Abstract
ObjectiveTo assess efficacy and safety of tonsil reduction with bipolar forceps electrocautery as treatment of paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS).Study designProspective interventional study.MethodsTwo hundred and sixty-three children aged 4–10 years with OSAHS and an apnea hypopnea index (AHI) > 3 were enrolled from March 2013 to January 2016. Pre-operative evaluation included oropharyngeal clinical examination with fiberoptic nasopharyngoscopy, OSA-18 questionnaire and overnight sleep study. All children were treated with adenoidectomy and tonsillotomy with bipolar forceps. OSA-18 questionnaire and overnight sleep study were performed 30 days after surgery.ResultsPre-operative average of the OSA-18 questionnaires was of 70.3 (SD = 9.7); 30-day post-operative score was 23.15 (SD = 8.2; p = 0.045). Pre-operative average Apnea Hypopnea Index (AHI) score was 9.41 (SD = 4.1); 30-day post-operative average of AHI score was of 1.75 (SD = 0.8; p = 0.012). Oxygen Desaturation Index (ODI) rate changed from 7.39 (SD = 4) to 1.34 (30-day post-operative) (SD = 4.7; p = 0.085). NADIR rate changed from 79% (SD = 6.32) to 90% (30-day post-operative) (SD = 5.18; p = 0.00012). Peri- and post-operative complications in our sample were mainly pain (average 75 doses of paracetamol), while bleeding did not occur (0%). All patients received a follow-up examination 5 years after surgery to evaluate tonsil size; at this time-point, a reduction in tonsil size from 3.6 (3–4; SD = 4.2) to 1.3 (1–2; SD = 5.5) was found, while tonsil regrowth was observed in five children (2%).ConclusionThis study showed that partial tonsillotomy with bipolar forceps electrocautery associated to adenoidectomy is an effective technique in treating OSAHS symptoms in children and ensures less complications in terms of hemorrhage, postoperative pain and infections compared to traditional adenotonsillectomy. The very low tonsillar regrowth rate reported in this study may support the routine use of this technique.
Highlights
Paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) in defined as a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that affects regular ventilation during sleep and normal sleep patterns [1]
Corticosteroids, anti-leukotrienes, and continuous positive airway pressure (CPAP) have been widely evaluated during decades as OSAHS therapy, but only surgery seems to resolve symptoms linked to adenotonsillar hypertrophy [7,8,9,10]
Tonsillectomy with/without adenoidectomy has been the most common surgical procedure performed in children with OSAHS due to tonsillar and/or adenotonsillar hypertrophy, representing about 15% of surgical procedures performed in paediatric population under the age of 15
Summary
Paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) in defined as a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that affects regular ventilation during sleep and normal sleep patterns [1]. OSAHS prevalence is 1.2–5.7% among paediatric population and reaches 36% in obese children [2]. Main risk factors for OSAHS in paediatric population are adeno-tonsillar hypertrophy, obesity, craniofacial malformations, Down Syndrome and neuromuscular diseases [3]. Corticosteroids (alone or in combination), anti-leukotrienes, and continuous positive airway pressure (CPAP) have been widely evaluated during decades as OSAHS therapy, but only surgery seems to resolve symptoms linked to adenotonsillar hypertrophy [7,8,9,10]. Tonsillectomy with/without adenoidectomy has been the most common surgical procedure performed in children with OSAHS due to tonsillar and/or adenotonsillar hypertrophy, representing about 15% of surgical procedures performed in paediatric population under the age of 15. The main complication of tonsils surgery is post-tonsillectomy bleeding [11,12,13]
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