Allison Chan

Adenotonsillectomy and obstructive sleep apnea in children: A prospective survey

Objective Prospective survey of children up to 14 years of age with OSA submitted to adenotonsillectomy. Methods Clinical evaluation, with questionnaires and clinical scales evaluating facial structures including tonsils and Mallampati scales and otolaryngologic evaluation; nocturnal polysomnography and repeat evaluation three to five months postsurgery. Results Of 207 successively seen children, 199 had follow-up polysomnography, and 94 had still abnormal sleep recording. Multivariate analysis indicates that Mallampati scale score 3 and 4, retro-position of mandible, enlargement of nasal inferior turbinates at +3 (subjective scale 1 to 3), and deviated septum were significantly associated with persistence of abnormal polysomnography (with high 95% CI for Mallampati scale and deviated septum). Conclusion Mallampati scale scores are resultant of several facial factors involving maxilla, mandible, and oral versus oral breathing but add information on risk of partial response to adenotonsillectomy. Significance Adenotonsillectomy may not resolve obstructive sleep apnea in children.

Is obstructive sleep apnea syndrome a neurological disorder? A continuous positive airway pressure follow‐up study

Abnormal sensory responses have been found in the upper airway of obstructive sleep apnea patients, but no long‐term study has been published previously regarding the evolution of obstructive sleep apnea syndrome and persistence of abnormal pharyngeal sensory evaluation in response to continuous positive airway pressure (CPAP) treatment. Over 5 years, we managed healthy, nonobese subjects compliant with nasal CPAP. Only 47 subjects completed this prospective study, due to protocol requirements. They underwent regular clinical evaluation, subjective scales, four polysomnographies without nasal CPAP, recalibration of nasal CPAP with polysomnography, regular downloading of home data, and a palatal two‐point discrimination study. None of the subjects presented normal results at any checkpoint when they had been without CPAP for two or three nights. By the completion of the study, all subjects required an increase in nasal CPAP (1–7cm H2O) and demonstrated abnormal two‐point palatal discrimination compared with control subjects. Despite initial control of clinical symptoms with regular usage of nasal CPAP in subjects without weight change, abnormal sensory palatal evaluation was present at the conclusion of the study. Obstructive sleep apnea syndrome involves abnormal upper airway sensory input, which may be responsible for the development of apneas and hypopneas. These neurological lesions are persistent despite nasal CPAP treatment. Ann Neurol 2006

Cyanotic breath-holding spells in children respond to adenotonsillectomy for sleep-disordered breathing

Children with breath‐holding (BH) spells may demonstrate sleep‐disordered breathing (SDB) during polysomnography. We studied five young children with cyanotic spells retrospectively and found both SDB and a response to adenotonsillectomy. We therefore proceeded with a prospective investigation of treatment for SDB in children with comorbid cyanotic spells. Nineteen children with cyanotic BH spells were identified and enrolled in the prospective study. Parents chose either treatment or observation. Fourteen children underwent complete SDB evaluation and treatment trials while five selected observation only (control group). Sleep and sleep‐surgery specialist evaluation and polysomnography revealed the presence of a narrow upper‐airway and an abnormal respiratory disturbance index in all 14 children. Nasal CPAP was not successful, but adenotonsillectomy performed near 14 months of age eliminated SDB. BH spells were eliminated 1 month after surgery, while they persisted to the end of the study (24 months of age) in the control group. In conclusion, the presence of cyanotic BH should prompt investigation and polysomnography for possible SDB. Independent treatment of SDB may hasten resolution of BH spells in these cases.

Response to Michael Friedman re: “Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey”

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