When Surgery Isn't a Cure-All for Sleep Apnea

Adenotonsillectomy in children may not always fully resolve obstructive sleep apnea

(RxWiki News) The earlier a serious sleep condition can be treated, the more likely a person is to avoid other health problems from that condition. For children with one sleep disorder, one treatment may not always be enough.

A recent study found that surgery may not always fully treat a child's obstructive sleep apnea.

Obstructive sleep apnea is a condition in which a person stops breathing or has a decrease in breathing for at least 10 seconds at a time during the night.

The condition can increase the risk for other health conditions such as heart disease, failure to thrive and cognitive and behavioral problems if not treated.

"Tell your pediatrician if your child snores."

This study, led by Andrea Nath, MD, of the Section of Otolaryngology–Head and Neck Surgery at the University of Chicago Medicine, looked at how common obstructive sleep apnea was in young children after an adenotonsillectomy.

An adenotonsillectomy is a surgical procedure that removes the adenoids and tonsils of a child. It is one type of treatment used for obstructive sleep apnea.

The researchers reviewed the medical records of 283 children, aged 3 and younger, who had been diagnosed with obstructive sleep apnea and then underwent an adenotonsillectomy between October 2002 and June 2010.

The researchers looked at the "apnea-hypopnea index" for the 70 children who underwent a sleep study both before and after their surgery.

The apnea-hypopnea index, or AHI, scores the number of times they stop breathing for at least 10 seconds (apnea) or experience a hypopnea. A hypopnea is a decrease in respiratory function of at least 50 percent with a drop of oxygen of at least 4 percent and/or an arousal.

A score of 1 to 5 means a child has mild obstructive sleep apnea while a score of 5 to 10 is moderate, and above 10 is severe.

Among the children who had sleep studies before and after their surgery, the average AHI dropped from 34.8 before surgery to 5.7 after surgery.

In addition, their baseline oxygen saturation increased from an average of 96.6 percent to 97.2 percent after the surgery.

The lowest point of oxygen saturation for these children increased from 77.2 percent before surgery to 89.9 percent after surgery.

Further, the children's "sleep efficiency" improved from 84.7 percent to 88.7 percent after the surgery. Sleep efficiency refers to how much time in bed a person spends actually asleep.

All of these outcomes showed improvements for the children who had undergone surgery.

However, an AHI of 5 meant a continued diagnosis of residual obstructive sleep apnea. Overall, 15 of the 70 patients had an AHI of 5 of higher after the adenotonsillectomy.

The researchers found the factor that most influenced the risk of having residual obstructive apnea after surgery was how severe the child's sleep apnea had been before the surgery.

The researchers therefore concluded that children who had severe sleep apnea before an adenotonsillectomy may need a follow-up sleep study after the surgery to see if they have residual obstructive sleep apnea.

William Kohler, MD, the medical director of the Florida Sleep Institute in Spring Hill, Florida, said it is important that children be evaluated after the operation if there is any concern that the condition has not gone away.

"Treatment should also consider lifestyle changes, including weight reduction as indicated, if the apnea is still there," Dr. Kohler said. He also said dental procedures or use of a CPAP could be considered.

CPAP stands for continuous positive airway pressure. This treatment is delivered through a mask a child wears while asleep.

"The bottom line is that the children need to be treated because if they are not treated early enough, the damage could be permanent," Dr. Kohler said. 

"Even though the surgery didn't cure the obstructive sleep apnea in everybody in the study, it did improve it, and for those for whom it didn't cure it, additional therapy needs to be carried out," he said. "It's so important to be sure that it does get treated because of the possible effects."

This study was published September 12 in the journal JAMA Otolaryngology–Head & Neck Surgery.

The researchers reported no conflicts of interest. Information regarding funding was not provided.

Review Date: 
September 13, 2013