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Adenotonsillectomy for obstructive sleep apnea in children

Author
Susan L Garetz, MD, MS
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Obstructive sleep apnea (OSA) is common in the pediatric population. If untreated, the disease has been associated with a wide range of cardiovascular and cognitive morbidities [1-3]. Surgical removal of the tonsils and adenoids is considered the first-line treatment for OSA in otherwise healthy children over two years of age with adenotonsillar hypertrophy, as recommended in guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) [4,5].

Adenotonsillectomy is one of the most common surgical procedures performed on children in the United States, with over 500,000 procedures performed annually [6]. The procedure is performed with increasing frequency for the indication of obstructive sleep-disordered breathing (SDB). In a survey of practice patterns by otolaryngologists in the United States, non-mutually exclusive indications for surgery included obstructed breathing of any type in 59 percent of cases, recurrent infections in 42 percent, and OSA in 39 percent of children; indicating that obstructed breathing now rivals recurrent infection as the most common surgical indication for adenotonsillectomy [7].

Although the majority of children undergoing adenotonsillectomy for SDB benefit from the procedure [8], the risk of complications or persistent disease after surgery mandates careful consideration of the risk-benefit ratio of surgical intervention for each individual patient. Moreover, children undergoing adenotonsillectomy for SDB should be evaluated postoperatively for symptom resolution to determine the need for additional evaluation or treatment [4].

PEDIATRIC SLEEP-DISORDERED BREATHING AND OBSTRUCTIVE SLEEP APNEA

Definitions

Obstructive sleep-disordered breathing (SDB) includes a range of nocturnal breathing abnormalities, ranging from habitual snoring to frank OSA. Obstructive SDB is generally suspected initially based on symptoms and signs.

OSA is defined as periodic episodes of nocturnal airflow restriction (hypopneas) or obstruction (apneas) in association with sleep disruption, arousals from sleep, oxygen desaturation, and possible hypercapnia [4]. A polysomnogram (PSG, also known as a sleep study) is required for a definitive diagnosis of OSA.

                                                

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
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