Adenotonsillectomy vs Observation for Management of Mild Obstructive Sleep Apnea in Children

Volsky, Peter G.; Woughter, Meghan; Beydoun, Hind A.; Derkay, Craig S.; Baldassari, Cristina M.

doi:10.1177/0194599813509780

Cited by 48 publications

(58 citation statements)

References 15 publications

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“…In a nonrandomized trial (moderate risk of bias), children with mild OSA (determined by PSG) were self-or caregiver-allocated to tonsillectomy or observation. 31 At a 4-month follow-up, quality of life assessed using OSA-18 was significantly improved in children who had surgery (P = .001), but not in the control group. Differences between groups, however, were not significant at the 8-month follow-up visit.…”

Section: Sleep-related Quality Of Lifementioning

confidence: 90%

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

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CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE:To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION:Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION:Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores. RESULTS:We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleeprelated quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months. LIMITATIONS:Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known. CONCLUSIONS:Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

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Section: Sleep-related Quality Of Lifementioning

confidence: 90%

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

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“…Most improvement in AHI occurs among children with an AHI >5 episodes·h −1 (class I and III) [126,211]. A class IV prospective, cohort study has provided evidence for potential OSAS recurrence within 3 years after adenotonsillectomy [212].…”

Section: Literature Reviewmentioning

confidence: 99%

“…Efficacy of adenotonsillectomy is modest in children with SDB and craniofacial abnormalities and/or neuromuscular disorders (class IV) [44,185,188,193,194,[214][215][216]. c) Quality of life improves post-adenotonsillectomy (class I and III, meta-analysis and systematic review) [111,113,126,178,211,217,218]. Evidence for the increase in growth rate and resolution of enuresis has been presented in two systematic reviews and in the CHAT study (class I) [109,110,180].…”

Section: Literature Reviewmentioning

confidence: 99%

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

et al. 2015

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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

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“…Despite tonsils size is surely implicated on etiology of OSA, it could not reliably predict the severity of OSA. Additionally, although OSA severity degree given by AHI is still on debate, the authors assumed an AHI>5 as a moderate level of OSA, a cutoff with clinical significance also used in other studies such as Volsky et al (20).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Radiofrequency Tonsils Reduction in Pediatric Obstructive Sleep Apnea

Jardim¹,

Marinho²,

Araujo³

et al. 2017

JOENTR

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Objective: Adenotonsillectomy is a well-accepted option for treatment of pediatric obstructive sleep apnea (OSA). This study pretends to evaluate the effectiveness and safety of radiofrequency tonsils reduction in surgical treatment of pediatric OSA. Study design:Retrospective study evaluating tonsils reduction after surgical treatment of pediatric OSA patients submitted to radiofrequency tonsils reduction and adenoidectomy. Subjects and methods:A retrospective cohort study, including children diagnosed with: OSA, tonsils hypertrophy (Brodsky scale > 2/2) and apnea-hypopnea index (AHI) > 1 (when polysomnography was made, n=50) who were submitted to radiofrequency tonsils reduction associated with classic adenoidectomy between 2011 and 2013 in CUF Descobertas Hospital (Lisbon). Children with recurrent tonsillitis (meeting criteria for tonsillectomy by AAO-HNS guidelines) were excluded. Outcomes measured: 1) variation in pre and postoperative tonsils size (Brodsky scale), maintenance of roncopathy, maintenance or suspicion of apnea (effectiveness outcomes); 2) postoperative hemorrhage, tonsillitis during postoperative follow up (safety outcomes). Data was collected by consulting clinical charts and by telephonic interviews made by an ENT physician. Statistical analysis was made with STATA 13.Results: A population of 64 children was obtained with 22 months of median follow up. The mean age was 4 yo with 56% males. 81.25% had a preoperative Brodsky scale of at least 3/3, and 64% had moderate or severe degree of OSA. A reduction of at least 2 grades between pre and postoperative Brodsky scale was found in 75.41% and the reduction wasn't associated with the follow up time. Postoperative absence of roncopathy and apnea was reported in 93% and 100% of cases, respectively. Postoperative frequency of hemorrhage was 0% and only 3 patients (4.68%) reported tonsillitis episodes. Conclusion:In our series, radiofrequency tonsils reduction proved to be an effective and safe technique in tonsils reduction, and therefore, in OSA pediatric surgical treatment.

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Adenotonsillectomy vs Observation for Management of Mild Obstructive Sleep Apnea in Children

Cited by 48 publications

References 15 publications

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

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

Effectiveness and Safety of Radiofrequency Tonsils Reduction in Pediatric Obstructive Sleep Apnea

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