Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study

Huang, Yu‐Shu; Guilleminault, Christian; Lee, Li‐Ang; Lin, Cheng–Hui; Hwang, Fan-Ming

doi:10.5665/sleep.3310

Cited by 135 publications

(104 citation statements)

References 22 publications

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“…12 This study demonstrated that children in the early-adenotonsillectomy group had significant improvements in behavior, quality-oflife, and polysomnographic findings, and a significantly greater reduction in symptoms than the watchful-waiting group. However, in another study Huang et al 13 demonstrated that any initial improvements in OSA severity observed six months following adenotonsillectomy, were no longer present after 3 years in 67% of school-aged children. It remains unknown if similar to older children, the immediate benefits of adenotonsillectomy are the same for preschool-aged children and, if so, whether the benefits are still present in the longer term.…”

Section: Brief Summarymentioning

confidence: 99%

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Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Walter

Biggs

Nisbet

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disordered breathing (SDB) in preschool-aged children is common, but long-term outcomes have not been investigated. We aimed to compare sleep and respiratory parameters in preschool children to examine the effects of treatment or non-treatment after 3 years. Methods: Children (3-5 years) diagnosed with SDB (n = 45) and non-snoring controls (n = 30) returned for repeat overnight polysomnography (39% of original cohort), 3 years following baseline polysomnography. Children with SDB were grouped according to whether they had received treatment or not. SDB resolution was defi ned as an obstructive apnea hypopnea index (OAHI) ≤ 1 event/h, no snoring detected on polysomnography and habitual snoring not indicated by parents on questionnaire. Results: Fifty-one percent (n = 23) of the children with SDB were treated. Overall, SDB resolved in 49% (n = 22), either spontaneously (n = 8) or with treatment (n = 14). SDB remained unresolved in 39% (n = 9) of those treated and 64% (n = 14) of the children who were untreated. Two of the non-snoring controls developed SDB at follow-up. The treated group had signifi cantly lower OAHI (p < 0.01), respiratory disturbance index (p < 0.001), total arousal and respiratory arousal indices (p < 0.01 for both) at follow-up compared with baseline. There were no differences between studies for the untreated group. Conclusion: Although treatment resulted in an improvement in indices related to SDB severity, 39% had SDB 3 years following diagnosis. These fi ndings highlight that parents should be made aware of the possibility that SDB may persist or recur several years after treatment. This is relevant regardless of the severity of SDB at baseline and the treatment given.

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Section: Brief Summarymentioning

confidence: 99%

“…OSA have included a wide age range, [9][10][11] older children, [12][13][14] or short follow-up periods of less than one year. 11,12,14,15 Similarly, the studies that have investigated the converse, i.e.…”

Section: Brief Summarymentioning

confidence: 99%

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Walter

Biggs

Nisbet

et al. 2015

Journal of Clinical Sleep Medicine

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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]. b) AHI >4.7 episodes·h −1 and obesity are significant risk factors for residual OSAS post-adenotonsillectomy (class I and IV, and meta-analysis) [126,156,213].…”

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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“…The rate of obesity in our cohort was 16.5%, which is lower than some related US studies, but is similar to others. 27,34,35,40 This study has several limitations that may guide future prospective research. Above all, the decision to perform adenoidectomy or adenotonsillectomy depended on ENT and parental decision and not on designed randomization.…”

Section: Discussionmentioning

confidence: 99%

Adenoidectomy for Obstructive Sleep Apnea in Children

Domany

Dana

Tauman

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objective: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Methods: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Results: Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). Conclusions:We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

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Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study

Abstract: Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.

Cited by 135 publications

References 22 publications

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

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

Adenoidectomy for Obstructive Sleep Apnea in Children

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