Efficacy of obstructive sleep apnea treatment by antileukotriene receptor and surgery therapy in children with adenotonsillar hypertrophy: A descriptive and cohort study

Abstract

BackgroundPrevalence of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy is high and related to the occlusion of the upper airway. The main treatments of OSA in these children is adenotonsillectomy. However, this intervention is an invasive method with a various success rate. Thus, the indications of tonsillectomy remain debatable and non-invasive treatment is still a potential choice in these patients.MethodsIt was a cross-sectional and interventional study. This study included children aged from 2 to 12 years-old who were diagnosed with OSA by respiratory polygraphy and had tonsillar hypertrophy with/without adenoid hypertrophy. All main data including age, gender, height, weight, body mass index (BMI), clinical symptoms, and medical history were recorded for analysis. Physical examination and endoscopy were done to evaluate the size of tonsillar and adenoid hypertrophy by using Brodsky and Likert classifications, respectively. The severity of OSA was done by using the classification of AHI severity for children.ResultsThere were 114 patients (2–12 years old) with a mean age of 5.5 ± 2.1 years included in the present study. The main reasons for consultations were snoring (96.7%), a pause of breathing (57.1%), an effort to breathe (36.8%), unrefreshing sleep (32%), doziness (28.2%), and hyperactivity (26.3%). There were 36% of subjects with tonsillar hypertrophy grade 1–2, 48.2% with grade 3, and 15.8% with grade 4 (Brodsky classification); among them, there were 46.5% of subjects with grades 1–2 of adenoid hypertrophy, 45.6% with grade 3, and 7.0% with grade 4 (Likert classification). The mean AHI was 12.6 ± 11.2 event/h. There was a significant correlation between the mean AHI and the level of tonsillar and adenoid hypertrophy severity (r = 0.7601 and r = 0.7903; p < 0.05 and p < 0.05, respectively). The improvement of clinical symptoms of study subjects was found in both groups treated with ALR (antileukotriene receptor) or ST (surgery therapy). The symptoms related to OSA at night including snoring, struggle to breathe, sleeping with the mouth open, and stopping breathing during sleep were significantly improved after treatment with ATR and with ST (p < 0.001 and p = 0.001, respectively). The mean AHI was significantly reduced in comparison with before treatment in study subjects treated with ALR (0.9 ± 1.0 vs. 3.9 ± 2.7 events/h; p = 0.001) or with ST (3.5 ± 1.4 vs. 23.4 ± 13.1 events/h; p < 0.001).ConclusionThe treatment of OSA due to adeno-tonsillar hypertrophy with ALR for moderate OSA or surgery for severe OSA might reduce the symptoms related to OSA at night and during the day.

Clinical-functional characteristics of children with asthma and obstructive sleep apnea overlap associated with attention deficit hyperactivity disorder: A cross-sectional study

“…In the present study, only a few children with overweight or obese in the asthma group with OSA ( Table 2 ). This result was different from other studies in Western countries, which showed that high BMI increased the prevalence of OSA ( 3 , 4 , 13 ), but similar to other Vietnamese studies ( 16 , 31 ).…”

“…OSA was considered as a risk for the presence of ADHD (OR: 3.355; 95% CI: 1.271–8.859; p < 0.05), rather than asthma control ( Figure 4 ). This result was similar to other studies ( 31 , 35 ). Moreover, OSA + ADHD group had a markedly higher AHI score and significantly lower saturation oxygen than the OSA-alone group.…”

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

“…Instrumental examinations useful for diagnosis include lateral neck X-ray, videofluoroscopy, and nasal endoscopy; nasal endoscopy performed by the otolaryngologist represents the gold standard [16,17]. Tonsillar hypertrophy is measured with Brodsky's grading scale [18]: grade 0, tonsils confined in tonsillar fossa; grade 1, oropharyngeal width occupied less than 25%; grade 2, occupied between 26 and 50%; grade 3, occupied between 51 and 75%; and grade 4, occupied more than 75% [18,19]. Likert's classification is used for adenoid hypertrophy [20].…”

“…However, tonsil size is slightly related to AHI, and thus with the severity of OSA [25,26]. Tonsil hypertrophy of 25-50% may lead to a two-fold increase in OSA development, hypertrophy of 50-75% to a three-fold increase, and hypertrophy of 75-100% up to an eight-fold increase [19]. An adenoidectomy and tonsillectomy are the first-line treatment for AH.…”

Clinical and functional characteristics of OSA in children with comorbid asthma treated by leukotriene receptor antagonist: A descriptive study

“…However, this intervention is an invasive method for children with asthma ( 1 ). Some recent reported showed that tonsillar tissue from children with OSA may overexpress cysteine leukotriene receptor-1 (CysLT1), which can be treated with anti-inflammatory therapy such as leukotriene receptor antagonists ( 10 , 11 ). In children with non-severe OSA, this therapy might have the potential efficacy in the treatment of asthmatic children with OSA associated with adenotonsillar hypertrophy ( 11 , 12 ).…”