Efficacy and Safety of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Across Various Age Groups: A Systematic Review

TL;DR

This study reviews how effective and safe adenotonsillectomy is for treating sleep apnea in children, finding it most beneficial for those aged 3 to 7.

Contribution

The paper provides age-specific insights into the efficacy and safety of adenotonsillectomy for pediatric obstructive sleep apnea.

Findings

Children under 7 years old showed greater improvement in sleep apnea severity and cardiovascular function after surgery.

Surgical complications were notably higher in children under 3 years old.

Cognitive and behavioral improvements were more linked to follow-up duration than age at surgery.

Abstract

Objectives: To assess the safety and efficacy of adenotonsillectomy (AT) for treating uncomplicated pediatric obstructive sleep apnea (OSA) in children of different ages. Methods: A systematic search was conducted in four electronic databases, and 71 studies with a total of 9087 participants were included in the analysis. The studies were all before-and-after studies, cohort studies, and randomized controlled trials. Surgical results were analyzed according to age, disease severity, and follow-up duration. Results: Children younger than 7 years at the time of AT had a significantly greater decrease in disease severity, a greater decrease in hypoxemic burden, improved sleep quality, and improved cardiovascular function than children older than 7 years. Both cognitive and behavioral performance improved postoperatively, although these changes were more significantly associated with the duration of follow-up than with age at surgery. Notably, the rate of surgical complications was much greater in children under the age of 3. Conclusions: The current evidence indicates that AT is performed optimally between the ages of 3 and 7 years, offering the greatest chance of disease resolution and remission of associated conditions, balanced with a reduction in surgical risk. We highly recommend conducting high-quality randomized controlled trials to further inform the clinical guidelines for pediatric AT.

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