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Children with Extreme OSA Need Extra Care After Surgery

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A recent study published in the journal Sleep Medicine examined how tonsillectomy and adenectomy surgery affects children with extreme sleep apnea.  This surgery is often the first line of treatment for children with obstructive sleep apnea.   However, because it’s performed under general anesthesia, it can be especially dangerous for children who already have breathing problems.

The researchers defined “extreme OSA” as a child having more than 100 apnea or hypopnea incidents in an hour during sleep.  This was a fairly small group of children, and it tilted male (80.5%), Hispanic (73.2%), and obese (92.7%).  As a result, the researchers warned that the results may not be universally applicable.

The risks of T&A, and what to do about them

28 patients in the study underwent T&A surgery. They skewed younger and less obese than the group as a whole, since the surgery is most effective in younger children and because extreme obesity is a contraindicator for surgery because of the risks from anesthesia.  Of these 28 children, 11 required breathing support after surgery.  6 of them needed oxygen with a nasal cannula, and 5 needed emergency PAP support in addition to oxygen.  After surgery, all children showed an improvement in symptoms, but some had a high enough Apnea-Hypopnea Index to require long-term PAP therapy.

The researchers concluded that for children with extreme OSA, surgery can be helpful, but that they should receive follow-up care in an ICU setting until their breathing recovers. It’s an important reminder that surgery, even routine surgery, can carry real risks, especially for our patients with severe OSA. On the other hand, the patients who did not undergo surgery were prescribed PAP therapy, and only 57% of them complied with therapy.  That means that there are a significant number of children who essentially received no treatment at all for their OSA.

What does this mean for my practice?

What are the takeaways for those of us who practice dental sleep medicine?

  • T&A surgery has very real risks. Surgery, and especially anesthesia, are always risky. It’s important for you and the parents of your patients to understand this.
  • Establish nasal breathing first.  Mouth breathing can irritate tonsils and adenoids. In these cases, the enlargement is a symptom of the airway issues, not a cause.  Oral-myofunctional therapy can help you establish nasal breathing.  If a child is mouth breathing, find out why!
  • PAP therapy is hard for kids to comply with. Studies continue to show that kids have trouble complying with treatment plans that involve PAP.  Remember, a treatment plan that the patient can’t use is not a real treatment.  There’s a need for alternatives to PAP therapy for these kids.
  • If you haven’t yet been trained in pediatric sleep dentistry, your community needs you to add this specialty. Kids are going without treatment due to a shortage of pediatric dentists who can provide sleep services.  Get trained.

Are you ready to take the next step to preserve the health of your patients?  Dr. Dassani has a full range of courses so that you can find one that suits your schedule and learning style!