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Obstructive sleep apnea in children with achondroplasia: surgical and anesthetic considerations
E A Sisk1, D G Heatley, B J Borowski
1Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Medical School, USA.
Insights
Obstructive sleep apnea (OSA) is highly prevalent in children with achondroplasia. Surgical treatment is effective, but adenoidectomy alone often leads to recurrent OSA, necessitating further intervention.
Area of Science:
- Pediatric Pulmonology
- Genetics
- Surgical Oncology
Background:
- Achondroplasia is a common skeletal dysplasia.
- Obstructive sleep apnea (OSA) is a significant concern in children with achondroplasia due to potential airway compromise.
Purpose of the Study:
- To determine the prevalence of OSA in children with achondroplasia.
- To assess the efficacy of adenoidectomy and/or tonsillectomy in treating OSA in this population.
Main Methods:
- Retrospective chart review of 95 children diagnosed with achondroplasia.
- Analysis of surgical interventions for OSA, including adenoidectomy, tonsillectomy, and adenotonsillectomy.
- Evaluation of recurrence rates and postoperative complications.
Main Results:
- 38% of children with achondroplasia exhibited clinical signs of OSA.
- Adenotonsillectomy was more effective in initial treatment (18% recurrence) compared to adenoidectomy alone (90% recurrence).
- Anesthesia required careful consideration of airway anatomy, with 53% needing smaller endotracheal tubes than age-predicted.
Conclusions:
- OSA is a frequent comorbidity in pediatric achondroplasia.
- Surgical management is effective, but adenotonsillectomy offers better outcomes than adenoidectomy alone for preventing recurrent OSA.
- While complication rates are higher than in the general pediatric population, they are manageable with appropriate anesthetic precautions.
Objective:
To evaluate the prevalence of obstructive sleep apnea in a large population of children with achondroplasia and to evaluate the effectiveness of adenoidectomy and/or tonsillectomy as treatment.
Methods:
Retrospective review of 95 children with achondroplasia.
Results:
Thirty-six patients (38%) had clinical evidence of obstructive sleep apnea. Thirty-four patients underwent surgery, with more than 1 procedure required in 10 children (29%). Adenotonsillectomy was the initial procedure for 22 of 34 patients, and further therapy was required in only 18% of this group. Adenoidectomy was the initial procedure for 10 of 34, with 90% requiring further surgery for recurrent obstructive sleep apnea. Tonsillectomy alone was performed in 2 patients: 1 was effectively treated and 1 later required adenoidectomy. Endotracheal intubation was accomplished in all patients without complication; 53% required a smaller endotracheal tube than would be predicted by their age. Eight postoperative complications were recorded.
Conclusions:
Obstructive sleep apnea is very common in children with achondroplasia. Surgery is effective, but recurrent symptoms are common, particularly when the initial procedure is adenoidectomy. The complication rate is higher than that observed in a general pediatric population but is readily managed with standard therapy. Anesthesia can be given safely to these patients with special consideration for limited neck extension and appropriate endotracheal tube size.