1019 Results of adenotonsillectomy for obstructive sleep apnoea in children

Obstructive sleep apnoea syndrome (OSAS) affects 2-3% of children. It’s key featrures are recurrent episodes of increased upper airway resistance with partial or complete obstruction of the upper airway during sleep. Also included in the spectrum of sleep disordered breathing is Habitual Snoring (≥3 times per week, not associated with obstructive apnoea) which affects ±12% of children). OSAS is often associated with obesity and also with medical conditions (e.g. Down syndrome), and has consequences that include neurocognitive and behavioural disturbances, enuresis, cardiovascular dysfunction (systemic and pulmonary hypertension), ventricular remodeling and endothelial dysfunction. Hypertrophy of adenotonsillar tissue contributes to the development of OSAS, with structural impingement of the upper airway ultimately resulting in episodic narrowing and collapse. Accordingly, guidelines recommend adenotonsillectomy as the first line of treatment. Meta-analyses have shown significant improvements after surgery, but few studies have actually reviewed overall efficacy and outcomes of the procedure in paediatric OSAS. To this end a retrospective study involving 6 leading US and 2 European academic hospitals with accredited sleep centres reviewed 2007-2008 data from 578 children. The key requirement was for pre- and post-surgery polysomnographic data to be available for the period >40 days (to allow for swelling to disappear) and before 720 days (to avoid effects of adenoidal regrowth). Average age was 6.9±3.8 years and 50% were obese (>95th centile for BMI). Postoperative sleep studies showed significantly fewer night-time awakenings and obstructive events, and improvements in the apnoea-hypopnoea index (AHI) and oxygen saturation. However, using an AHI of <1/hour of total sleep time, only 27.2% of children actually normalized breathing patterns after the procedure. In fact almost 22% of subjects had AHI’s of >5/hr of total sleep time, i.e. still within accepted criteria for OSAS. Age and BMI z-score emerged as leading contributors to high post-operative AHI, while asthma was important in non-obese children. These results suggest that older and/or obese children, and non-obese with asthma should be followed up with greater care after adenotonsillectomy as they appear to be at ongoing risk for OSAS.

Am J Resp Crit Care Med, 2010 doi:10.1164/rccm.200912-1930OC
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