Adenoidectomy for Obstructive Sleep Apnea in Children.

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Adenoidectomy for Obstructive Sleep Apnea in Children.

J Clin Sleep Med. 2016 Jul 19;

Authors: Domany KA, Dana E, Tauman R, Gut G, Greenfeld M, Yakir BE, Sivan Y

Abstract
STUDY OBJECTIVE: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea syndrome (OSAS). 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 OSAS.
METHODS: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSAS (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 obstructive sleep apnea syndrome using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of obstructive sleep apnea syndrome resolution was defined as a positive mean PSQ score ≥0.33. Contribution of age, obesity, tonsil size, and obstructive sleep apnea syndrome 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.

PMID: 27448429 [PubMed - as supplied by publisher]

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