RT Journal Article
SR Electronic
T1 Comparison between adenotonsillectomy and adenoidectomy in the treatment of obstructive sleep apnea in children
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP OA1477
DO 10.1183/13993003.congress-2015.OA1477
VO 46
IS suppl 59
A1 Yakov Sivan
A1 Keren Armoni Domany
A1 Guy Gut
A1 Elad Dana
A1 Riva Tauman
A1 Bat El Yakir
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/OA1477.abstract
AB Rationale: Adenotonsillectomy (AT) is the first line treatment of OSAS in children. AT is associated with morbidity resulting mainly from the tonsillectomy part. The purpose of this study was to compare AT to adenoidectomy (A).Methods: 659 children with moderate-to-severe OSAS were reevaluated 18-73 months (median=41) after diagnosis for residual OSAS using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Children who underwent AT were compared to children who underwent A or no treatment (NT). The decision of treatment was made by parents and ENT physicians. Treatment failure was defined as a positive mean PSQ score of >0.33. Contribution of tonsils size and OSAS severity at baseline to failure was studied.Results: Study groups comprised: 404 AT (61.3%), 134 A (23.3%) and 121 NT (18.4%) children. Compared to AT, the risk of failure was higher in the NT group (odds ratio [OR]: 2.02 [95% CI: 1.26-3.51]), p=0.012). The risk for failure for the A group was not significantly increased compared to AT (OR: 1.4 [95% CI: 0.8-2.46]), p=0.23). For children with tonsils size >3, failure rate for AT was significantly lower compared to NT (OR: 2.52 [95% CI: 1.15-5.53]), p=0.021). No difference was observed between AT and A. NT individuals with AHI <15 had higher PSQ scores compared to A and AT (p=0.011 and <0.001, respectively). No difference was found for A versus AT.Conclusions: The success rate of A is high and may not be significantly inferior to AT in many children with OSAS, especially in the subgroup of children with large tonsils size and AHI=5-15. Future prospective randomized studies are warranted in order to delineate those children in whom A replace AT.