Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy

Abstract

Forty children (age group four to 12 years) undergoing adenoidectomy and/or tonsillectomy were subjected to pre- and post-operative polysomnography. Thorough clinical evaluation and X-ray soft tissue nasopharynx lateral view was carried out for all the patients. The tonsils were clinically graded from grade I to IV, whereas the adenoids were measured radiographically (using three different measurements) in all children. Thirty out of 40 (75 per cent) children presented with predominant obstructive symptoms, out of whom 22 (73.3 per cent) were found to have obstructive sleep apnoea (OSA), i.e. apnoea index > five per hour. The remaining 10 (25 per cent) had predominantly inflammatory symptoms on presentation and out of these two (20 per cent) were found to have OSA. Relative adenoid size expressed as a ratio between the distance from the point of maximum thickness of adenoids along a line drawn along a straight part of the basiocciput and distance from the posterior nasal spine to the antero-inferior edge of the sphenobasioccipital synchondrosis, was found to have a highly significant correlation with the grade of OSA. In our study, all patients with this ratio greater than 0.64 were found to have OSA. No correlation between tonsil size and grade of OSA was found. There was a highly significant improvement in polysomnographic scores following surgery in all patients.

Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea

“…As expected, and previously reported [16,17,[19][20][21], marked pre-to-post-surgical changes in respiratory indices during sleep were found. Both the AHI and apnoea index were reduced after T&A, and no longer differed from those of matched controls.…”

“…Although T&A may not be universally effective in paediatric patients [18], several studies have shown that post-operative recovery from OSA treated with T&A includes normalisation of sleep and respiratory measures [16,17,[19][20][21], and improvements in school performance [2], cognitive function [13,22,23], behaviour [24] and quality of life [25,26].…”

Neurocognitive abilities in children with adenotonsillar hypertrophy

“…The obstructive apnea index (OAI) was defined as the number of obstructive apneas per hour of sleep. A diagnosis of obstructive sleep apnea was based on PSG in patient with obstructive apnea index >1 and oxygen desaturation Sp O 2 < 92% [10].…”

“…Daytime somnolence, fatigue, headaches, poor appetite, short attention span are caused by constant hypoxia and frequent arousals [14,16,19]. Moreover respiratory disorders and frequent infections of upper respiratory tract appear in children with sleep-disordered breathing [1,3,5,6,10]. Sleep apnea may lead to failure to thrive and to physical and mental delay in development, including cognitive disturbances [12,20].…”

“…If the physical examination (including tonsil size) and clinical history do not provide for a reliable diagnosis, the gold standard--polysomnography (PSG) can be ordered [2,10].…”