Adenotonsillectomy For Pediatric Sleep Apnea Research Articles

Measuring sleep quality after adenotonsillectomy in pediatric sleep apnea

The aim of this study was to demonstrate postoperative changes in sleep quality in children with obstructive sleep apnea (OSA), using both conventional sleep staging and electrocardiogram-based cardiopulmonary coupling (CPC) analysis. The hypothesis is that being electroencephalography (EEG)-independent, CPC may detect changes in sleep quality that traditional sleep architecture analysis cannot. Retrospective outcome research. We included 37 children (aged 6.89 ± 2.76 years, 28 male) with OSA who underwent adenotonsillectomy, and analyzed standard polysomnography and CPC parameters from a full-night study before and after adenotonsillectomy. High-frequency coupling (HFC) and low-frequency coupling (LFC) were used as indices of stable and unstable sleep, respectively. Adenotonsillectomy led to a significant change in CPC parameters (HFC, 50.3 ± 16.1% to 56.1 ± 14.7%, P = .03; LFC, 35.1 ± 14.5% to 27.3 ± 13.0%, P = .003), which was paralleled by improvements in the apnea-hypopnea (12.7 ± 13.7 to 1.0 ± 0.8, P < .001) and arousal index (20.8 ± 11.5 to 9.9 ± 3.9, P < .001). Polysomnographic sleep stage parameters other than the arousal index did not reflect postoperative resolution of OSA. In pediatric OSA, postoperative improvement of sleep quality is more readily discernible by CPC analysis than EEG-based sleep staging. The CPC analysis may have potential advantages in the assessment of sleep quality in pediatric populations.

Does Adenotonsillectomy Cure Pediatric Sleep Apnea?

Objective 1) Perform an updated meta-analysis to determine the cure rate of adenotonsillectomy for pediatric sleep apnea. 2) Report the findings of 5 years of experience with standardized coblation intracapsular tonsillectomy for the treatment of pediatric sleep apnea. Methods A thorough literature search of multiple databases was performed. Inclusion criteria for studies were: 1) Adenotonsillectomy as the primary treatment of sleep apnea (age&lt;18). 2) Pre-and postoperative polysomnography data was included. 20 studies fit the inclusion criteria and a metaanalysis was performed to determine the overall success. A 5–year retrospective analysis of coblation tonsillectomy performed by a single surgeon for sleep apnea was also performed. Results The meta-analysis included 904 subjects with average follow-up time of 21.6 weeks. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k= 20 studies) with T/A based on pre-and postoperative PSG data. Random-effects model estimated the treatment success of adenotonsillectomy was 61.1%. When “cure” was defined as an AHI of &lt;1, the cure rate was 53.8%. 200 adenotonsillectomy cases performed with coblation technique were reviewed. The mean preoperative was AHI 28.3 and mean postoperative AHI was 3.8. Surgical cure, as defined as a postoperative AHI &lt;1, was achieved in 51.7% of patients. Conclusions 1) Contrary to popular belief, meta-analysis of current literature and a review of 200 cases demonstrates that pediatric sleep apnea is often not cured by adenotonsillectomy. 2) Although complete resolution is not achieved in most cases, adenotonsillectomy still offers significant improvements in AHI.