TY - JOUR
T1 - Adenoidectomy Without Tonsillectomy for Pediatric Obstructive Sleep Apnea
AU - Chorney, Stephen R.
AU - Zur, Karen B.
N1 - Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020.
PY - 2021/5
Y1 - 2021/5
N2 - Objective: The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy. Study Design: Case series with chart review. Setting: Tertiary children’s hospital between 2016 and 2018. Methods: The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG). Results: Seventy-one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8-2.2) and 71.8% were male. Mean follow-up was 2.5 years (95% CI, 2.3-2.7). Twenty-six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3-13.2) after adenoidectomy. Among those with a postoperative PSG, apnea-hypopnea index decreased in 77.0% (mean, –3.2 events/h; 95% CI, –14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% (P =.03). Six children (23.1%) had a normal PSG after adenoidectomy. Tonsillectomy was performed in 14.1% of children at 12.1 months (95% CI, 7.5-16.7) after adenoidectomy. Despite similar preoperative PSG variables, younger children (1.5 vs 2.1 years, P =.02) were more likely to require tonsillectomy. Substantial adenoid regrowth was identified in 1 child at the time of tonsillectomy. Conclusion: Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.
AB - Objective: The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy. Study Design: Case series with chart review. Setting: Tertiary children’s hospital between 2016 and 2018. Methods: The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG). Results: Seventy-one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8-2.2) and 71.8% were male. Mean follow-up was 2.5 years (95% CI, 2.3-2.7). Twenty-six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3-13.2) after adenoidectomy. Among those with a postoperative PSG, apnea-hypopnea index decreased in 77.0% (mean, –3.2 events/h; 95% CI, –14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% (P =.03). Six children (23.1%) had a normal PSG after adenoidectomy. Tonsillectomy was performed in 14.1% of children at 12.1 months (95% CI, 7.5-16.7) after adenoidectomy. Despite similar preoperative PSG variables, younger children (1.5 vs 2.1 years, P =.02) were more likely to require tonsillectomy. Substantial adenoid regrowth was identified in 1 child at the time of tonsillectomy. Conclusion: Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.
KW - adenoidectomy
KW - obstructive sleep apnea
KW - pediatrics
KW - polysomnogram
KW - tonsillectomy
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U2 - 10.1177/0194599820955172
DO - 10.1177/0194599820955172
M3 - Article
C2 - 32960140
AN - SCOPUS:85091371140
SN - 0194-5998
VL - 164
SP - 1100
EP - 1107
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 5
ER -