Nocturnal oximetry results can be used to identify children with sleep-disordered breathing who are most likely to benefit from adenotonsillectomy, researchers report.

Adenotonsillar hypertrophy leading to increased upper airway resistance is the main pathogenetic mechanism of obstructive sleep-disordered breathing (SDB) in children.

But the efficacy of adenotonsillectomy in otherwise healthy children with SDB related to pharyngeal lymphoid tissue hypertrophy has not been assessed in randomized controlled trials by using oximetry, researchers say.

Dr. Athanasios G. Kaditis from National and Kapodistrian University of Athens, Greece, and colleagues evaluated the efficacy of adenotonsillectomy in children with SDB, hypothesizing that children with SDB and abnormal nocturnal oximetry would have improved hypoxemia indices after adenotonsillectomy.

Adenotonsillectomy

Over the three-month study period, the percentage of children with an abnormal baseline McGill oximetry score (MOS >1) who achieved a normal MOS did not differ significantly between the adenotonsillectomy group and the control group.

The median decline in the number of episodes per hour of oxygen desaturation of 3% or greater (ODI3) by nocturnal oximetry between baseline and follow-up was significantly greater in the adenotonsillectomy group (3.2) than in the control group (1.7), the researchers report in Pediatrics, online August 7.

Moreover, children in the adenotonsillectomy group were significantly more likely than children in the control group to normalize their ODI3 at follow-up, after adjusting for baseline ODI3, age, sex and presence of obesity. A preoperative ODI3 of 3.5 episodes per hour or greater was associated with attainment of normal ODI3 in about 40% of patients after adenotonsillectomy.

Three children with elevated ODI3 needed to undergo adenotonsillectomy to prevent two or more ODI3 episodes per hour in one child at the three-month follow-up, that is, the number needed to treat was three.

Children in the adenotonsillectomy group had significantly more significant improvements in disease-specific quality-of-life scores between baseline and three months than did children in the control group.

"The present randomized controlled study reveals that nocturnal oximetry can be used in community settings to identify children with snoring and tonsillar hypertrophy who are likely to have a resolution of intermittent nocturnal hypoxemia after undergoing adenotonsillectomy," the researchers conclude.

"An ODI3 that is not elevated does not necessarily exclude the need for treatment, because the impaired quality of life improves post-adenotonsillectomy regardless of the severity of nocturnal hypoxemia and oxygen saturation drops do not always accompany obstructive apneas or hypopneas," they add.