Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T05:17:23.115Z Has data issue: false hasContentIssue false
  • English
  • Français

Paediatric obstructive sleep apnoea: is our operative management evidence-based?

Published online by Cambridge University Press:  21 February 2018

L Pabla ,
J Duffin ,
L Flood  and
K Blackmore
L Pabla*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
J Duffin
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
L Flood
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
K Blackmore
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
Address for correspondence: Miss Lakhbinder Pabla, ENT Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence.

Methods:

A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment.

Results and conclusion:

There are many gaps in the evidence base for the surgical correction of obstructive sleep apnoea. There is emerging evidence favouring subtotal tonsillectomy. There is continuing uncertainty around the prediction of the level of post-operative care that any individual child might require. The long-term benefit of surgical correction is a particularly fertile ground for further research.

Keywords

ChildTonsillectomySleep Apnea, ObstructiveTreatment
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 4 , April 2018 , pp. 293 - 298
Copyright
Copyright © JLO (1984) Limited 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Marcus, CL, Chapman, D, Ward, SD, McColley, SA, Herrerias, CT, Stillwell, PC et al. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704–12Google Scholar
2Sharma, SD, Kanona, H, Kumar, G, Kotecha, B. Latest trends in the assessment and management of paediatric snoring and sleep apnoea. J Laryngol Otol 2016;130:482–9Google Scholar
3Leong, A, Davis, J. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. J Laryngol Otol 2007;121:809–17Google Scholar
4Friedman, M, Wilson, M, Lin, HC, Chang, HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009;140:800–8CrossRefGoogle ScholarPubMed
5Schwengel, DA, Sterni, LM, Tunkel, DE, Heitmiller, ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg 2009;109:60–75CrossRefGoogle ScholarPubMed
6Baugh, RF, Archer, SM, Mitchell, RB, Rosenfeld, RM, Amin, R, Burns, JJ et al. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144(1 suppl):S1–30CrossRefGoogle ScholarPubMed
7Teo, DT, Mitchell, RB. Systematic review of effects of adenotonsillectomy on cardiovascular parameters in children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2013;148:21–8CrossRefGoogle ScholarPubMed
8Wood, JM, Cho, M, Carney, AS. Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep disordered breathing. J Laryngol Otol 2014;128(suppl 1):S3–7CrossRefGoogle ScholarPubMed
9Weber, SA, Pierri Carvalho, R, Ridley, G, Williams, K, El Dib, R. A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2014;78:1571–8CrossRefGoogle Scholar
10Wang, H, Fu, Y, Feng, Y, Guan, J, Yin, S. Tonsillectomy versus tonsillotomy for sleep-disordered breathing in children: a meta analysis. PLoS One 2015;10:e0121500CrossRefGoogle ScholarPubMed
11Wood, KL, Besecker, BY. Perioperative issues and sleep-disordered breathing. Crit Care Clin 2015;31:497–510Google Scholar
12Harper, P, Rawling, L, Brown, Z. Update on ENT anaesthesia. Anaesthesia and Intensive Care Medicine 2015;16:635–40Google Scholar
13Dehlink, E, Tan, HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis 2016;8:224–35Google Scholar
14Anderson, IG, Holm, JC, Homoe, P. Obstructive sleep apnoea in obese children and adolescents, treatment methods and outcome of treatment – a systematic review. Int J Pediatr Otorhinolaryngol 2016;87:190–7Google Scholar
15Reckley, LK, Song, SA, Chang, ET, Cable, BB, Certal, V, Camacho, M. Adenoidectomy can improve obstructive sleep apnoea in young children: systematic review and meta-analysis. J Laryngol Otol 2016;130:990–4CrossRefGoogle ScholarPubMed
16Konstantinopoulou, S, Tapia, IE. Neurocognitive and behavioural outcomes following intervention for obstructive sleep apnoea syndrome in children. Paediatr Respir Rev 2016;20:51–4Google ScholarPubMed
17Song, SA, Tolisano, AM, Cable, BB, Camacho, M. Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2016;83:205–10Google Scholar
18Van, M, Khan, I, Hussain, SS. Short-term weight gain after adenotonsillectomy in children with obstructive sleep apnoea: systematic review. J Laryngol Otol 2016;30:214–18Google Scholar
19Manickam, PV, Shott, SR, Boss, EF, Cohen, AP, Meinzen-Derr, JK, Amin, RS et al. Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea. Laryngoscope 2016;126:491–500CrossRefGoogle ScholarPubMed
20Marcus, CL, Rosen, G, Davidson Ward, SL, Halbower, AC, Sterni, L, Lutz, J et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006;117:442–51Google Scholar
21Wilson, YL, Merer, DM, Moscatello, AL. Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope 2009;119:162–70Google Scholar
22Marcus, CL, Moore, RH, Rosen, CL, Giordani, B, Garetz, SL, Taylor, HG et al. Childhood Adenotonsillectomy Trial. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013;368:2366–76CrossRefGoogle Scholar
23Katz, ES, Moore, RH, Rosen, CL, Mitchell, RB, Amin, R, Arens, R et al. Growth after adenotonsillectomy for obstructive sleep apnea: an RCT. Pediatrics 2014;134:282–9Google Scholar
24Quante, M, Wang, R, Weng, J, Rosen, CL, Amin, R, Garetz, SL et al. Childhood Adenotonsillectomy Trial. The effect of adenotonsillectomy for childhood sleep apnea on cardiometabolic measures. Sleep 2015;38:1395–403Google Scholar
25Bar, A, Tarasiuk, A, Segev, Y, Phillip, M, Tal, A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. Pediatrics 1999;135:76–80Google ScholarPubMed
26Row, BW, Kheirandish, L, Neville, JJ, Gozal, D. Impaired spatial learning and hyperactivity in developing rats exposed to intermittent hypoxia. Pediatr Res 2002;52:449–53Google Scholar
27Tarasiuk, A, Simon, T, Tal, A, Reuveni, H. Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization. Pediatrics 2004;113:351–6Google Scholar
28Goldstein, NA, Post, J, Rosenfeld, RM, Campbell, TF. Impact of tonsillectomy and adenoidectomy on child behavior. Arch Otolaryngol Head Neck Surg 2000;126:494–8Google Scholar
29Massa, F, Gonsalez, S, Laverty, A, Wallis, C, Lane, R. The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea. Arch Dis Child 2002;87:438–43Google Scholar
30Bourke, R, Anderson, V, Yang, JS, Jackman, AR, Killedar, A, Nixon, GM et al. Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med 2011;12:489–96Google Scholar
31Ross, KR, Storfer-Isser, A, Hart, MA, Kibler, AM, Rueschman, M, Rosen, CL et al. Sleep-disordered breathing is associated with asthma severity in children. Pediatrics 2012;160:736–42Google ScholarPubMed
32Mukhatiyar, P, Nandalike, K, Cohen, HW, Sin, S, Gangar, M, Bent, JP et al. Intracapsular and extracapsular tonsillectomy and adenoidectomy in pediatric obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2016;142:25–31CrossRefGoogle ScholarPubMed
33Hoey, AW, Foden, NM, Hadjisymeou Andreou, S, Noonan, F, Chowdhury, AK, Greig, SR et al. Coblation intracapsular tonsillectomy (tonsillotomy) in children: a prospective study of 500 consecutive cases with long-term follow-up. Clin Otolaryngol 2017;42:1211–17Google Scholar
34Nardone, HC, McKee-Cole, KM, Friedman, NR. Current pediatric tertiary care admission practices following adenotonsillectomy. JAMA Otolaryngol Head Neck Surg 2016;142:452–6CrossRefGoogle ScholarPubMed
35Chng, SY, Goh, DY, Wang, XS, Tan, TN, Ong, NB. Snoring and atopic disease: a strong association. Pediatr Pulmonol 2004;38:210–16Google Scholar