Surgery May Help Sleep Disorder in Young Children

NEW YORK (Reuters Health) - In children under the age of three who have obstructive sleep apnea (OSA), removal of the tonsils and adenoids (adenotonsillectomy) often leads to significant improvements in sleep, a new study shows. OSA is a disorder in which the airway repeatedly becomes blocked during sleep resulting in a temporary halt in breathing, which can lead to very poor quality sleep and subsequent daytime drowsiness.

However, youngsters who are candidates for the procedure are also more likely than older children to have other illnesses and problems during and after surgery.

"Children under three years are at high-risk for complications after adenotonsillectomy and should be observed overnight in hospital following surgery," Dr. Ron B Mitchell from the Virginia Commonwealth University in Richmond told Reuters Health.

Dr. Mitchell and Dr. James Kelly from the University of New Mexico Health Sciences Center in Albuquerque evaluated the changes in sleep after adenotonsillectomy in 20 children who ranged in age from one to three years old. All of the children underwent full-night sleep monitoring before and approximately seven months after surgery.

Sixteen (80 percent) of the children had other medical conditions, most commonly gastroesophageal reflux disease, asthma, obesity, Down's syndrome, and congenital heart disease, according to the investigators' report in the May issue of Otolaryngology - Head and Neck Surgery.

Mitchell and Kelly found that adenotonsillectomy led to significant improvement in measures of respiratory distress.

"In a proportion of these young children, sleep improves but does not normalize," Mitchell noted in comments to Reuters Health. "A sleep-study, or polysomnography, is therefore recommended in all children under three after adenotonsillectomy for OSA."

It is also noteworthy, he said, that more than 25 percent of children developed postoperative complications, which highlights the need for overnight observation following surgery.

SOURCE: Otolaryngology - Head and Neck Surgery, May 2005.