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Upper airway obstruction and disordered nocturnal breathing in children
Insights
Surgical intervention for upper airway obstruction in children significantly improves disordered breathing during sleep. Even mild obstructive sleep apnea or hypopnea cases benefit from removing tonsils, adenoids, or correcting deviated septums.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Physiology
Background:
- Disordered breathing during sleep, including obstructive apnea and hypopnea, is common in children with upper airway obstruction.
- Conditions like hypertrophied tonsils and adenoids or deviated nasal septum cause these breathing issues.
- The study focused on children without severe sequelae of sleep apnea, such as cor pulmonale or pulmonary hypertension.
Purpose of the Study:
- To evaluate the effectiveness of surgical correction for upper airway obstruction in children experiencing disordered breathing during sleep.
- To determine if surgical intervention benefits children with mild obstructive sleep apnea or hypopnea, not just those with severe conditions.
Main Methods:
- Polysomnographic studies were conducted on 14 children with diagnosed upper airway obstruction and sleep-disordered breathing.
- Surgical removal or correction of the obstructive lesion was performed in 12 children.
- Two children declined surgical intervention for comparison.
Main Results:
- All 14 children exhibited abnormal polysomnographic findings.
- Obstructive hypopnea was more prevalent than obstructive apnea.
- Surgery resolved nocturnal respiratory disturbances in 12 children; symptoms persisted in the two untreated patients.
Conclusions:
- Surgical correction of upper airway obstruction is highly effective for improving sleep-disordered breathing in children.
- Intervention should be considered for children with mild obstructive sleep apnea or hypopnea, not solely for those with severe sequelae.
- Addressing anatomical obstructions offers considerable benefits for pediatric patients with disturbed nocturnal sleep.
Abstract:
Fourteen children with disordered breathing during sleep (obstructive apnea, obstructive hypopnea, or snoring) and anatomic obstruction of the upper airway were studied. Twelve children had hypertrophied tonsils and adenoids, and two had a deviated nasal septum. No child had sequelae of severe sleep apnea--that is, cor pulmonale, pulmonary hypertension, or alveolar hypoventilation. Results of polysomnographic studies were abnormal in all and revealed that obstructive hypopnea (increased respiratory effort with decreased airflow) was more common than obstructive apnea (increased respiratory effort without airflow). Surgical removal or correction of the upper airway obstructive lesion in 12 children resulted in normal nocturnal respiration. Surgical intervention was declined in two patients, and their symptoms persist. We conclude that surgical removal of upper airway obstructive lesions in children with disturbed nocturnal sleep should not be reserved only for those with serious sequelae of obstructive sleep apnea; considerable benefit is gained in selected patients with mild obstructive sleep apnea or hypopnea.