The effect of adenotonsillectomy in children with OSA
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.
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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,
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