title: Outcomes of adenotonsillectomy in patients with Prader-Willi syndrome.
abstract: OBJECTIVE
  To assess the efficacy of upper airway surgical intervention in patients with Prader-Willi syndrome (PWS). Due to reports of sudden death in children undergoing treatment with growth hormone for PWS, detection of sleep-disordered breathing by polysomnography (PSG) has been recommended.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Multidisciplinary PWS Center at a tertiary care children's hospital.
  
  
  METHODS
  Thirteen pediatric patients with PWS who underwent adenotonsillectomy (T&A) with pre-PSG and post-PSG.
  
  
  METHODS
  Comparison of PSG results before and after T&A.
  
  
  RESULTS
  Six of our patients were girls (46%); 8 had genetic characteristics consistent with deletion (61%), and the remaining 5 had genetic characteristics consistent with uniparental disomy (39%). The median age at T&A was 3 years (age range, 6 months to 11 years), and the median age at start of growth hormone treatment was 8.5 months (range, 2 months to 6 years). Nine of the 13 patients had mild to moderate obstructive sleep apnea (OSA) or obstructive hypoventilation (69%); in 8 of these 9, breathing normalized after T&A. Four children had severe OSA prior to surgery (31%). Breathing normalized in 2 of these after surgery, but 2 had PSG findings of residual combined obstructive and central apneas postoperatively.
  
  
  CONCLUSIONS
  Adenotonsillectomy, while effective in most children with PWS who demonstrate mild to moderate OSA, may not be curative in children with severe OSA. An increase in central apneas can occur in some children with PWS postoperatively, and it is important to repeat PSG after surgery. Further studies are necessary to determine optimal treatment for some children with PWS and sleep-disordered breathing.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Meyer
authors.forename: Mark
authors.initials: M
authors.lastname: Splaingard
authors.forename: David R
authors.initials: DR
authors.lastname: Repaske
authors.forename: William
authors.initials: W
authors.lastname: Zipf
authors.forename: Joan
authors.initials: J
authors.lastname: Atkins
authors.forename: Kris
authors.initials: K
authors.lastname: Jatana
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011218:Prader-Willi Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome