Is it necessary to perform a follow-up study after adenotonsillectomy in all children with moderate-severe obstructive sleep apnoea?

Abstract

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents' impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI < 2/h) after adenotonsillectomy was 80.48%. A very good correlation was observed between the parents' perception after treatment and the follow-up PSG parameters, specifically when the parents perceived that the patient had shown "complete resolution" (no snoring or apnoea), 90.62% of the children had an AHI < 2/h in the follow-up PSG, the maximum residual AHI being 2.6/h. In healthy children with no underlying pathology, the information provided by the parents on clinical progression after surgery could be useful and might enable the selection of those patients who require a follow-up study, avoiding overload in sleep units.

Keywords: Adenoamigdalectomía; Adenotonsillectomy; Obstructive sleep apnoea; Polisomnografía; Polysomnography; Síndrome de apnea-hipopnea de sueño.