Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence

Kang, Kun-Tai; Hsu, Wei-Chung

doi:10.1016/j.jfma.2023.09.004

Cited by 2 publications

(4 citation statements)

References 97 publications

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“…These data confirm most of the evidence in the literature, suggesting that the first line of treatment for healthy pediatric OSA should be surgical adenotonsillectomy [15][16][17][18][19][20][21][22][23][24][25].…”

Section: Indication To the Pediatric Disesupporting

confidence: 85%

“…In recent years, the use of DISE has gained popularity as a method for assessing the dynamic blockages in the upper airways that occur during sleep and guiding decisions regarding the treatment of OSA patients. Sleep surgeons globally using DISE and the notable progress in DISE-related studies have resulted in a growing body of literature agreeing on the effectiveness and application of DISE for adult OSA patients [15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the available evidence showcasing its usefulness and efficiency is insufficient. The majority of literature regarding this subject is constituted by small case series or retrospective studies [17][18][19][20][21][22][23][24][25][26][27][28]. Despite evidence demonstrating that DISE impacts the decisions made regarding surgery in children, it remains unclear how many sleep doctors actually use this procedure and if the results from interventions guided by DISE surpass those from conventional methods.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Iannella,

Magliulo,

Greco

et al. 2024

Children

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Objectives: To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. Methods: A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. Results: A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. Conclusion: Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.

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Section: Indication To the Pediatric Disesupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Iannella,

Magliulo,

Greco

et al. 2024

Children

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“…The persistence of OSA and SDB after the surgical treatment of tonsils and adenoids can occur in pediatric patients with genetic conditions associated with craniofacial malformations and upper airway abnormalities [44]. Some of the genetic diseases at high risk of persistent OSA are Down syndrome [35,45], Prader-Willi syndrome [46], achondroplasia [47], and other craniofacial syndromes [44,48]. However, despite the high prevalence of SDB in children with Down syndrome, studies on the effects on cardiovascular control are limited [49].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

Zaffanello,

Ersu,

Nosetti

et al. 2024

Children

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This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and –I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.

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Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence

Cited by 2 publications

References 97 publications

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

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