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Effects of adenotonsillectomy in children with sickle cell disease

Lisa Van Geyzel, Bethany Singh, Baba Inusa, Morium Akthar, Cara Bossley, Wanda Kozlowska, David Rees, Subarna Chakravorty, Gary Ruiz, Ian Hore, Atul Gupta
European Respiratory Journal 2016 48: PA4353; DOI: 10.1183/13993003.congress-2016.PA4353
Lisa Van Geyzel
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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Bethany Singh
2Department of Paediatric Haematology, Evelina London Children's Hospital, London, United Kingdom
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Baba Inusa
2Department of Paediatric Haematology, Evelina London Children's Hospital, London, United Kingdom
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Morium Akthar
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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Cara Bossley
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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Wanda Kozlowska
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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David Rees
3Department of Paediatric Haematology, King's College Hospital, London, United Kingdom
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Subarna Chakravorty
3Department of Paediatric Haematology, King's College Hospital, London, United Kingdom
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Gary Ruiz
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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Ian Hore
4Department of Paediatric ENT, Evelina London Children's Hospital, London, United Kingdom
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Atul Gupta
1Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
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Abstract

Introduction: Children with Sickle cell disease (SCD) have a higher prevalence of Obstructive sleep apnea (OSA) and OSA has been identified as an important comorbidity in children with SCD. There evidence linking nocturnal desaturations with an increased rate of both vaso-occlusive episodes (VOE) and acute chest syndrome (ACS).

Methods: In our centre, all children and adolescents with SCD and OSA are evaluated for adenotonsillar hypertrophy, as adenotonsillectomy may be curative in some. Retrospective review of children with SCD who underwent adenotonsillectomyfor OSA between 2004 to 2015. Sleep study data and admission rates due to VOE & ACS were compared, before & after adenotonsillectomy.

Results: 37 children with SCD underwent adenotonsillectomy during this time frame. 22 children (13 male) with a median age of 7 years (range 3-12 years) had sleep study before and after adenotonsillectomy.

BeforeAfterP value
Nocturnal oxygen saturations (Sp02) %94.495.00.412
Overnight nadir oxygen saturations (Sp02) %81.087.00.002
Nocturnal 3% oxygen desaturation index (ODI)5.452.40.003
Nocturnal carbon dioxide (pC02) kPa6.005.780.438
ACS (admissions per year)0.590.230.254
VOE (admission per year)0.450.500.922
  • *All values median (range)

TABLE 1.

Comparison of sleep study results & rate of ACS and VOE in children with SCD who underwent adenotonsillectomy.

Discussion: Children with SCD and OSA, who had adenotonsillectomy, appeared to have a significant increase in overnight nadir oxygen saturations, as well as a reduction in the overnight ODI; but no change in the rates of severe ACS or VOE. Further testing by a randomised controlled trial or prospective longitudinal study is needed.

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Effects of adenotonsillectomy in children with sickle cell disease
Lisa Van Geyzel, Bethany Singh, Baba Inusa, Morium Akthar, Cara Bossley, Wanda Kozlowska, David Rees, Subarna Chakravorty, Gary Ruiz, Ian Hore, Atul Gupta
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4353; DOI: 10.1183/13993003.congress-2016.PA4353

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Effects of adenotonsillectomy in children with sickle cell disease
Lisa Van Geyzel, Bethany Singh, Baba Inusa, Morium Akthar, Cara Bossley, Wanda Kozlowska, David Rees, Subarna Chakravorty, Gary Ruiz, Ian Hore, Atul Gupta
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4353; DOI: 10.1183/13993003.congress-2016.PA4353
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