Abstract
Background: sleep apnea is a clinical entity characterized by the presence of apnea events during sleep present in his side rapid eye movement to an obstruction of the airway. Among the therapeutic strategies exist surgical management (tonsillectomy) and medical management with positive pressure devices in the area continues (CPAP), which can be used according to the selection of the case by the characteristics of our patients. Objective: to evaluate the therapeutic efficacy of tonsillectomy comparing it with other therapeutic alternatives for obstructive sleep apnea syndrome through a systematic literature review. Methods: a systematic literature review of randomized controlled trials was performed. Studies were included if the target population was included child and if the clinical and / or surgical evaluation of such interventions tonsillectomy in the management of sleep apnea syndrome; outcome measures included, improvement in polysomnography parameters, improvement instruments in functionality for this health condition, intraoperative blood loss, operative time and post operative pain. Results: were included for this review 5 studios and a significantly higher quality of life improvement, and behavioral outcomes , polysomnographic was observed in the adenotonsillectomy group early in the watchful waiting group . Normalization of polysomnographic findings were observed in a higher proportion of children in the adenotonsillectomy group early in the expectant management group (79% vs 46%). Conclusions: the primary tonsillectomy is an effective intervention for the management of obstructive sleep apnea syndrome in children between 0-18 years old.
References
ICSD- International classification of sleep disorders: diagnostic and coding manual. Diagnostic Classification Steering Committee. American Sleep.Thorpy MJ, Chairman. American Sleep Disorders Association, 2001.
American Academy of Pediatrics. Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109:704-12. https://doi.org/10.1542/peds.109.4.704
American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. En: Diagnostic and coding manual. Westchester: American Academy of Sleep Medicine; 2005.
Teculescus DB, Cailluier I, Perrin R, Rebstock E, Rauch A. Snoring in French preschool children. Pediatr Pulmonol. 1992; 13:239-44. https://doi.org/10.1002/ppul.1950130412
Consensus document on sleep apnea-hypopnea syndrome in children (full version), M.L. Alonso-Álvarez et al / Arch Bronconeumol. 2011; 47 (Supl 5):2-18
Isono S, Shimada A, Utsugi M y cols. Comparision of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing. Am J RespirCrit Care Med 1998; 157:1204-1212. https://doi.org/10.1164/ajrccm.157.4.9702042
Hui-Leng Tan,DavidGozal, Leila Kheirandish-Gozal1, Obstructive sleep apnea in children: a critical update, Nature and Science of Sleep March 2013 Volume 2013:5 Pages 27 - 35.
Marcus CL, Brooks LJ, Draper KA, et al; American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130(3):576-584. https://doi.org/10.1542/peds.2012-1671
Owens J.A, Mehlenbeck R, Lee J, King MN. Effect of weight, sleep duration and co morbid sleep disorders on behavioral outcomes in children with sleep-disordered breathing. Arch Pediatric Adolescent Med. 2008; 162:313-21. https://doi.org/10.1001/archpedi.162.4.313
Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behaviour, and cognition in children before and after adenotonsillectomy. Pediatrics.2006; 117(4):e769-e778. https://doi.org/10.1542/peds.2005-1837
Friedman BC, Hendeles-Amitai A, Kozminsky E, et al. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep. 2003; 26(8):999-1005. https://doi.org/10.1093/sleep/26.8.999
Marcus CL, Brooks LJ, Draper KA , at al; American Academy of Pediatrics. Diagnosis an management of childhood sleep apnea syndrome. Pediatric.2012; 130(3):e714-e755. https://doi.org/10.1542/peds.2012-1672
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds JM, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin. Trials 1996, 17:1-2. https://doi.org/10.1016/0197-2456(95)00134-4
Berger VW, Alperson SY: A General Framework for the Evaluation of Clinical Trial Quality. Rev Recent Clin Trials 2009, 4:79-88. https://doi.org/10.2174/157488709788186021
Hedges LV, Olkin I: Statistical methods for meta-analysis. Orlando: Academic Press; 1985:108-138.
Marcus CL, Moore RH, Rosen CL, et al; Childhood Adeno-tonsillectomy Trial (CHAT).A randomized trial of adeno-tonsillectomy for childhood sleep apnea. N England J Med. 2013; 368(25):2366-2376. https://doi.org/10.1056/NEJMoa1215881
Paramasivan VK, Arumugam SV, Kameswaran M. Randomised comparative study of adenotonsillectomy by conventional and coblation method for children with obstructive sleep apnoea.Int J Pediatr Otorhinolaryngol. 2012 Jun;76 (6):816-21. https://doi.org/10.1016/j.ijporl.2012.02.049
Stephens J, Singh A, Hughes J, Goswami T, Ghufoor K, Sandhu G. A prospective multi-centre randomised controlled trial comparing PlasmaKnife with bipolar dissection tonsillectomy: evaluating an emerging technology.Int J Pediatr Otorhinolaryngol. 2009 Apr https://doi.org/10.1016/j.ijporl.2008.12.008 73 (4):597-601.
Rivero Millán p., Domínguez Reyes A; La Apnea del Sueño en el niño, Sociedad de Pediatría de Andalucía occidental y Extremadura Vox Paediatrica abril 2011; XVIII (1):77-85.
Maya Capua, Negar Ahmadi, Colin Shapiro. Overview of Obstructive Sleep Apnea in Children: Exploring the Role of Dentists in Diagnosis and Treatment. JCDA 2009 May; 75 (4).
Carvalho FR et al. Aparatos bucales y aparatos ortopédicos funcionales para la apnea obstructiva del sueño en niños. The Cochrane Collaboration. Febrero 2007.
López-Herce Cid J, García Teresa MªA. El síndrome de apnea obstructiva del sueño. An. Esp. Pediatric 1991;35 (5):301-306.
Gozal D. Serum, urine, and breath-related biomarkers in the diagnosis of obstructive sleep apnea in children: is it for real? Curr Opin Pulm Med. 2012;18(6):561-567" https://doi.org/10.1097/MCP.0b013e328358be2d