Does adenotonsillectomy cure hypoxaemia in children with sleep apnoea and congenital cardiac pathology?
BACKGROUND
Adenotonsillectomy usually cures obstructive sleep apnoea in otherwise healthy children. When children, with congenital cardiac pathology, suffer sleep hypoxaemia following their corrective cardiac surgery, they are referred to an otolaryngologist for adenotonsillectomy. Hardly any studies have been published to show how effective this operation is for these children.


OBJECTIVE
To determine whether adenotonsillectomy significantly improves hypoxaemia in children with congenital cardiac pathology following corrective cardiac surgery.


METHODS
Thirty children with sleep apnoea (aged 2-8 years) were recruited. Fifteen children with congenital cardiac pathology (Gp I) and 15 children who were otherwise healthy (Gp II). All children were assessed pre-operatively and at 1 and 3 months post-operatively with transcutaneous oxygen saturation monitoring. Tonsillar size, base oxygen saturation level, apnoeic episodes and snoring were recorded. Sleep apnoea and snoring was graded on a 5 point scale from I (no apnoea/snoring) to V (severe apnoea and snoring).


RESULTS
All children had an initial sleep grade of IV or V. Tonsillar size did not appear to be a significant factor on sleep grade in Gp I and Gp II. The median base line oxygen saturation was 88 and 93%, respectively in Gp I and II pre-operatively and improved to 90.1 and 99.2%, post-operatively. Following surgery, snoring and sleep apnoea disappeared in group II. In group I, there was significant reduction in the number of apnoeic episodes at 3 months, but the majority of children were still snoring with hypoxaemic episodes.


CONCLUSIONS
This study shows that adenotonsillectomy significantly reduces the apnoeic episodes in children with cardiac pathology but does not abolish it. At 3 months after surgery there was significant overall improvement in the baseline oxygen saturation.
Nandapalan
V
V
Department of Otolaryngology, Alder Hey Children's Hospital, UK.
McCormick
M S
MS
Jones
T M
TM
Gibson
H
H
D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D011182:Postoperative Care; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome