Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach

Leong, A.C.; Davis, Jeremy

doi:10.1017/s0022215107008900

Cited by 43 publications

(36 citation statements)

References 49 publications

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“…Consistent with published data, majority of patients in this study were discharged within a few hours of surgery [20][21][22]. Ambulatory T&A is now established to be a safe procedure in most patients.…”

Section: Discussionsupporting

confidence: 83%

Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy

Nafiu¹,

Green²,

Walton³

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionsupporting

confidence: 83%

Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy

Nafiu¹,

Green²,

Walton³

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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“…34 Previous studies have emphasized respiratory complications and bleeding as the most common adverse events after AT. 10,11,[35][36][37][38] Despite these risks, the duration of postoperative monitoring is highly variable in high-risk children. 39 Further, unforeseen complications including deaths due to nonhemorrhagic events have been reported at home, 8,40,41 and were attributed to possible respiratory events linked to perioperative narcotic use.…”

Section: Discussionmentioning

confidence: 99%

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Waltuch

Gonik

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

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“…13,15 The impact of persistent snoring on preschool-aged children is unknown; in older children, persistent snoring increases the chances for new or worsening behavior problems over time. 10,[16][17][18] Care decisions for preschool-aged children who snore are based on guidelines developed largely for older children and involve weighing the rare but real risks of interventions (eg, adenotonsillectomy) 19,20 against suspected but unknown risks associated with persistent SDB.…”

mentioning

confidence: 99%

Persistent Snoring in Preschool Children: Predictors and Behavioral and Developmental Correlates

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Loud snoring, which spikes at ∼2 to 3 years of age, has been associated with behavior problems in school-aged children in cross-sectional studies, but no longitudinal studies have quantified predictors and the behavioral impact of persistent snoring in preschool-aged children.WHAT THIS STUDY ADDS: Persistent loud snoring, which occurs in 9% of children 2 to 3 years of age, is linked with behavior problems. Higher socioeconomic status and a history of breastfeeding were associated with lower rates of transient and persistent snoring in young children. abstract OBJECTIVE: To clarify whether persistent snoring in 2-to 3-year-olds is associated with behavioral and cognitive development, and to identify predictors of transient and persistent snoring. METHODS:Two hundred forty-nine mother/child pairs participated in a prospective birth cohort study. Based upon parental report of loud snoring $2 times weekly at 2 and 3 years of age, children were designated as nonsnorers, transient snorers (snored at 2 or 3 years of age, but not both), or persistent snorers (snored at both ages). We compared groups by using validated measures of behavioral and cognitive functioning. Potential predictors of snoring included child race and gender, socioeconomic status (parent education and income), birth weight, prenatal tobacco exposure (maternal serum cotinine), childhood tobacco exposure (serum cotinine), history and duration of breast milk feeding, and body mass relative to norms. RESULTS:In multivariable analyses, persistent snorers had significantly higher reported overall behavior problems, particularly hyperactivity, depression, and inattention. Nonsnorers had significantly stronger cognitive development than transient and persistent snorers in unadjusted analyses, but not after demographic adjustment. The strongest predictors of the presence and persistence of snoring were lower socioeconomic status and the absence or shorter duration of breast milk feeding. Secondary analyses suggested that race may modify the association of childhood tobacco smoke exposure and snoring.CONCLUSIONS: Persistent, loud snoring was associated with higher rates of problem behaviors. These results support routine screening and tracking of snoring, especially in children from low socioeconomic backgrounds; referral for follow-up care of persistent snoring in young children; and encouragement and facilitation of infant breastfeeding. This manuscript has not been published elsewhere, and all authors approve of its submission for review. Each author made a substantive intellectual contribution to the study. Dr Beebe participated in early conceptualization and design of sleep measurement methodology, conducted preliminary analyses, and collaborated with coauthors on final analyses and data interpretation; he took the lead role with drafting and revising the manuscript. Dr Rausch provided critical contributions to formulating the data analytic plan, conducted final data analyses, assisted with data interpretation, and reviewed ...

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Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach

Cited by 43 publications

References 49 publications

Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy

Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Persistent Snoring in Preschool Children: Predictors and Behavioral and Developmental Correlates

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