There is a growing awareness that sleep apnea in children may cause developmental delay, failure to thrive, cardio-respiratory complications and behavioral disorders.  Within the last ten years, the primary reason that children have had surgery to remove their tonsils and adenoids is not infection but obstructive sleep apnea (OSA)  with up to nine in ten having an adenotonsillectomy for this sleep disorder. 

A study by two members of the School of Medicine Department of Surgery faculty shows very young children can improve markedly after adenotonsillectomy for severe OSA, but the most have persistent symptoms of the disorder.  Children younger than age three years with obstructive sleep apnea usually have a number of concurrent but unrelated illnesses and the  study revealed they are at high-risk for complications after adenotonsillectomy, and should be kept hospitalized overnight following surgery for observation.

The authors of "Outcome of Adenotonsillectomy for Obstructive Sleep Apnea in Children under Three Years," Ron B. Mitchell MD, and James Kelly Ph.D., were both in the UNM Department of Surgery at the time of the study.  Dr. Mitchell is now affiliated with Virginia Commonwealth University in Richmond, VA.

The study showed that children under three years of age did show significant improvement in the respiratory distress index (RDI), defined as the average number of apneas and hypopneas per hour of sleep, as measured by a laboratory sleep study. 

Children younger than age three are considered to be at high-risk for the development of complications after adenotonsillectomy. 

These complications include respiratory compromise caused by edema in the relatively narrow oropharynx of a young child, circulatory collapse as a consequence of blood loss in a child with low blood volume reserves, and high rates of dehydration because of poor oral intake.    

The UNM study confirmed previous reports that children less than three years represent a high-risk group for complications after adenotonsillectomy for OSA.   More than 25 percent of the children included in the study were affected by complications that included laryngospasm, severe desaturations requiring supplemental oxygen and poor oral intake.  The average length of hospitalization was 2.4 days but about 30 percent of children stayed for four days or longer and some stayed as long as six days. Two children required monitoring in the intensive care unit.  

The number of children with severe OSA after surgery decreased significantly.  However, only seven children (35 percent) had complete resolution of OSA as measured by a post-operative RDI of less than five. Three children had persistent severe OSA after surgery and five others had minimum oxygen desaturations below 80 percent.  These findings imply that children younger than three years should have routine post-operative sleep studies to identify persistent OSA.

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Contact: Cindy Foster, 272-3322