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Infants And Toddlers With Obstructive Sleep Apnea Benefit Through Adenotonsillectomy

In a retrospective study, a surgical treatment improved apnea-hypopnea index in children up to 2 years of age with obstructive sleep apnea (OSA) and comorbidities, although the rate of significant postsurgical complications was relatively high at 18%.

Sleep apnea has been implicated in a number of sequelae, including failure to thrive, chronic respiratory failure, cardiomegaly, developmental delay, and possibly sudden infant death syndrome, told Dr. R. Christopher Miyamoto and co-investigators at Indiana University School of Medicine, Indianapolis.

However, they explained that the concerns about complications have made surgical management in patients younger than 2 years old controversial.

They observed 73 patients ages 8 to 24 months treated for OSA, sleep disordered breathing and adenotonsillar hypertrophy between 2000 and 2005 at their clinic. Comorbidities were present in 63 patients, including neurodevelopmental or neuromuscular disorders, craniofacial abnormalities, and syndromic features.

Sixty-one were treated surgically (adenotonsillectomy in 55, adenoidectomy in 5, and tonsillectomy in 1 patient who underwent a prior adenoidectomy). The remaining 12 were treated either with observation, oxygen, or continuous positive airway pressure.

According to observations during polysomnography conducted at baseline and approximately 6 to 7 months later, the apnea hypopnea index (AHI) improved from a mean of 17.7 to 8.2 in the surgical group. Corresponding AHIs in the medical group were 18.3 and 21.3 (p = 0.013 for between-group difference).

A 50% reduction in AHI was documented in 46% of those treated surgically and 17% of those treated medically, although none was cured as defined by a reduction in AHI to less than 1.

Significant postoperative surgical complications included 10 infants with respiratory distress, 4 of whom required intubation, and 1 infant with postoperative hemorrhage. Another patient had prolonged stay due to poor oral intake.

The risks of post-operative complications were not significantly affected by age, severity of OSA, or comorbidities, the authors note.

Dr. Miyamoto’s team concludes that their data support surgical treatment and demonstrate that it may be performed with an acceptable complication rate in those with comorbidities.