.
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