What is the role of adenotonsillectomy in childhood obstructive sleep apnea (OSA) treatment?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Obstructive sleep apnea in pediatric patients generally responds to adenotonsillectomy. However, not all children with obstructive sleep apnea (OSA) are surgical candidates.

Adenotonsillectomy, along with weight normalization, is considered the first line of therapy in children and adolescents with obstructive sleep apnea. Surgically removing the tonsils and adenoids increases cross-sectional airway caliber in patients, although it does not directly affect the fatty infiltration of the soft tissues of the velopharynx and hypopharynx that occurs in children who are obese. Children with obstructive sleep apnea who are obese generally require follow-up polysomnography 8-12 weeks following adenotonsillectomy to assess for residual sleep apnea and determine whether other interventions (eg, continuous positive airway pressure [CPAP]) are needed.

Children with severe obstructive sleep apnea require overnight hospital observation following adenotonsillectomy, especially if they fall into one of the high-risk groups.

Absence of snoring following surgery does not equal an absence of obstructive apnea.

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