Impact of adenotonsillectomy in children with severe obstructive sleep apnea: A systematic review |
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| Authors: | Francesca Galluzzi Werner Garavello |
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| Affiliation: | 1. Department of Otorhinolaryngology, San Gerardo Hospital, Via Pergolesi, 33, 20052 Monza, MI, Italy;2. Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy;1. Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro 080-0833, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa 078-8510, Japan;3. Department of Cardiovascular Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro 080-0833, Japan;4. Department of Pathology, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro 080-0833, Japan;5. Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo 160-8582, Japan;6. Department of Surgical Pathology, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa 078-8510, Japan;1. Sen-En Rifu Otological Surgery Center, Miyagi, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan;3. Department of Neurosurgery, Southern Tohoku General Hospital, Fukushima, Japan;1. Otorhinolaryngology, Faculty of Medicine, Kafr Elsheikh University, Egypt;2. Otorhinolaryngology, Faculty of Medicine, Tanta University, Egypt;1. Department of Otorhinolaryngology, The National University of Malaysia, Malaysia;2. Department of Otorhinolaryngology, Hospital Kuala Lumpur, Malaysia;1. Sen-En Rifu Otological Surgery Center, Miyagi, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan;3. Department of Mechanical Engineering and Intelligent Systems, Tohoku Gakuin University, Sendai, Japan;4. Department of Intelligent Information Systems, Tohoku Bunka Gakuen University, Sendai, Japan;1. Beckman Laser Institute Korea, College of Medicine, Dankook University, Cheonan, South Korea;2. Department of Otolaryngology-Head & Neck Surgery, College of Medicine, Dankook University Cheonan, South Korea |
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| Abstract: | ObjectivesTo determine the impact of adenotonsillectomy for treatment of severe obstructive sleep apnea (OSA) in children without comorbidities.MethodsA systematic review was performed to identify studies regarding adenotonsillectomy for treatment of children with severe sleep apnea. Polysomnographic parameters were considered as metric of cure and the number of patients of persistent apnea was calculated. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.ResultsThe systematic review included nine studies. Five studies were prospective and four retrospectives. No one was controlled. The number of subjects with severe OSA included was 499 with a prevalence of male. The mean age varied from 4.3 to 8.2. The follow-up period ranges from 1 to 23 months. The criteria for considering severe OSA ranges from AHI or RDI ≥10 to ≥30.All the trials have found a statistically significant reduction of postoperative AHI or RDI values in patients who had undergone adenotonsillectomy for severe OSA. The AHI and RDI improving varied from 57.7% to 93.3%. All the studies documented persistent OSA after adenotonsillectomy. The number of residual OSA considering AHI≥5 varied from 30 to 55.5%, in case of AHI ≥1 from 60 to 90.6%.ConclusionTo the best of our knowledge, this is the first review regarding the effectiveness of adenotonsillectomy for severe OSA in otherwise healthy children. Adenotonsillectomy is partially effective in the treatment of severe OSA in children without comorbidities. However, it reduces the severity of OSA determining a significant reduction of polysomnographic parameters. These results suggest a clinical and polysomnographic follow-up after surgery in order to manage the residual mild and moderate OSA. |
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