Is it necessary to perform a follow-up study after adenotonsillectomy in all children with moderate-severe obstructive sleep apnoea?

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents' impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI < 2/h) after adenotonsillectomy was 80.48%. A very good correlation was observed between the parents' perception after treatment and the follow-up PSG parameters, specifically when the parents perceived that the patient had shown "complete resolution" (no snoring or apnoea), 90.62% of the children had an AHI < 2/h in the follow-up PSG, the maximum residual AHI being 2.6/h. In healthy children with no underlying pathology, the information provided by the parents on clinical progression after surgery could be useful and might enable the selection of those patients who require a follow-up study, avoiding overload in sleep units.

¿Es necesario repetir el estudio de sueño de control a todos los niños con SAHOS moderado-severo tras la cirugía? / Is it necessary to perform a follow-up study after adenotonsillectomy in all children with moderate-severe obstructive sleep apnoea?

La hipertrofia adenoamigdalar es, en niños sin patología de base, la causa más frecuente de SAHOS y, por tanto, la adenoamigdalectomía constituye la primera línea de tratamiento. Diferentes sociedades científicas recomiendan la realización de una PSG de control en el seguimiento, en caso de niños con patología de base o si el diagnóstico previo a la cirugía era de SAHOS moderado o severo, debido a la tendencia creciente de publicaciones con SAHOS residual tras adenoamigdalectomía. Se analiza retrospectivamente la correlación entre la percepción de los padres tras cirugía ORL y el resultado de la PSG de control en niños con diagnóstico de SAHOS severo en los que se ha realizado tratamiento quirúrgico. Se incluyeron 41 niños con SAHOS severo y cirugía adenoamigdalar, cuya tasa de curación ha sido del 80,48%. Se observa muy buena correlación entre la percepción de los padres tras el tratamiento y los índices en la PSG de control, destacando que cuando los padres percibían que el paciente había experimentado una «resolución completa» (no ronquido ni apneas), el 90,62% de los niños presentaban un IAHO<2/h en el control posterior al tratamiento, siendo el IAHO residual máximo de 2,6/h. Concluimos que, en un niño sin patología de base, la información aportada por los padres acerca de la evolución clínica tras la cirugía podría ser discriminativa para elegir a aquellos pacientes a los que solicitar un estudio de control, evitando sobrecargas en las unidades de sueño.(AU)

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents’ impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI <2/h) after adenotonsillectomy was 80.48%. A very good correlation was observed between the parents’ perception after treatment and the follow-up PSG parameters, specifically when the parents perceived that the patient had shown «complete resolution» (no snoring or apnoea), 90.62% of the children had an AHI <2/h in the follow-up PSG, the maximum residual AHI being 2.6/h. In healthy children with no underlying pathology, the information provided by the parents on clinical progression after surgery could be useful and might enable the selection of those patients who require a follow-up study, avoiding overload in sleep units.(AU)

Is it necessary to perform a follow-up study after adenotonsillectomy in all children with moderate-severe obstructive sleep apnoea? / ¿Es necesario repetir el estudio de sueño de control a todos los niños con SAHOS moderado-severo tras la cirugía?

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents' impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI <2/h) after adenotonsillectomy was 80.48%. A very good correlation was observed between the parents' perception after treatment and the follow-up PSG parameters, specifically when the parents perceived that the patient had shown «complete resolution¼ (no snoring or apnoea), 90.62% of the children had an AHI <2/h in the follow-up PSG, the maximum residual AHI being 2.6/h. In healthy children with no underlying pathology, the information provided by the parents on clinical progression after surgery could be useful and might enable the selection of those patients who require a follow-up study, avoiding overload in sleep units.

Specific IgE levels as an outcome predictor in egg-allergic children.

BACKGROUND: Diagnosis of immunoglobulin E (IgE)-mediated egg allergy is often based on both a compatible clinical history and either elevated IgE levels or a positive skin prick test. However, the gold standard is the oral food challenge (OFC). Previous studies have pointed to a correlation between IgE levels and OFC outcomes. OBJECTIVE: This study aimed to determine the relationship between IgE levels and the outcome of OFC, seeking to establish cut-off OFC values that indicate a high likelihood of positive OFC results. METHODS: A total of 198 patients who underwent OFC (and a serological IgE antibody assay within the three preceding months) were reviewed and divided by OFC type (i.e., baked, cooked, or raw egg). IgE-specific levels were assessed against the challenge outcome as well as cut-offs proposed by other authors. RESULTS: Receiver-operating characteristic (ROC) curve analysis yielded a potentially useful ovomucoid IgE-specific cutoff used in OFC with cooked egg and several egg white and ovalbumin IgE-specific cut-offs for OFC with raw egg. We found no significant relationship between other specific IgE concentrations and the challenge threshold level with baked eggs. CONCLUSIONS: IgE-specific concentrations are useful as predictors of OFC outcome and should be considered when selecting patients challenge testing with boiled or raw egg. However, patients should undergo OFC with baked egg regardless of IgE levels.

Specific IgE levels as an outcome predictor in egg-allergic children

BACKGROUND: Diagnosis of immunoglobulin E (IgE)-mediated egg allergy is often based on both a compatible clinical history and either elevated IgE levels or a positive skin prick test. However, the gold standard is the oral food challenge (OFC). Previous studies have pointed to a correla­tion between IgE levels and OFC outcomes. OBJECTIVE: This study aimed to determine the relationship between IgE levels and the outcome of OFC, seeking to establish cut-off OFC values that indicate a high likelihood of positive OFC results. METHODS: A total of 198 patients who underwent OFC (and a serological IgE antibody assay within the three preceding months) were reviewed and divided by OFC type (i.e., baked, cooked, or raw egg). IgE-specific levels were assessed against the challenge outcome as well as cut-offs proposed by other authors. RESULTS: Receiver-operating characteristic (ROC) curve analysis yielded a potentially useful ovomucoid IgE-specific cutoff used in OFC with cooked egg and several egg white and ovalbu­min IgE-specific cut-offs for OFC with raw egg. We found no significant relationship between other specific IgE concentrations and the challenge threshold level with baked eggs. CONCLUSIONS: IgE-specific concentrations are useful as predictors of OFC outcome and should be considered when selecting patients challenge testing with boiled or raw egg. However, patients should undergo OFC with baked egg regardless of IgE levels

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Análisis de la serie roja en niños con síndrome de apnea-hipopnea del sueño / Analysis of red blood cells in children diagnosed with obstructive sleep apnoea síndrome

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Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición / Postoperative complications after adenotonsillectomy in two paediatric groups: Obstructive sleep apnoea syndrome and recurrent tonsilitis

INTRODUCCIÓN Y OBJETIVOS: La adenoamigdalectomía es una cirugía indicada por amigdalitis recurrentes e igualmente por síndrome de apnea-hipopnea del sueño (SAHS). Es considerada segura y con pocas complicaciones. Así, en pacientes mayores de 3 años y sin comorbilidades no hay más complicaciones respiratorias (fuera del postoperatorio inmediato), por lo que no precisan la hospitalización rutinaria en la unidad de cuidados intensivos pediátricos, independientemente de la gravedad del SAHS. El objetivo de este estudio es reanalizar la situación, para comprobar que esta tendencia se mantiene, poniendo especial énfasis en menores de 3 años, subgrupo donde hay menos datos disponibles. MÉTODOS: Estudio retrospectivo observacional, incluyendo los niños adenoamigdalectomizados en nuestro centro durante 5 años. RESULTADOS: Se operaron 418 niños (56,7% por amigdalitis y 43,3% por SAHS). Solo 24 (5,7%) tuvieron complicaciones: un 1,2% vómitos, un 3,1% sangrados y un 1,4% complicaciones respiratorias. Estas últimas ocurrieron siempre en quirófano o recuperación postanestésica y más frecuentemente en SAHS grave, mientras que las amigdalitis tuvieron más sangrados (p = 0,046). No hay diferencias por edad (p = 0,174), aunque el subgrupo de menores de 3 años sigue siendo más pequeño. CONCLUSIONES: No encontramos diferencias en el porcentaje de complicaciones entre SAHS y amigdalitis. Las amigdalitis tienen más sangrados, y el SAHS grave más complicaciones respiratorias, pero siempre en el postoperatorio inmediato en nuestra serie. Estos datos apoyan la hipótesis previa de no ingresar rutinariamente en la unidad de cuidados intensivos pediátricos salvo en los casos anteriormente mencionados

INTRODUCTION AND OBJECTIVES: Adenotonsillectomy is a surgery to treat recurrent tonsillitis or obstructive sleep apnoea syndrome (OSAS). It is considered a safe procedure, with few complications. Moreover, patients over 3 years and without comorbidities do not present a higher rate of respiratory adverse events after the immediate postoperative period, and do not need systematic admission to a paediatric intensive care unit (PICU), regardless of their OSAS severity. The aim of this study is to reanalyse the situation, including patients under the age of 3 years, for whom there are fewer available data, to confirm that this trend has not changed. METHODS: A retrospective observational study was performed, including all adenotonsillectomised children in our hospital over 5 years. RESULTS: 418 adenotonsillectomised children were included, 56.7% due to recurrent tonsillitis, and 43.3% because of OSAS. Only 24 patients (5%7%) experienced adverse events, of whom 1.2% had vomiting, 3.1% bleeding, and 1.4% respiratory events. All the respiratory events occurred in the operating theatre or in the post-anaesthetic unit, most frequently in children with severe OSAS, while the tonsillitis group had more bleeding (P = .046). No differences in complications were observed according to age (P = 0.174), but the group of patients under three years was relatively small. CONCLUSIONS: No differences were found in the percentage of complications between the two groups. Although the OSAS group exhibited more respiratory events, these occurred in the immediate postoperative period; otherwise, there was a higher risk of bleeding in the tonsillitis group. These results support the findings indicating that routine PICU admission is not required for these patients

Postoperative complications after adenotonsillectomy in two paediatric groups: Obstructive sleep apnoea syndrome and recurrent tonsillitis. / Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición.

INTRODUCTION AND OBJECTIVES: Adenotonsillectomy is a surgery to treat recurrent tonsillitis or obstructive sleep apnoea syndrome (OSAS). It is considered a safe procedure, with few complications. Moreover, patients over 3 years and without comorbidities do not present a higher rate of respiratory adverse events after the immediate postoperative period, and do not need systematic admission to a paediatric intensive care unit (PICU), regardless of their OSAS severity. The aim of this study is to reanalyse the situation, including patients under the age of 3 years, for whom there are fewer available data, to confirm that this trend has not changed. METHODS: A retrospective observational study was performed, including all adenotonsillectomised children in our hospital over 5 years. RESULTS: 418 adenotonsillectomised children were included, 56.7% due to recurrent tonsillitis, and 43.3% because of OSAS. Only 24 patients (5%7%) experienced adverse events, of whom 1.2% had vomiting, 3.1% bleeding, and 1.4% respiratory events. All the respiratory events occurred in the operating theatre or in the post-anaesthetic unit, most frequently in children with severe OSAS, while the tonsillitis group had more bleeding (P=.046). No differences in complications were observed according to age (P=0.174), but the group of patients under three years was relatively small. CONCLUSIONS: No differences were found in the percentage of complications between the two groups. Although the OSAS group exhibited more respiratory events, these occurred in the immediate postoperative period; otherwise, there was a higher risk of bleeding in the tonsillitis group. These results support the findings indicating that routine PICU admission is not required for these patients.

Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy.

BACKGROUND: Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed. METHODS: We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change. RESULTS: Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed. CONCLUSION: The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.