Tuesday, October 08, 2013

Sleep apnea symptoms persist after adenoid and tonsil removal in children

A study claims that children with severe obstructive sleep apnea saw residual sleep apnea symptoms following an adenotonsillectomy procedure.

Children with severe obstructive sleep apnea before adenotonsillectomy were more likely to experience residual symptoms after surgery, according to findings in a retrospective study.

Researchers evaluated data from 283 children younger than 3 years (mean age, 22 months). Each child underwent a preoperative polysomnogram between 2002 and 2010.
Of the study population, 61.8% were boys and 84.8% were black. According to their BMI, 46.7% of the children were obese, whereas 33.1% were classified as having a healthy weight. At baseline, 65.7% of the children had a severe apnea hypopnea index (>10).
Seventy of the children also underwent a post-adenotonsillectomypolysomnogram after a mean time of 7.7 months. Compared with the children who only underwent a preoperative polysomnogram, those who had preoperative and postoperative polysomnograms were younger (23 vs. 20 months; P=.002), shorter (81 cm vs. 79 cm; P=.04) and weighed less (13 kg vs. 11 kg; P=.01). They were also more likely to have had a severe index before surgery (22 vs. 35; P=.002) and lower mean minimal oxygen saturations (83% vs. 77%; P<.001).
Fifteen of the 70 children had residual obstructive sleep apnea (index, >5) and a significantly higher preoperative index (P=.02) compared with those without residual symptoms. However, these 15 children had a mean apnea hypopnea index that dropped from 55 to 21 (P=.03), whereas mean minimum oxygen saturations increased from 74% to 82% (P=.09) after surgery.
“Our data support the finding that, although [adenotonsillectomy] leads to a dramatic improvement in this age group, a high proportion of this population will have residual [obstructive sleep apnea],” the researchers wrote. “Although this proportion gives some insight into residual disease after [adenotonsillectomy] in this young population, the result is flawed because of the retrospective design of the study and the fact that only 25% of the children treated received postoperative [polysomnogram].”
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