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(ArabMedicare.com
News) -- For children
who suffer from obstructive
sleep apnea (OSA), a
tonsillectomy and
adenoidectomy can provide
dramatic relief and is
successful in solving sleep
problems for 80 to 90
percent of children, a Saint
Louis University School of
Medicine study found.
The study, published in a
recent issue of The
Laryngoscope, is the largest
to date that looks at how
children with varying
severities of OSA fare
before and after they have
surgery, using both
preoperative and
postoperative sleep studies.
The study also looked at
potential factors such as
age and ethnicity that could
affect the diagnosis of OSA
and impact of the surgery.
Children who suffer from OSA
stop breathing periodically
throughout the night and
snore very loudly. In normal
weight children, the
condition is caused by
enlargement of the tonsils
and adenoids that aggravate
upper airway collapse during
sleep, which disrupts normal
breathing.
"Obstructive sleep
apnea has a considerable
impact on children's quality
of life, similar to chronic
asthma or rheumatoid
arthritis" says Ron
Mitchell, M.D., professor of
pediatric otolaryngology at
Saint Louis University and
the study's author.
"Our study has shown
that surgery can have a
profound positive effect on
children's lives."
OSA affects boys and girls
equally. Approximately 2 to
4 percent of children ages 4
to 6 years old have OSA,
although Mitchell suspects
the number is probably
actually higher because
parents don't recognize or
tell doctors about the
problem.
All 79 children in the study
showed significant
improvement after the
surgery, although some
children had persistent OSA.
The study found that the
success of the surgery was
directly related the
preoperative severity of OSA.
The study defined resolution
of OSA as experiencing less
than five incidents of
interrupted breathing
throughout the course of a
night. OSA was resolved in
all children with mild
preoperative OSA (five to
nine incidents per night).
For children with moderate
preoperative OSA (10-19
incidents per night), 88
percent experienced
resolution, while 64 percent
of children with severe
preoperative OSA (20
incidents or more)
experienced resolution.
"The results of the
surgery were dramatic, even
for children who had
persistent OSA,"
Mitchell says. "To go
from having 40 or more
incidents of interrupted
breathing in a night to
having only five or six -
that is a pretty remarkable
improvement in their sleep
that leads to a dramatic
improvement in quality of
life."
Because they do not sleep
soundly, OSA can negatively
affect children's behavior,
health, growth, attention,
memory and classroom
performance. OSA has also
been linked to lower
childhood IQ scores.
"Not all children with
sleep problems have
behavioral issues before
surgery, and not all
behavioral problems resolve
post-surgery," Dr.
Mitchell emphasized.
"Children who score way
outside normal parameters on
behavioral measures benefit
the most from surgery."
Obstructive sleep apnea has
become a better recognized
problem among children in
recent years, Mitchell says.
The sleep center at Cardinal
Glennon Children's Medical
Center, which is one of the
largest sleep center
dedicated exclusively for
children in St. Louis,
conducts approximately 600
sleep studies per year.
A sleep study monitors many
body functions including
brain, eye movements, muscle
activity, heart rhythm and
breathing during sleep. A
sleep study is the only way
to objectively measure OSA
and is recommended by both
the American Academy of
Pediatrics and the American
Thoracic Society prior to
conducting a surgical
procedure.
Michell's research confirmed
the need for preoperative
sleep studies in selected
children. Caregiver reports
of symptoms they observed,
such as snoring and restless
sleep, did not correlate to
the severity of OSA. In
fact, the study found that
only large tonsil size was
related to the preoperative
severity of OSA.
Mitchell's research also
showed the importance of
postoperative follow up,
especially for children who
had severe OSA.
"Even though OSA
resolved in the overwhelming
majority of children after
the surgery, it is still
crucial to identify and
treat children with
persistent OSA,"
Mitchell says.
"Otherwise these
children will continue to
experience the health,
behavioral and learning
problems associated with OSA."
Several options for treating
persistent OSA exist,
including: nasal steroids,
allergy treatment,
additional surgery or
continuous positive airway
pressure (CPAP) mask. Over
time, some children who did
not experience immediate
resolution will normalize,
Mitchell says. Children who
are overweight must lose
weight in conjunction with
the surgery for a successful
outcome.
Obese
children and children with
Down's syndrome or other
genetic disorders that
affect the craniofacial
anatomy were excluded from
the study because the rate
of OSA is known to be
higher.
Established in 1836, Saint
Louis University School of
Medicine is based in the
state of Missouri in the
United States. The
university educates
physicians and biomedical
scientists, conducts medical
research, and provides
health care on a local,
national and international
level. Research at the
school also seeks new cures
and treatments in five key
areas: cancer, liver
disease, heart/lung disease,
aging and brain disease, and
infectious disease.
Posted:
16/FEB/08
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