The effect of adenotonsillectomy in children with OSA

https://doi.org/10.1016/S0165-5876(98)00047-0Get rights and content

Abstract

Adenotonsillar hypertrophy and abnormal facial morphology are thought to be important for the occurrence of obstructive sleep apnea syndrome (OSA). We evaluated the effects of adenidectomy and/or tonsillectomy and the relationship between the treatment results and facial morphology in 134 children with OSA. Significant improvements in apnea-hypopnea indes (AHI) and lowest blood oxygen saturtion (SaO2) were noted and 78.5% of the patients improved after adenoidectomy and/or tonsillectomy. Additional operations were needed in two out of 13 cases of the adenoidectomy group and two out of four cases of the adeno-monotonsillectomy group. In the adenotonsillectomy group, the unimproved children tended to have smaller tonsils, narrower epipharyngeal airspace, and more poorly-developed maxillary and mandibular protrusion than the improved children.

Introduction

Obstructive sleep apnea (OSA) has been recognized as an important entity in children [3]. The symptoms of OSA are snoring, apnea, and open mouth [5]. Continuity of upper airway obstruction may lead to abnormal facial morphology [13], chest deformation [7]and growth retardation 5, 11, 15. In severe cases, arrhythmia, right-sided heart failure,and cor pulmonale (pulmonary hypertension) may also be noted 1, 8, 9, 11, 16, and in some cases, they can cause death. Adenotonsillar hypertrophy is the most common cause of obstructive sleep apnea in children 9, 16. In children with OSA, adenoidectomy and/or tonsillectomy are often the initial treatment [2]. The symptoms of OSA such as snoring, apnea, mouth breathing and poor school performance have been shown by several studies to be improved following adenotonsillectomy 9, 17. However, not every child with large tonsils and adenoids has symptoms of OSA. In our previous study [14], it was suspected that the abnormal facial morphology in OSA children may be influenced by both environmental (upper airway obstruction) and genetic factors and that facial morphology may contribute to the occurrence of OSA in children.

In this study, we analyzed OSA children surgically treated in our hospital to determine the factors that related to the effect of adenoidectomy and/or tonsillectomy.

Section snippets

Subjects

One hundred and thirty-four children who complained of snoring and apnea (1–9 years old, mean age 4.4±1.5) were surgically treated at the University hospital of Sapporo Medical University from 1988 to 1993. Ninety-two patients were male and 42 were female. Children with mental and motor delay, Down's syndrome, craniofacial anomaly or excessive obesity were not included in this study.

A macroscopic tonsillar hypertrophy was graded in the following way: one degree hypertrophy defined tonsil within

Treatment results

The changes of AHI and the lowest SaO2 in A only group and AT group are indicated in Fig. 3. Significant improvements of these values were noted after the treatments. 84.5% (11/13) of A only group and 75.4% (86/114) of AT group children were defined as `improved patients'. Improvements were also noted in AMT and T only groups (pre- vs. post-operative AHI and lowest SaO2 were 14.8±6.9 vs 5.1±1.7 and 67.6±12.5 vs 85.5±0.87 in AMT group, and 22.4±10.5 vs 6.6±1.8 and 89.5±0.5 vs 89±1.0 respectively

Discussion

Adenoidectomy and/or tonsillectomy were performed on 134 OSA children. 77.6% of the patients were successfully treated by the initial operation, suggesting that the most common cause of OSA in children is adenoid and/or tonsillar hypertrophy. Sometimes, adenotonsillar hypertrophy has been noted in very young children (under 2 years old). It would be easy for these young children with severe OSA to progress to heart failure and pulmonary hypertension due to immaturity in their function. However,

References (17)

There are more references available in the full text version of this article.

Cited by (106)

  • Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation

    2022, Brazilian Journal of Otorhinolaryngology
    Citation Excerpt :

    Smoking, obesity, increased neck circumference, tongue dimension and craniofacial malformations are the common condition associated with OSA.4,5 In children, OSA may be associated to adenotonsillary hypertrophy.6 OSA is associated with many diseases or disorders such as: cardiovascular diseases,7 metabolic disorders (i.e., diabetes),8 gastric disorders (i.e., gastroesophageal reflux disease),9 respiratory disorders (i.e., asthma),10 emotional and psychological disorders11 and increased mortality rates.12

  • Sleep-disordered breathing and orthodontic variables in children-Pilot study

    2014, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    One study in Camaragibe City with 173 children where the prevalence of normal occlusion was 17.9% and that of malocclusion 82.1% [43]. However, there was a higher prevalence of malocclusion in two other Brazilians studies, one in the city of Bauru City (88.53%) [44] and the other a multicenter study conducted in 18 Brazilian states (85.17%) [45]. When we compare this with other studies a higher prevalence of malocclusion is shown [46–48].

View all citing articles on Scopus
View full text