Outcome of tonsillotomy in children with obstructive sleep-disordered breathing

Tina Kissow Lildal; An Boudewyns; Konstantinos Kamperis; Søren Rittig; Jannik B Bertelsen; Jonas Holm; Thomas Qvist Barrett; Jakob Korsholm; Ali Abood; Therese Ovesen

doi:10.1016/j.sleep.2024.04.014

Outcome of tonsillotomy in children with obstructive sleep-disordered breathing

Sleep Med. 2024 Apr 15:119:73-79. doi: 10.1016/j.sleep.2024.04.014. Online ahead of print.

Authors

Affiliations

¹ Department of Otorhinolaryngology, Head & Neck Surgery, University Clinic for Flavor, Balance and Sleep, Gødstrup Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Denmark. Electronic address: tinlil@rm.dk.
² Department of Otolaryngology, Antwerp University Hospital, Belgium; University of Antwerp, Faculty of Medicine and Translational Neurosciences, Antwerp, Belgium.
³ Department of Pediatrics Aarhus University Hospital, Denmark.
⁴ Department of Otorhinolaryngology, Head & Neck Surgery, University Clinic for Flavor, Balance and Sleep, Gødstrup Hospital, Denmark.
⁵ Private ENT Clinic, Randers, Denmark.
⁶ Department of Otorhinolaryngology, Head & Neck Surgery, University Clinic for Flavor, Balance and Sleep, Gødstrup Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.

PMID: 38652931
DOI: 10.1016/j.sleep.2024.04.014

Abstract

Objective/background: Most children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters.

Methods: Children aged 2-10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire -Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h.

Results: Fifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47-0.56) to 0.26 (CI 0.21-0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events.

Conclusions: Adeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.

Keywords: Diagnosis; Intracapsular tonsillectomy; Obstructive sleep apnea; Obstructive sleep disordered breathing; Outcome; Pediatric sleep questionnaire –sleep related breathing disorder; Tonsillotomy.