Adenotonsillectomy Helps At-Risk Preschoolers With Obstructive Sleep Apnea

Jennifer Reid Holman

June 10, 2004

June 10, 2004 (Philadelphia) — Low-income preschool children who are diagnosed with obstructive sleep apnea (OSA) may reap significant cognitive and sleep/breathing pattern benefits from adenotonsillectomy (T&A) treatment, according to research presented here at the Associated Professional Sleep Societies annual meeting.

The population of low-income preschoolers was of particular interest in this study, according to lead investigator Hawley E. Montgomery-Downs, PhD, a postdoctoral research fellow at the University of Louisville Kosair Children's Hospital in Kentucky, because animal models have shown that an impoverished environment can increase susceptibility to OSA and enhance its effects.

The researchers first identified the 19 treatment candidates followed in this community study by distributing questionnaires to nearly 2,000 parents of children attending a Texas-based Jump Start early preschool program, which enrolls three- to five-year-old children who live at or below poverty levels. The children for whom T&A surgery was recommended included those who reportedly snored loudly at least three nights per week and who also exhibited sleep architecture disorders based on standard overnight polysomnography (PSG). The 19 preschoolers who underwent T&A surgery were matched with 19 nonsnoring control children who also underwent PSG and cognitive studies.

Initially, the preschoolers diagnosed with OSA scored significantly lower on the Differential Ability Scales (DAS) cognitive testing than did control subjects. At follow-up testing four months after surgery, cognitive function had improved to the point that no statistical difference in DAS scores was seen between children with OSA and control children postoperatively.

In addition, the preschoolers who underwent T&A showed normalized sleep patterns after surgery. The data revealed an increase in the percentage of slow-wave delta sleep and a decrease in the percentage of REM sleep. Statistical improvements in OSA indices were also noted, including improved respiratory and total arousal indices, apnea index, and apnea-hypopnea-index. At the four-month follow-up, there were no significant differences in either sleep or breathing patterns between the preschoolers with OSA and the healthy control children.

T&A surgery is considered a first-line treatment for children with OSA. Although sleep and breathing patterns were normalized in all the preschoolers with OSA treated in this study, "we know T&A is not uniformly efficacious in all children with obstructive sleep apnea, and it's hard to predict who are the best candidates," Dr. Montgomery-Downs told Medscape.

Nonetheless, she said the study highlights the possible value of instituting outreach screening programs to low-income preschool-aged children who may be particularly vulnerable to developing OSA. More parental education may also help, she suggested. "Some of the parents said they thought snoring was a sound of good healthy sleep. And some were more worried about their children after the surgery," she said.

The research was funded by grants from the U.S. Department of Education, the Centers for Disease Control and Prevention, and the National Institutes of Health.

APSS 18th Annual Meeting: Abstract 185. Presented June 9, 2004.

Reviewed by Gary D. Vogin, MD

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