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Surgical Philosophy for Children

Philosophy of Pediatric Sleep Apnea Surgery

Obstructive sleep apnea affects up to 10% of children. Symptoms of obstructive sleep apnea in children may consist of restless sleep, sweating during sleep, snoring, night terror, sleepwalking, bed wetting, daytime fatigue, hyperactive behavior and poor school performance due to an inability to concentrate. It is important to emphasize that the signs and symptoms of obstructive sleep apnea in children are much more subtle than in adults. Children rarely stop breathing, and snoring may be very limited or non-existent. Many children only exhibit attention-deficit and hyperactive behaviors. In addition, since obstructive sleep apnea is a familial problem, it is commonly seen in siblings.

The cause of obstructive sleep apnea in children is usually due to enlarged adenoid and tonsillar tissues. Nasal obstruction due to enlarged nasal turbinates and jaw deformity can also be major contributors to developing obstructive sleep apnea.

The primary treatment for obstructive sleep apnea in children is adenoidectomy and tonsillectomy. Occasionally, turbinate reduction by radiofrequency may be performed in conjunction to enlarge the nasal airway.

A sleep study (polysomnogram) to confirm the presence of obstructive sleep apnea before surgery is often recommended but is not mandatory when there are obvious signs and symptoms of it. A sleep study after surgery is more important in order to determine the extent of the improvement from surgery. Although the success rate is quite high at approximately 80%, many children still exhibit residual problems. Additional treatment options such as nasal CPAP (continuous positive airway pressure), orthodontic therapy to widen the jaw or even future jaw surgery may be considered.

 

 

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