Adenotonsillectomy for childhood obstructive sleep apnoea reduces thoraco-abdominal asynchrony but spontaneous apnoea-hypopnoea index normalisation does not.
The efficacy of adenotonsillectomy for treating obstructive sleep apnoea syndrome (OSAS) in children has been established, but its precise effects on inspiratory effort are not well documented.In 353 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either early adenotonsillectomy (n=182) or a strategy of watchful waiting with supportive care (WWSC) (n=171), thoraco-abdominal asynchrony (TAA) was analysed during quiet, non-apnoeic and non-hypopnoeic breathing during sleep at baseline and at 7 months using overnight polysomnography.Children who underwent early adenotonsillectomy demonstrated a reduction in TAA post-surgery while the WWSC arm showed no change. On assessing TAA with regard to normalisation of clinical polysomnography findings at follow-up, TAA was reduced in children who had surgical resolution of OSAS (based on apnoea-hypopnoea index), but not in children who displayed spontaneous normalisation of apnoea-hypopnoea index. In the latter group, TAA was inversely correlated with quality of life.We conclude that adenotonsillectomy reduces TAA during quiet sleep. Monitoring of instantaneous TAA may yield additional insight in the dynamic changes of inspiratory effort. In combination with traditional indices of obstruction, TAA may more accurately characterise the degree of sleep-disordered breathing in children.
School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.
Xiao
X
Liu
School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.
Sarah
S
Immanuel
Dept of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia.
Yvonne
Y
Pamula
Dept of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia.|Children's Research Centre, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
Declan
D
Kennedy
Dept of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia.
James
J
Martin
School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia mathias.baumert@adelaide.edu.au.
Mathias
M
Baumert
D000233:Adenoidectomy; D002648:Child; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D064926:Neurophysiological Monitoring; D017286:Polysomnography; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology; D014068:Tonsillectomy; D016896:Treatment Outcome; D014481:United States