O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono

Arrarte, Jaime Luís Freitas; Neto, José Faibes Lubianca; Fischer, Gilberto Bueno

doi:10.1590/s1806-37132007000100013

Cited by 11 publications

(5 citation statements)

References 26 publications

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“…We reviewed the current published literature to determine the reliability of using preoperative tonsil and adenoid size as an indicator of adenotonsillectomy success. The results suggest that preoperative tonsil size is not associated with outcome because most studies 6,7,[9][10][11][12][13][14][15][16][17][18][19][20]22 found no direct association between subjective tonsil size and adenotonsillectomy success. The success rate for adenotonsillectomy appeared to be high regardless of tonsil size.…”

Section: Discussionmentioning

confidence: 82%

“…Tonsil size assessment also varied among studies. Although most studies 5,8,[13][14][15][16][17][18][19]22,24,[26][27][28][29][30][31] applied the Brodsky grading scale, which assigns a grade of 0 to 4 or greater to tonsils based on the severity of hypertrophy, other studies 10,11,21,23 used the Friedman grading scale 34 or a fiber optic grading scale. Only a few studies 8,12,19 additionally graded adenoids on a 1-to 4-point or greater scale.…”

Section: Limitationsmentioning

confidence: 99%

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Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Pierce

Brietzke

2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Tonsil size assessment on physical examination is often used as a key component of clinical decision-making, specifically in estimating the success or failure of adenotonsillectomy surgery. The accuracy of this approach is not specifically known.OBJECTIVE To systematically review the biomedical literature for data comparing subjective preoperative tonsil (and adenoid) size (0-to >4-point scale) with adenotonsillectomy outcomes using polysomnography and/or quality of life outcomes. EVIDENCE REVIEW A PubMed and Embase search was conducted from June 1, 2018, through November 1, 2018, to identify articles comparing preoperative subjective tonsil and adenoid size with surgical outcomes. Key search terms included adenotonsillectomy, tonsil size, Brodsky scale, apnea-hypopnea index, OSA-18, polysomnography, and quality of life, with limits of 0 to 18 years of age. Inclusion criteria included articles on pediatric patients only, articles on patients who underwent tonsillectomy or adenotonsillectomy, and articles that included presurgical and postsurgical data. Exclusion criteria included patients who received surgery beyond adenotonsillectomy and studies that did not compare tonsil and adenoid size grades with surgical outcomes. FINDINGS A total of 27 studies were included in the final data set. The mean sample size was 79.7 (range, 17-250), and the mean age was 6.3 years (range, 4.2-12.8 years). Case series was the predominant study design (20 studies). Fourteen studies specifically excluded obesity and craniofacial syndromes, whereas 2 studies addressed patients with trisomy 21 only, and 5 studies focused on patients with obesity. Outcome measures included polysomnography (19 studies), Obstructive Sleep Apnea 18 survey (4 studies), Obstructive Sleep Apnea 6 (1 study), oxygen desaturation index (1 study), and overnight pulse oximetry (1 study). Ten studies conducted postoperative evaluations within 90 days of the intervention, and 17 studies had greater than 90-day follow-up. A total of 22 of the 27 studies (81.5%) concluded that there was no association between tonsil and adenoid size and surgical outcome, whereas 5 studies (18.5%) concluded that there was an association. Studies that found no association had a higher mean quality score than those that found an association (15.6 vs 14.5; difference in means, 1.13; 95% CI, 0.07-2.19). CONCLUSIONS AND RELEVANCEMost published clinical evidence suggests that subjective tonsil and adenoid size is not reliably associated with adenotonsillectomy success or failure because success rates are typically high regardless of tonsil size. Physicians should understand the potential limitations of using tonsil size alone as the key component of clinical decision-making for adenotonsillectomy.

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Section: Discussionmentioning

confidence: 82%

Section: Limitationsmentioning

confidence: 99%

Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Pierce

Brietzke

2019

JAMA Otolaryngol Head Neck Surg

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“…A significant and well established association exists between OSDB and several nocturnal HR parameters (Baumert et al, 2016; Evans et al, 2014; Muzumdar et al, 2011). Nocturnal oxygen saturation and HR are important predictors of OSDB severity and have been used to measure responsiveness to OSDB treatment in children (Álvarez et al, 2017; Arrarte et al, 2007; Garde et al, 2013; Mbam et al, 2014). Nevertheless, the diurnal cardiovascular impact in children suffering from OSDB is a less visited topic in the literature (Brockmann, 2015).…”

Section: Discussionmentioning

confidence: 99%

Modelling metabolic performance in paediatric obstructive sleep disordered breathing: A case–control study

Sousa

Pinho

Pinto

et al. 2023

Journal of Sleep Research

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SummaryPaediatric obstructive sleep disordered breathing (OSDB) has a considerable impact on cardiovascular physiology, but the consequences on children's basal metabolism and response to exercise are far from being known. The objective was to propose model estimations for paediatric OSDB metabolism at rest and during exercise. A retrospective case–control analysis of data from children submitted to otorhinolaryngology surgery was performed. The heart rate (HR) was measured, while oxygen consumption (VO2) and energy expenditure (EE) at rest and during exercise were obtained using predictive equations. The results for the patients with OSDB were compared with controls. A total of 1256 children were included. A total of 449 (35.7%) had OSDB. The patients with OSDB showed a significantly higher resting heart rate (94.55 ± 15.061 bpm in OSDB vs. 92.41 ± 15.332 bpm in no‐OSDB, p = 0.041). The children with OSDB showed a higher VO2 at rest (13.49 ± 6.02 mL min−1kg−1 in OSDB vs. 11.55 ± 6.83 mL min−1kg−1 in no‐OSDB, p = 0.004) and a higher EE at rest (67.5 ± 30.10 cal min−1kg−1 in OSDB vs. 57.8 + 34.15 cal min−1kg−1 in no‐OSDB, p = 0.004). At maximal exercise, patients with OSDB showed a lower VO2max (33.25 ± 5.82 mL min−1kg−1 in OSDB vs. 34.28 ± 6.71 in no‐OSDB, p = 0.008) and a lower EE (166.3 ± 29.11 cal min−1kg−1 in OSDB vs. 171.4 ± 33.53 cal min−1kg−1 in no‐OSDB, p = 0.008). The VO2/EE increment with exercise (Δ VO2 and Δ EE) was lower in OSDB for all exercise intensities (p = 0.009). This model unveils the effect of paediatric OSDB on resting and exercise metabolism. Our findings support the higher basal metabolic rates, poorer fitness performance, and cardiovascular impairment found in children with OSDB.

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“…Adenotonsillectomy may be necessary for patients with respiratory disorders caused by hypertrophy of the tonsils and adenoids; these patients show significant improvements in their oxygen saturation and quality of life after surgery. 7 8 In view of this evidence, we aimed to evaluate the relationship between tonsillar hypertrophy, adenoids, microorganisms, and immunoglobulins in patients with surgical indications.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Microorganisms and Immunoglobulins in Children with Tonsillar Hypertrophy and Adenoiditis

Miramontes

Fagundes

Jurgielewicz

et al. 2014

Int. Arch. Otorhinolaryngol.

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Introduction: Benign idiopathic tonsillar hypertrophy (HBI) may affect a child's quality of life and sleep. Several studies have sought to relate the clinical features of HBI with the infectious and/or immunologic changes that occur. Objective: To increase the knowledge of the etiology of HBI. Data Synthesis: From 2012 to 2013 we conducted a retrospective observational study of 101 children with HBI who underwent tonsillectomies at Ambulatory ENT General Hospital of the East Zone of São Paulo City, a region with a poor socioeconomic population. Preoperative serologic results were available to confirm mononucleosis, cytomegalovirus, anti-streptolysin O (ASLO) and immunoglobulins. The mean patient age was 5.8 years (55% male, 45% female). Using the Mann-Whitney U test, we identified significant gender differences in the parameters of immunoglobulins (Ig) M (IgM), IgA, and IgE. Forty-seven percent of the patients had increased ASLO levels, and 37% had increased IgE levels. Conclusion: An evaluation of a patient's serologic parameters and laboratory results may be relevant to the etiology and prevention of HBI. Based on the results obtained from the study sample, the identification of etiologic agents and causative factors remain a public health challenge that affects the quality of life of children.

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O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono

Abstract: Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.

Cited by 11 publications

References 26 publications

Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Modelling metabolic performance in paediatric obstructive sleep disordered breathing: A case–control study

Prevalence of Microorganisms and Immunoglobulins in Children with Tonsillar Hypertrophy and Adenoiditis

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