Family history of adenotonsillectomy as a risk factor for tonsillar hypertrophy and snoring in childhood

Kalampouka, Efthimia; Moudaki, Aggeliki; Malakasioti, Georgia; Panaghiotopoulou-Gartagani, Polytimi; Chrousos, George P.; Kaditis, Athanasios G.

doi:10.1002/ppul.22830

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…b) Low-quality evidence (class III-IV) indicates an increased risk of OSAS and adenotonsillar hypertrophy in children with a family history of OSAS or enlarged pharyngeal lymphoid tissue [74][75][76][77].…”

Section: Literature Reviewmentioning

confidence: 99%

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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Section: Literature Reviewmentioning

confidence: 99%

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

et al. 2015

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“… 6 , 8 , 29 , 30 , 32 , 33 A potential concern when we used tonsillectomy to address genetic control of the tonsillar immune response to infection, was that tonsillectomy is increasingly performed for a less infection-related cause than tonsillitis, notably tonsilar and adenoid hyperthrophy causing obstructive sleep apnea. 8 , 34 , 35 However, we adjusted RRs for calendar year and in the additional analysis, we found similar RRs when excluding tonsillectomies caused by tonsil hypertrophy or performed as adenotonsillectomies.…”

Section: Discussionmentioning

confidence: 71%

Familial aggregation of tonsillectomy in early childhood and adolescence

Bager

Corn

Wohlfahrt

et al. 2018

CLEP

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BackgroundThe tonsils are immunological gatekeepers against pathogens. Immunological response to tonsillitis may vary clinically from no enlargement of the tonsils to nearly obstructive conditions. In this investigation, we studied the familial aggregation of tonsillectomy, as an indicator of the extent to which tonsillar immune responses to infections might be genetically controlled.MethodsData on kinship relations and vital status from the Danish Civil Registration System were used to establish a cohort of Danes with relatives born since 1977. Tonsillectomies in all hospitals and clinics from 1977 to 2013 were identified in national registers together with the indication for tonsillectomy. Rate ratios (RRs) for tonsillectomy >1 year after tonsillectomy in specific types of relatives (first to fourth degree) were estimated in Poisson regression models with adjustment for calendar period, sex, age, and total number of specified relatives.ResultsA cohort of 2.4 million persons was followed for 44,100,697 million person-years (mean 18.4 years/person), and included 148,190 tonsillectomies. RRs of tonsillectomy were consistently higher when the relatedness and the number of tonsillectomized relatives were higher. RRs were similar in boys and girls, but were larger in early childhood. Additional analyses suggested that this relatively higher RR at younger ages was due to a larger influence of shared environment at younger ages, whereas the genetic influence was similar at all ages. Results were similar for tonsillectomies performed strictly due to tonsillitis.ConclusionsGenetic factors appear to predispose to severe tonsillitis underlying tonsillectomies, regardless of age and sex. Further studies are needed to understand how genes regulate the tonsils’ immune response against infections.

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“…In a second epidemiologic study, children with a parent diagnosed with OSAS in adulthood had increased incidence of adenotonsillar or tonsillar hypertrophy . In another cohort study, parental history of adenotonsillectomy (AT) in parents was a risk factor for pharyngeal lymphoid tissue hypertrophy and habitual snoring in the offspring . Paternal history of AT was associated with 3.5‐fold increased risk and maternal history of AT with 4.5‐fold increased risk of tonsillar hypertrophy.…”

Section: Newly Described Associations Between Clinical History and Osasmentioning

confidence: 99%

“…In their analysis, tonsillar hypertrophy combined with a history of AT in at least one of the parents had high specificity (84%) and positive likelihood ratio (1.78) for identifying children with AHI >5 episodes/hr. It has been speculated that familial predisposition to adenotonsillar hypertrophy may be explained by genetic variants in the biosynthetic pathway of cysteinyl leukotrienes which promote their overproduction within the pharyngeal lymphoid tissues …”

Section: Newly Described Associations Between Clinical History and Osasmentioning

confidence: 99%

How do we recognize the child with OSAS?

Joosten

Larramona

Miano

et al. 2016

Pediatric Pulmonology

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Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.

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Family history of adenotonsillectomy as a risk factor for tonsillar hypertrophy and snoring in childhood

Abstract: Children with parental history of AT have more frequently tonsillar hypertrophy than those without such history. Tonsillar hypertrophy mediates at least in part the association between maternal history of AT and habitual snoring in childhood.

Cited by 13 publications

References 26 publications

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

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

Familial aggregation of tonsillectomy in early childhood and adolescence

How do we recognize the child with OSAS?

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