Obstructive Sleep Apnea and Adenotonsillectomy in Children

This research highlight was provided by Judith Owens, MD, MPH, Director of Sleep Medicine at Children’s National Medical Center and MyApnea.Org Steering Committee Member.

Background

Obstructive sleep apnea is now the number one reason for performing adenotonsillectomy (surgical removal of the tonsils and adenoids) in children in the U.S. It is estimated that over 500,000 adenotonsillectomies are performed annually in children. While in general this procedure is considered low risk, there are known potential consequences include bleeding and blockage of the airway due to swelling in the immediate post-operative period. Media attention paid to the unfortunate brain death of a 13-year-old girl in Oakland, California following an adenotonsillectomy last December raised understandable concerns for parents regarding the safety of this procedure.

The Study

A large prospective study by Dr. Anchana Thongyan and colleagues was designed specifically to address the question of what factors might predict medical complications in children in the 2-week period following surgery.¹

Study Results

There were 329 subjects; 27% were less than 3 years old and 24% were obese and thus a substantial percentage was considered “high risk”. Almost 30% had some respiratory complications, and a third had non-respiratory complications such as bleeding, although none of these were serious. Severity of sleep apnea as determined by an overnight sleep study done prior to the surgery was associated with respiratory but not non-respiratory complications. African American children and those less than 3 years old were also at higher risk for respiratory complications.

What does this research mean to you?

While adenotonsillectomy for sleep apnea in children is generally safe, there may be specific groups that have an increased risk of complications related to surgery, including very young and African-American children. In these groups, more intensive monitoring in the post-surgery period may be warranted. The association between severity of sleep apnea and complications points out the importance of obtaining a sleep study before surgery to determine relative risk.

References

1. Thongyam A, Marcus CL, Lockman JL, Cornaglia MA, Caroff A, Gallagher PR, Shults J, Traylor JT, Rizzi MD, Elden L. Predictors of Perioperative Complications in Higher Risk Children after Adenotonsillectomy for Obstructive Sleep Apnea: A Prospective Study. Otolaryngol Head Neck Surg. 2014 Oct 9. pii: 0194599814552059. [Epub ahead of print]

Thanks Judy! Its helpful to understand that every treatment decision needs to balance the treatment's benefits vs possible harm. In the Childhood Adenotonsillectomy Trial, a large multicenter study that compared tonsillectomy to watchful waiting for 6 months in children ages 5 to 9 with sleep apnea, we also saw a very low rate of surgical complications from adenotonsillectomy-but nonetheless, the occurrence of some problems- like transient breathing problems, bleeding, and dehydration require that the medical team and family be alert to these, and ready to intervene as appopriate. We were also very concerned about the possible increased rate of complications among children who are very overweight. It is important for parents to discuss all these issues with their doctors and understand too what to look for after a tonsillectomy. On the other hand, it is important to note that this rigorous study showed that who received a tonsillectomy had marked improvements in behavior and quality of life.

Soon we will be inviting parents of children with sleep apnea to participate in MyApnea.Org and hope we can further discuss some of these important issues.