Adenotonsillectomy in Obese Children with Obstructive Sleep Apnea Syndrome: Magnetic Resonance Imaging Findings and Considerations

Nandalike, Kiran; Shifteh, Keivan; Sin, Sanghun; Strauss, Temima; Stakofsky, Allison; Gonik, Nathan; Bent, John P.; Parikh, Sanjay R.; Bassila, Maha; Nikova, Margarita; Muzumdar, Hiren; Arens, Raanan

doi:10.5665/sleep.2708

Cited by 58 publications

(65 citation statements)

References 42 publications

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“…38,39 Correspondingly, our study confirmed the higher failure rate in obese children during the followup evaluation. The rate of obesity in our cohort was 16.5%, which is lower than some related US studies, but is similar to others.…”

Section: Discussionsupporting

confidence: 77%

Adenoidectomy for Obstructive Sleep Apnea in Children

Domany

Dana

Tauman

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objective: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Methods: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Results: Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). Conclusions:We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

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Section: Discussionsupporting

confidence: 77%

Adenoidectomy for Obstructive Sleep Apnea in Children

Domany

Dana

Tauman

et al. 2016

Journal of Clinical Sleep Medicine

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“…Further, we have previously shown by volumetric analysis that there is significant residual adenoid tissue following AT in obese patients that may be contributing to residual OSA in this population. 29 A recent prospective study by Thongyam et al examined the current AAP and AAO-HNS guidelines for predicting complications following AT in a large pediatric population. 12 The AAP admission criteria were found to be more significantly predictive of respiratory complications than the AAO-HNS criteria.…”

Section: Discussionmentioning

confidence: 99%

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Waltuch

Gonik

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

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“…Drug-induced sleep endoscopy in children with persistent SDB may demonstrate laryngomalacia, adenoidal tissue regrowth, tongue base obstruction and pharyngeal collapse (class III and IV) [69,[263][264][265]. MRI of the upper airway may reveal residual adenoid tissue in obese children with persistent OSAS following adenotonsillectomy (class IV) [266]. Regrowth of adenoidal tissue, glossoptosis, hypopharyngeal collapse, soft palate collapse and hypertrophic lingual tonsil are abnormalities that may be identified by cine MRI in children with Down syndrome and persistent SDB after adenotonsillectomy (class IV) [267,268].…”

Section: Literature Reviewmentioning

confidence: 99%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Adenotonsillectomy in Obese Children with Obstructive Sleep Apnea Syndrome: Magnetic Resonance Imaging Findings and Considerations

Cited by 58 publications

References 42 publications

Adenoidectomy for Obstructive Sleep Apnea in Children

Adenoidectomy for Obstructive Sleep Apnea in Children

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

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