Follow-up of children with obstructive sleep apnea syndrome treated with adenotonsillectomy

Abstract

Background: Hypertrophy of adenotonsillar tissue is an undisputed contributor to the development of OSAS in otherwise healthy children. A multicenter retrospective study shows the surgery approach has a resolution rate of about 27%. So it will be important to identify children who will not resolve OSAS after adenotonsillectomy (AT) in order to plan an appropriate and integrated treatment for them.

Aim: To evaluate the role of AT in the outcome of children with OSAS.

Methods: Children affected by adenotonsillar hypertrophy, who underwent adenotonsillectomy for moderate-severe OSAS, were enrolled, from 2008 to 2009. All children underwent a complete clinical examination and overnight polysomnographic study before AT and after 12 months of follow-up.

Results: We included 21 children (mean age 4.09±1.76; M/F 17/4), with a mean body mass index –BMI- of 15.86±2.4 kg/m², with a mean apnea hyponea index (AHI) of 15.08±8.8 ev/hr. Twelve children (57.1%) had malocclusions. After one year, 13 children showed a complete resolution of disease (61.9%) (AHI 0.3±0.3 ev/hr), while 8 children (38.1%) had a residual disease (AHI 2.6±1.1 ev/hr). Children with a residual disease had a higher BMI at baseline (16.5±3.7kg/m² vs 15.4±1.1 kg/m², p<0.05) and a higher prevalence of malocclusions compared to those with a complete resolution (7/8, vs 5/13, X²=4.86, p<0.05). Stepwise multiple linear regression analysis identify malocclusion as the most important variable influencing the outcome (R²=0.24).

Conclusions: Although AT is the gold standard in children with OSAS and adenotonsillar hypertrophy, treatment of malocclusions need to be added to achieve a complete resolution of the disease.