Is adenotonsillectomy effective in improving central apnea events in patients with obstructive sleep apnea? A systematic review and meta-analysis.
Adenoidectomy
Adenotonsillectomy
Central apnea hypopnea
Central sleep apnea
Obstructive sleep apnea
Tonsillectomy
Journal
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN: 1434-4726
Titre abrégé: Eur Arch Otorhinolaryngol
Pays: Germany
ID NLM: 9002937
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
26
04
2023
accepted:
19
08
2023
medline:
2
11
2023
pubmed:
29
8
2023
entrez:
29
8
2023
Statut:
ppublish
Résumé
To evaluate the effects of adenotonsillectomy on improving central sleep apnea events in children with obstructive sleep apnea (OSA). We searched four online databases for relevant articles published from inception until October 2022. We included studies that measured the number of central apnea events per sleep and central apnea-hypopnea index (CAHI) or central apnea index (CAI) scores in children with OSA before and after adenotonsillectomy. Our primary outcomes were changes in CAI scores, the number of central apnea events per sleep, and CAHI scores after surgery. Our secondary outcomes were changes in total and mixed apnea events, improvement of sleep outcomes, and differences in oxygen or carbon dioxide saturation during sleep. We performed meta-analyses by pooling the mean changes of all included studies with a 95% confidence interval using Stata 17. Subsequently, we performed subgroup analyses based on the presence of comorbidities. We included 22 studies comprising 1287 patients. Central and total sleep apnea parameters, except for CAHI and mixed apnea index scores, showed significant improvements after surgery. In addition, all respiratory parameters and second and third stages of non-rapid eye movement sleep showed significant postsurgical improvements. Patients with comorbidities showed significant improvements only in the total apnea-hypopnea index, oxygen desaturation index, and minimal oxygen saturation. Adenotonsillectomy improves central apnea events in patients with OSA but not in those with comorbidities.
Identifiants
pubmed: 37642712
doi: 10.1007/s00405-023-08202-7
pii: 10.1007/s00405-023-08202-7
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
5205-5217Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Kaplan A, Ulualp SO (2022) Assessment of central sleep apnea events in children with sleep-disordered breathing. Sleep Disorders 2022:1–7. https://doi.org/10.1155/2022/2590337
doi: 10.1155/2022/2590337
American Academy of Sleep Medicine W (IL) (2005) American Academy of Sleep Medicine The international Classification of Sleep Disorders: Diagnostic and Coding Manual
Berry RB, Albertario CL, Harding SM, Lloyd RM, Plante DT, Quan SF, Troester, MM, Vaughn BV, American Academy of Sleep Medicine (2018) The AASM Manual for the Scoring of Sleep and Associated Events. Darien, Ilinois
American Academy of Sleep Medicine (2014) International classification of sleep disorders. In: 3rd ed. Darien, IL https://learn.aasm.org/Listing/a1341000002XmRvAAK . Accessed 3 Jan 2023
Gouthro K, Slowik JM (2022) Pediatric obstructive sleep apnea. StatPearls, Treasure Island
McLaren AT, Bin-Hasan S, Narang I (2019) Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatr Respir Rev 30:49–57. https://doi.org/10.1016/j.prrv.2018.07.005
doi: 10.1016/j.prrv.2018.07.005
pubmed: 30170958
Sullivan CE, Kozar LF, Murphy E, Phillipson EA (1978) Primary role of respiratory afferents in sustaining breathing rhythm. J Appl Physiol 45:11–17. https://doi.org/10.1152/jappl.1978.45.1.11
doi: 10.1152/jappl.1978.45.1.11
pubmed: 209006
Muza RT (2015) Central sleep apnoea—a clinical review. J Thorac Dis 7:930–937. https://doi.org/10.3978/j.issn.2072-1439.2015.04.45
doi: 10.3978/j.issn.2072-1439.2015.04.45
pubmed: 26101651
pmcid: 4454847
Judd RT, Mokhlesi B, Shogan A, Baroody FM (2022) Improvement in central sleep apnea following adenotonsillectomy in children. Laryngoscope. https://doi.org/10.1002/lary.29784
doi: 10.1002/lary.29784
pubmed: 35642620
Katz S, Murto K, Barrowman N et al (2015) Neck circumference percentile: a screening tool for pediatric obstructive sleep apnea. Pediatr Pulmonol 50:196–201. https://doi.org/10.1002/ppul.23003
doi: 10.1002/ppul.23003
pubmed: 24574055
Bradley TD, Brown IG, Zamel N et al (1987) Differences in pharyngeal properties between snorers with predominantly central sleep apnea and those without sleep apnea. Am Rev Respir Dis 135:387–391. https://doi.org/10.1164/arrd.1987.135.2.387
doi: 10.1164/arrd.1987.135.2.387
pubmed: 3813202
Del-Río Camacho G, Medina Castillo L, Rodríguez-Catalán J et al (2019) Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy. Pediatr Pulmonol. https://doi.org/10.1002/ppul.24469
doi: 10.1002/ppul.24469
pubmed: 31373175
Friedman M, Wilson M, Lin H-C, Chang H-W (2009) Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 140:800–808. https://doi.org/10.1016/j.otohns.2009.01.043
doi: 10.1016/j.otohns.2009.01.043
pubmed: 19467393
Marcus CL, Brooks LJ, Draper KA et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:e714-755. https://doi.org/10.1542/peds.2012-1671
doi: 10.1542/peds.2012-1671
pubmed: 22926176
Arima S, Koike S, Fujinaga M et al (2019) Normalization of breathing with adenotonsillectomy in Japanese pediatric OSA. Auris Nasus Larynx 46:758–763. https://doi.org/10.1016/j.anl.2019.01.001
doi: 10.1016/j.anl.2019.01.001
pubmed: 30799139
Venekamp RP, Hearne BJ, Chandrasekharan D et al (2015) Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011165.pub2
doi: 10.1002/14651858.CD011165.pub2
pubmed: 26465274
pmcid: 9242010
Todd CA, Bareiss AK, McCoul ED, Rodriguez KH (2017) Adenotonsillectomy for obstructive sleep apnea and quality of life: systematic review and meta-analysis. Otolaryngol Head Neck Surg 157:767–773. https://doi.org/10.1177/0194599817717480
doi: 10.1177/0194599817717480
pubmed: 28675097
Galluzzi F, Garavello W (2021) Impact of adenotonsillectomy in children with severe obstructive sleep apnea: a systematic review. Auris Nasus Larynx 48:549–554. https://doi.org/10.1016/j.anl.2020.10.008
doi: 10.1016/j.anl.2020.10.008
pubmed: 33109425
Page MJ, Moher D, Bossuyt PM et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ (Clin Res ed) 372:n160–n160. https://doi.org/10.1136/bmj.n160
doi: 10.1136/bmj.n160
The National Heart Lung and Blood Institute. Quality assessment tool for case series studies. Available at http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/case_series . Accessed Oct 2014
Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clin Res) 343:d5928. https://doi.org/10.1136/bmj.d5928
doi: 10.1136/bmj.d5928
Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clin Res) 355:i4919. https://doi.org/10.1136/bmj.i4919
doi: 10.1136/bmj.i4919
Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev 10:ED000142
pubmed: 31643080
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res ed) 315:629–634. https://doi.org/10.1136/bmj.315.7109.629
doi: 10.1136/bmj.315.7109.629
da Rocha M, Ferraz RCM, Guo Chen V et al (2017) Clinical variables determining the success of adenotonsillectomy in children with Down syndromed. Int J Pediatr Otorhinolaryngol 102:148–153. https://doi.org/10.1016/j.ijporl.2017.09.017
doi: 10.1016/j.ijporl.2017.09.017
pubmed: 29106863
Fehrm J, Nerfeldt P, Browaldh N, Friberg D (2020) Effectiveness of adenotonsillectomy vs watchful waiting in young children with mild to moderate obstructive sleep apnea: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 146:647–654. https://doi.org/10.1001/jamaoto.2020.0869
doi: 10.1001/jamaoto.2020.0869
pubmed: 32463430
pmcid: 7256861
Mitchell RB, Kelly J (2007) Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 137:43–48. https://doi.org/10.1016/j.otohns.2007.03.028
doi: 10.1016/j.otohns.2007.03.028
pubmed: 17599563
Mitchell RB (2007) Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 117:1844–1854. https://doi.org/10.1097/MLG.0b013e318123ee56
doi: 10.1097/MLG.0b013e318123ee56
pubmed: 17721406
Mukhatiyar P, Nandalike K, Cohen HW et al (2016) Intracapsular and extracapsular tonsillectomy and adenoidectomy in pediatric obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 142:25–31. https://doi.org/10.1001/jamaoto.2015.2603
doi: 10.1001/jamaoto.2015.2603
pubmed: 26583828
Nieminen P, Tolonen U, Löppönen H (2000) Snoring and obstructive sleep apnea in children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg 126:481–486. https://doi.org/10.1001/archotol.126.4.481
doi: 10.1001/archotol.126.4.481
pubmed: 10772301
Øverland B, Berdal H, Akre H (2021) Surgery for obstructive sleep apnea in young children: outcome evaluated by polysomnograhy and quality of life. Int J Pediatr Otorhinolaryngol 142:110609. https://doi.org/10.1016/j.ijporl.2021.110609
doi: 10.1016/j.ijporl.2021.110609
pubmed: 33418205
Pavone M, Paglietti MG, Petrone A et al (2006) Adenotonsillectomy for obstructive sleep apnea in children with Prader-Willi syndrome. Pediatr Pulmonol 41:74–79. https://doi.org/10.1002/ppul.20334
doi: 10.1002/ppul.20334
pubmed: 16283627
Saadeh C, Ulualp SO (2021) The effect of tonsillectomy and adenoidectomy on isolated sleep associated hypoventilation in children. Laryngoscope 131:E1380–E1382. https://doi.org/10.1002/lary.29079
doi: 10.1002/lary.29079
pubmed: 32876345
Suen JS, Arnold JE, Brooks LJ (1995) Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 121:525–530. https://doi.org/10.1001/archotol.1995.01890050023005
doi: 10.1001/archotol.1995.01890050023005
pubmed: 7727086
Thottam PJ, Choi S, Simons JP, Kitsko DJ (2015) Effect of adenotonsillectomy on central and obstructive sleep apnea in children with down syndrome. Otolaryngol Head Neck Surg (US) 153:644–648. https://doi.org/10.1177/0194599815587877
doi: 10.1177/0194599815587877
Baldassari CM, Kepchar J, Bryant L et al (2012) Changes in central apnea index following pediatric adenotonsillectomy. Otolaryngol-Head Neck Surg 146:487–490. https://doi.org/10.1177/0194599811428118
doi: 10.1177/0194599811428118
pubmed: 22075072
Abijay CA, Tomkies A, Rayasam S et al (2022) Children with down syndrome and obstructive sleep apnea: outcomes after tonsillectomy. Otolaryngol Head Neck Surg (US) 166:557–564. https://doi.org/10.1177/01945998211023102
doi: 10.1177/01945998211023102
Al-Zaabi K, Al-Adawi S, Jaju S et al (2018) Effects of an adenotonsillectomy on the cognitive and behavioural function of children who snore: a naturalistic observational study. Sultan Qaboos Univ Med J 18:e455–e460. https://doi.org/10.18295/squmj.2018.18.04.005
doi: 10.18295/squmj.2018.18.04.005
pubmed: 30988963
Alonso-Álvarez ML, Terán-Santos J, Navazo-Egüia AI et al (2015) Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study. Eur Respir J 46:717–727. https://doi.org/10.1183/09031936.00013815
doi: 10.1183/09031936.00013815
pubmed: 26065566
Booth KL, Levy DA, White DR et al (2020) Management of obstructive sleep apnea in children with achondroplasia: outcomes of surgical interventions. Int J Pediatr Otorhinolaryngol 138:110332. https://doi.org/10.1016/j.ijporl.2020.110332
doi: 10.1016/j.ijporl.2020.110332
pubmed: 32898830
Borgström A, Nerfeldt P, Friberg D (2017) Adenotonsillotomy versus adenotonsillectomy in pediatric obstructive sleep apnea: an RCT. Pediatrics 139:e20163314. https://doi.org/10.1542/peds.2016-3314
doi: 10.1542/peds.2016-3314
pubmed: 28320866
Boudewyns A, Van de Heyning P, Verhulst S (2016) Central apneas in children with obstructive sleep apnea syndrome: prevalence and effect of upper airway surgery. Sleep Med 25:93–97. https://doi.org/10.1016/j.sleep.2016.05.018
doi: 10.1016/j.sleep.2016.05.018
pubmed: 27823724
Kritzinger FE, Al-Saleh S, Narang I (2011) Descriptive analysis of central sleep apnea in childhood at a single center. Pediatr Pulmonol 46:1023–1030. https://doi.org/10.1002/ppul.21469
doi: 10.1002/ppul.21469
pubmed: 21520440
Xie A, Bedekar A, Skatrud JB et al (2011) The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea). Sleep 34:745–750. https://doi.org/10.5665/SLEEP.1040
doi: 10.5665/SLEEP.1040
pubmed: 21629362
pmcid: 3099495