AJN, American Journal of Nursing:
Evidence is insufficient to recommend its use.
Editor's note: This is the fifth in a series of summaries of nursing care–related systematic reviews from the Cochrane Library.
Raquel Luengo González is on the health technology assessment unit of the Agencia Lan Entralgo in Madrid. She is also a member of the Cochrane Nursing Care Field.
Is adenotonsillectomy an effective intervention for obstructive sleep apnea in children?
TYPE OF REVIEW
This is a Cochrane review; only one study met the review's entry criteria.
RELEVANCE FOR NURSING
Obstructive sleep apnea is considered to be on the most severe end of a spectrum of sleep-disordered breathing problems in children, which also includes primary snoring, upper airway resistance, and obstructive hypopnea syndromes. Its prevalence is estimated to be 1.1%, and girls and boys are equally affected, with peak incidence at between three and six years of age.
Obstructive sleep apnea may be treated with medical, mechanical, or surgical measures. The current surgical treatments of choice in children are tonsillectomy and adenoidectomy (the removal of tonsils and adenoids, respectively), but there's a lack of strong evidence to support the use of these interventions.
CHARACTERISTICS OF THE EVIDENCE
This review included randomized trials that recruited children with a diagnosis of obstructive sleep apnea. Only one small study (involving 23 children) met the review's entry criteria, therefore a meta-analysis wasn't possible. The method of randomization wasn't stated and four participants were excluded from the analysis due to loss at follow-up. Participants were between two and 12 years of age.
The study addressed the relative merits of two surgical techniques for obstructive sleep apnea: temperature-controlled radiofrequency tonsillectomy and adenoidectomy, and complete tonsillectomy and adenoidectomy. Following surgery, participants were observed for 24 hours in the hospital and took part in three months of overnight sleep studies.
Results showed no statistically significant differences in median respiratory disturbance index measurements or in the visual analog scores for symptoms (such as snoring and sleepiness or swallowing and speech) between patients undergoing either treatment. Moreover, more children in the temperature-controlled radiofrequency tonsillectomy and adenoidectomy group were able to return to a normal diet at seven days after surgery compared with those in the complete tonsillectomy and adenoidectomy group. Neither treatment led to significant postoperative complications.
BEST PRACTICE RECOMMENDATIONS
Results from one small study cannot provide sufficient evidence to support one treatment over the other, although return to a normal diet occurred sooner in the group that received temperature-controlled radiofrequency tonsillectomy and adenoidectomy than in the complete tonsillectomy and adenoidectomy group.
There's a need for high-quality randomized controlled trials to investigate the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea in children that incorporate long-term follow-up. Further research should also be undertaken to define the natural history of the various severities of obstructive sleep apnea.