Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome.
OBJECTIVE
Perform an updated systematic review and meta-analysis to determine the cure rate of tonsillectomy and adenoidectomy (T&A) for pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS).


METHODS
A systematic review was performed to identify English-language studies that evaluate the treatment of pediatric (age < 20 years) OSAHS patients with T&A using polysomnography as a metric of cure. Twenty-three studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success. Meta-analysis was also performed to determine the success in obese and comorbid populations vs cohorts of healthy children.


RESULTS
The meta-analysis included 1079 subjects (mean sample size of 42 patients) with a mean age of 6.5 years. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k = 22 studies) with T&A based on preoperative and postoperative PSG data. Random-effects model estimated the treatment success of T&A was 66.3 percent, when cure was defined per each individual study. When "cure" was defined as an apnea-hypopnea index (AHI) of <1 (k = 9 studies), random-effects model estimate for OSAHS treatment success with T&A was 59.8 percent. Postoperative mean AHI was significantly decreased from preoperative levels.


CONCLUSIONS
Contrary to popular belief, meta-analysis of current literature demonstrates that pediatric sleep apnea is often not cured by T&A. Although complete resolution is not achieved in most cases, T&A still offers significant improvements in AHI, making it a valuable first-line treatment for pediatric OSAHS.
Friedman
Michael
M
Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA. hednnek@aol.com
Wilson
Meghan
M
Lin
Hsin-Ching
HC
Chang
Hsueh-Wen
HW
D000233:Adenoidectomy; D002648:Child; D015897:Comorbidity; D019317:Evidence-Based Medicine; D006801:Humans; D015233:Models, Statistical; D009765:Obesity / Q000150:complications; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy