Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome

Friedman, Michael; Wilson, Meghan N.; Lin, Huang‐Chi; Chang, Hung‐Wen

doi:10.1016/j.otohns.2009.01.043

Cited by 417 publications

(368 citation statements)

References 40 publications

Supporting

Mentioning

339

Contrasting

Unclassified

Order By: Relevance

“…Rates of PSG "normalization" varied depending on the cut point employed, with 12% of children achieving postoperative OAHI < 1 event/h, 21% with OAHI < 2 events/h, and 48% of the cohort had a postoperative OAHI < 5 events/h. These rates of PSG improvement are substantially lower compared to generally healthy children, 11,21,22 but similar to that observed in obese children and smaller cohorts of children with DS. 15,16 Although the goal of any sleep surgery is to cure OSA, a positive outcome is to convert a child from moderate/severe obstruction to mild.…”

Section: Discussionsupporting

confidence: 74%

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

Ingram

Ruiz

Gao³

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and associated with significant morbidity. In the current study we examined polysomnographic outcomes of children with DS who underwent tonsillectomy. Methods: A retrospective chart review of children with DS who underwent a tonsillectomy between 2009-2015 was performed. All children had either a concurrent adenoidectomy or had previously underwent an adenoidectomy. Children with preoperative and postoperative polysomnograms within 6 months of surgery were included in the analysis. Preoperative OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as follows: mild = 1.5-4.9 events/h; moderate = 5-9.9 events/h; severe ≥ 10 events/h. Results: Seventy-five children with DS met inclusion criteria. The cohort included 41 males and 34 females with mean age of 5.1 years (± 3.6 years), range of 0.51-16.60 years. Preoperative OSA severity was as follows, mild = 8/75; moderate = 16/75; severe = 51/75. Cure rates varied depending on definition: 12% for OAHI < 1 event/h and 21% for OAHI < 2 events/h. 48% had residual OAHI < 5 events/h. On postoperative PSG 16/75 saw resolution (OAHI < 2) in OSA; mild = 21/75; moderate = 20/75; severe = 18/75. 48% moderate/severe patients saw conversion to mild or cure. Overall, tonsillectomy resulted in significant improvements in multiple respiratory parameters, including OAHI (OAHI; 21.3 ± 19.7 to 8.0 ± 8.1, P < .001), percent sleep time with oxygen saturations < 90% (19.0 ± 25.0 to 6.1 ± 10.1, P < .001), and percent sleep time with end-tidal carbon dioxide above 50 mmHg (7.7 ± 18.0 to 1.8 ± 6.6, P = .001). Average asleep oxygen saturation was associated with postoperative OSA severity. Conclusions: Children with DS and OSA who undergo tonsillectomy experience improvements in both respiratory event frequency and gas exchange but approximately half still have moderate to severe residual OSA. Keywords: child, Down syndrome, gas exchange, obstructive sleep apnea, polysomnography, tonsillectomy

show abstract

Section: Discussionsupporting

confidence: 74%

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

Ingram

Ruiz

Gao³

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…Literature review a) Nonrandomised, uncontrolled studies which included children who underwent surgical resection of adenoids and/or tonsils with a mean preoperative AHI of 6.4-69.3 episodes·h −1 were reviewed in two meta-analyses [170,171]. After adenotonsillectomy, AHI decreased.…”

Section: 4mentioning

confidence: 99%

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

et al. 2015

View full text Add to dashboard Cite

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

show abstract

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…However, many reports have suggested that 20% to 40% of pediatric OSA patients continue to show OSA after AT. [9][10][11][12] This phenomenon implies that other predisposing factors may be present in patients with pediatric OSA.An abnormality of the maxillofacial morphology, especially small mandibular size relative to oropharyngeal soft tissue, has been revealed to play an important role in the development of OSA in adults. 13 Similarly, a small mandible has been reported to be responsible for the familial aggregation of OSA in both adult and pediatric patients.…”

mentioning

confidence: 99%

Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study

Maeda

Tsuiki

Nakata

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

). Written informed consent was obtained from each participant after the aim and potential risks were fully explained.The Japanese patients enrolled in this study were diagnosed as having OSA based on the following criteria: (1) an apnea hypopnea index (AHI) ≥ 1 (/h) on overnight polysomnogram Study Objectives: Pediatric obstructive sleep apnea (OSA) is frequently associated with adenotonsillar hypertrophy, and the fact that about 30% of affected children continue to show OSA after adenotonsillectomy (AT) suggests the presence of some other predisposing factor(s). We hypothesized that abnormal maxillofacial morphology may be a predisposing factor for residual OSA in pediatric patients. Methods: A total of 13 pediatric OSA patients (9 boys and 4 girls, age [median (interquartile range)] = 4.7 (4.0, 6.4) y, body mass index (BMI) z score = -0.3 (-0.8, 0.5)) who had undergone AT were recruited for this study. Maxillomandibular size was measured using an upright lateral cephalogram, and correlations between size and the apnea hypopnea index (AHI) values obtained before (pre AT AHI) and about 6 months after AT (post AT AHI) were analyzed.Results: AHI decreased from 12.3 (8.9, 26.5)/h to 3.0 (1.5, 4.6)/h after AT (p < 0.05). Residual OSA was seen in 11 of the 13 patients (84.6%) and their AHI after AT was 3.1 (2.7, 4.7)/h. The mandible was smaller than the Japanese standard value, and a signifi cant negative correlation was seen between maxillomandibular size and post AT AHI (p < 0.05). Conclusions: These fi ndings suggest that the persistence of OSA after AT may be partly due to the smaller sizes of the mandible in pediatric patients. We propose that the maxillomandibular morphology should be carefully examined when a treatment plan is developed for OSA children. Keywords: obstructive sleep apnea, pediatric, small mandible Citation: Maeda K, Tsuiki S, Nakata S, Suzuki K, Itoh E, Inoue Y. Craniofacial contribution to residual obstructive sleep apnea after adenotonsillectomy in children: a preliminary study. J Clin Sleep Med 2014;10(9):973-977. S C I E N T I F I C I N V E S T I G A T I O N ST he prevalence of obstructive sleep apnea (OSA) in children has been estimated to be 1% to 3%, 1,2 and unstable sleep brought about by this disorder may cause decreased neurocognitive performance and behavioral impairments, both of which may lead to degraded school performance.3-8 Most cases of OSA in children have been believed to be associated with adenotonsillar hypertrophy, and adenotonsillectomy (AT) has been widely accepted as the fi rst choice of treatment. However, many reports have suggested that 20% to 40% of pediatric OSA patients continue to show OSA after AT. [9][10][11][12] This phenomenon implies that other predisposing factors may be present in patients with pediatric OSA.An abnormality of the maxillofacial morphology, especially small mandibular size relative to oropharyngeal soft tissue, has been revealed to play an important role in the development of OSA in adults. 13 Similarly, a small mandible has been reported...

show abstract

Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome

Cited by 417 publications

References 40 publications

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

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

Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study

Contact Info

Product

Resources

About