Treatment of Pediatric Obstructive Sleep Apnea beyond Tonsillectomy and Adenoidectomy

Abstract

Objective: 1) Compare the efficacy of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone in the treatment of pediatric OSAHS. 2) Compare the morbidity of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone. Method: Randomized single-blind controlled study of 60 pediatric patients treated between January 2009 to January 2010 at a tertiary care center. Patients were randomized into 2 groups: adenotonsillectomy alone (group I) and adenotonsillectomy with pharyngoplasty (group II). Endpoints included: pre- and postsurgical AHI, number of cures, pain levels, and change in OSA-18. Results: Sixty patients were enrolled and 52 patients completed the study (group I n = 27, group II n = 25). The mean age, BMI, and baseline AHI did not differ significantly between the two groups. The change in AHI from pre- to postsurgery was not found to be significant between the 2 groups ( P = .337). No significant differences were found in the number of cures ( P = .709). There was no significant difference between groups for OSA-18 score ( P = .478). Pain outcomes measured on postoperative days 1 to 7 using VAS did not reveal a significant difference in pain levels. Conclusion: With short-term follow-up, the addition of pillar closure to traditional adenotonsillectomy did not significantly improve sleep parameters as measured by polysomnogram or in quality of life as measured using the OSA-18. It is unknown if pharyngoplasty will have long-term benefits in preventing progression of OSA.