Adenotonsillectomy for obstructive sleep apnoea in children

The current treatment of choice for surgical treatment of obstructive sleep apnoea (reduction of airflow at the nose and mouth during sleep) in children is adenotonsillectomy (the removal of the adenoids and tonsils), due to its perceived efficacy, cost effectiveness and the relative size of adenoid and tonsil tissue in children. There is a lack of strong evidence to support the use of adenotonsillectomy in children with sleep apnoea, although there are some data to indicate that a procedure which removes part of the tonsils (temperature controlled radiofrequency tonsillectomy and adenoidectomy) leads to quicker return to normal diet in the post-surgery phase than complete tonsillectomy and adenoidectomy. There is some debate as to the diagnosis of obstructive sleep apnoea in children and further research would need to undertake extensive diagnostic tests to make an appropriate diagnosis.

Authors' conclusions: 

One small study failed to find a difference between two surgical techniques, although return to normal diet was more frequent in the group treated by temperature controlled radiofrequency tonsillectomy and adenoidectomy. At present there is still debate as to the criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of confirmed obstructive sleep apnoea with adenotonsillectomy in children. Research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated. The quality of research in this area could be improved with the use of sleep studies at baseline to determine the extent of severity of sleep apnoea in children who are recruited to studies in this area. Long-term follow up is also required in order to explore the effect of adenotonsillectomy on paediatric sleep apnoea.

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Background: 

Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children.

Objectives: 

To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children.

Search strategy: 

The Cochrane Airways Group Specialised Register was searched with pre-specified terms. Searches were current as of August 2010.

Selection criteria: 

Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea.

Data collection and analysis: 

Two reviewers examined the search results and collected data from the studies in terms of their characteristics before deciding which ones would be included in the review.

Main results: 

One study met the review entry criteria. This study addressed the relative merits of two surgical techniques in treating OSA in children (temperature controlled radiofrequency tonsillectomy and adenoidectomy, and complete tonsillectomy and adenoidectomy). No significant difference was apparent for either symptoms or respiratory disturbance index. More children in the TCFR&A group were able to return to normal diet at seven days compared with complete T&A. No significant complications were observed in the study.