Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns

Weatherly, Robert A.; Evelyn, Fuentes Smith Lisset; Ruzicka, Deborah L.; Chervin, Ronald D.

doi:10.1016/s1389-9457(03)00100-x

Cited by 120 publications

(98 citation statements)

References 28 publications

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“…There are no clinical practice guidelines regarding the use of PSG and candidacy for AT [2]. Most otolaryngologists make decisions or recommendations based on medical history that is suggestive of SDB, as well as on physical examination demonstrating adenoid and/or tonsillar hypertrophy [2,[8][9][10]. However, predictive accuracy of clinically suspected OSAS may be as low as 30% when PSG testing was performed as well [13,19].…”

Section: Discussionmentioning

confidence: 99%

“…SDB has been recognized as a spectrum of sleep-related breathing disturbances with severity ranging from mild obstruction of upper airway producing snoring primarily, through increased upper airway resistance with obstructive hypoventilation, to continuous episodes of complete upper airway obstruction producing obstructive sleep apnea syndrome (OSAS) [2][3][4]7]. Apart from snoring, other manifestations of obstructive adenotonsillar hypertrophy include mouth breathing, apneic pulses during sleep, difficulty in breathing, restless sleep, frequent awakening, failure to thrive, and behavioral disturbance [2,4,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Although polysomnography performed overnight in a laboratory setting is considered the gold standard for evaluation of OSAS, it is expensive, time-consuming, and not widely available for evaluation of SDB in children [1,[9][10][11][12][13]. The 'Symptomatology score' (SS) and other graded clinical assessments have been validated against roentgenographic ratings of upper airway obstruction by adenoid vegetations, and shown to be simple, reliable and easy-to-use tools in evaluating the obstructive impact of adenoid vegetations in children [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

Orji

Ezeanolue

2012

Indian J Otolaryngol Head Neck Surg

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The aim of this study was to examine improvements or otherwise, in sleep disturbance and breathing difficulties after adenotonsillectomy (AT) for chronic upper airway obstruction in children. In a prospective clinical study and tertiary referral center setting, the study population included consecutive children aged 1.5 through 12 years who underwent AT for chronic upper airway obstruction due to adenotonsillar enlargement, without any history of previous AT. The validated ''Symptomatology score'' (SS) parameters were used to grade the symptoms before and after AT. The extent of improvement of the symptoms after surgery were estimated by a standardized response mean (SRM). The study included 59 children, 40 of whom were males (68%). Their ages ranged from 1.5 to 12 years with a mean of 3.3 years and 63% were \4 years. The results showed that tonsillar size was correlated significantly with a high preoperative SS (P B 0.001). The mean preoperative SS for the study population was 7.2, whereas the mean postoperative SS was 1.7. This change was highly significant (P \ 0.001). The symptom domain with the greatest change in mean score was snoring, which improved by 2 points with SRM of 2.2. The changes in total score and in the scores for each symptom domain were highly significant (P \ 0.002). We concluded that adenotonsillectomy is associated with remarkable improvement in breathing difficulties and sleep disturbances in children with obstructive adenotonsillar hypertrophy regardless of the condition whether it is mild or severe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

Orji

Ezeanolue

2012

Indian J Otolaryngol Head Neck Surg

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“…7 In contrast, the American Academy of Pediatrics recommends objective sleep testing before AT for SDB. 8 This is because several studies have shown poor correlation between office-based impressions and sleep laboratory results.…”

Section: Introductionmentioning

confidence: 99%

Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy

et al. 2006

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Objectives: Most children with sleep-disordered breathing (SDB) have mild to moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically-indicated adenotonsillectomy or unrelated surgical care.Methods: We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically-indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children.Results: Adenotonsillectomy subjects, in comparison to controls, were more hyperactive on wellvalidated parent rating scales (p<0.001), inattentive on cognitive testing (p=0.003), sleepy on Multiple Sleep Latency Tests (p=0.002), and likely to have DSM-IV-defined Attention-Deficit/ Hyperactivity Disorder as judged by a child psychiatrist (p=0.03). In contrast, one year later, the two groups showed no significant differences in the same measures. Adenotonsillectomy subjects had improved substantially (p≤0.01) in all measures and control subjects in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness.Conclusions: Children scheduled for adenotonsillectomy often have mild to moderate SDB and significant neurobehavioral morbidity --including hyperactivity, inattention, Attention-Deficit/ Hyperactivity Disorder, and excessive daytime sleepiness --all of which tend to improve by one year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.

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“…The surgery has been thought to solve the young patient's snoring or OSA problems [3,4], which is not the case for most adults' snoring and sleep apnea syndrome (OSAS) after surgery for the similar condition [5]. Sleep registration before and after surgery has seldom been performed in children [6,7] and long-term follow-up to control the postoperative results has rarely been done [8].…”

Section: Introductionmentioning

confidence: 99%

The development of sleep disordered breathing from 4 to 12 years and dental arch morphology

Hultcrantz

Tidestrom

2009

International Journal of Pediatric Otorhinolaryngology

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Objective: To track the development of sleep disordered breathing (SDB) as well as dentofacial morphology in cohort of children by having them complete a questionaire at ages 4, 6 and 12 . Clinical examination, sleep studies (at ages 4 and 12) and orthodontic evaluation were carried out on all who were reported to snore regularly and children who did not snore at all. Results: Out of the original group of 615 children, 64% (393) answered the inquiry on all three occasions. Of those, 27 snored regularly and 231 did not snore at all at the age of twelve.There were differences between those groups on all answers, especially prevalence of oral breathing: 78% versus 5% (p< 0.001). The prevalence of OSA decreased from 3.1% at the age of four to 0.8% at age 12 and the severity decreased from a mean AHI 14.8 at four to a mean AHI of 1.95 at age 12. The minimum prevalence of snoring regularly was estimated to 4.2% at 12 yrs compared to 5.3% at four, calculated for the original cohort of 644 children. The odds for a child who snored regularly at four or six years to be snoring regularly also at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children had undergone surgery due to snoring by age 12. 14 of them never snored and 17 snored regularly at the age 12. The dental arch was narrower in the children snoring regularly at four, six and 12 years compared to not snoring children. Cross-bites were more common among snoring children than among non snoring children, at four and six as well as at twelve. Conclusion: The prevalence of regular snoring is about the same from four to twelve years independent of surgery, but the prevalence of OSA decreased considerably. The children snoring regularly generally have a narrower maxilla compared to children not snoring. Surgery in young children is necessary but -cures‖ the snoring only temporary.

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Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns

Cited by 120 publications

References 28 publications

Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy

The development of sleep disordered breathing from 4 to 12 years and dental arch morphology

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