How adenotonsillectomy can benefit pediatric sleep-disordered breathing

For children struggling with sleep-disordered breathing (SDB) and its more severe form, sleep apnea, each night can feel like a battle for air. Sleep-disordered breathing encompasses a spectrum of breathing abnormalities during sleep. These range from snoring and partial obstructions to complete cessations of breathing, known as apneas.

In children, enlarged adenoids and tonsils are often key contributors to these issues, leading to interrupted sleep patterns, daytime fatigue, and potential long-term health risks.

In cases of mild to moderate pediatric sleep apnea, healthcare providers often recommend adenotonsillectomy. An adenotonsillectomy is a surgical procedure to remove the adenoids and tonsils. This procedure can improve affected children’s quality of life by addressing their sleep apnea’s underlying cause.

Let’s discuss how adenotonsillectomy can benefit children with mild to moderate sleep apnea.

Understanding pediatric sleep-disordered breathing (SDB)

Before discussing the benefits of adenotonsillectomy, you should understand the impact of sleep-disordered breathing, such as sleep apnea, on children’s health. 

SDB encompasses a range of breathing disturbances during sleep, from loud snoring to sleep apnea. According to the National Institutes of Health, between 6 and 17% of typically developing children in the United States experience SDB. Left untreated, SDB may lead to various issues, including behavioral problems, learning difficulties, and cardiovascular diseases. Consequently, researchers and parents want to know more about how sleep problems may affect children’s health and development.

Sleep apnea disrupts children’s normal sleep cycle. It prevents children from obtaining the restorative rest they need for proper growth and development. As a result, children with untreated sleep apnea may experience the following: 

• Daytime sleepiness and fatigue
• Difficulty concentrating in school
• Behavioral problems such as irritability, impatience, and hyperactivity
• Poor academic performance
• Delayed growth and development

Identifying and treating sleep apnea in children is crucial to mitigate these adverse effects and promote good health. 

The role of adenotonsillectomy

Adenotonsillectomy is a surgical procedure commonly performed to treat sleep apnea in children with enlarged adenoids and tonsils. The adenoids and tonsils are lymphoid tissues located at the back of the throat and the roof of the mouth, respectively. When these tissues become enlarged, they can obstruct children’s upper airways. In turn, this can lead to breathing difficulties during sleep.

By removing the adenoids and tonsils, an adenotonsillectomy gets rid of the obstruction and restores normal airflow during sleep. This improves breathing and reduces sleep apnea symptoms. Adenotonsillectomy is typically performed under general anesthesia. Healthcare providers consider the procedure safe and effective for children with mild to moderate sleep apnea.

A recent clinical trial supported by the National Institutes of Health sheds light on the effectiveness of adenotonsillectomy in children experiencing snoring and mild breathing difficulties during sleep. The study marks a significant step in understanding the impact of surgical intervention on children with mild sleep-disordered breathing.

Adenotonsillectomy has long been a standard treatment for moderate to severe SDB. But its effectiveness for children with milder forms of SDB has been unclear.

The study involved a randomized clinical trial with 459 children and adolescents with mild SDB. The trial spanned from 2016 to 2021 across seven academic sleep centers in the United States. The study aimed to test the efficacy of adenotonsillectomy compared to supportive care without surgery.

During the trial, half the participants underwent adenotonsillectomy, while the other half received supportive care, including education on healthy sleep and lifestyle, and referrals for untreated allergies or asthma. The researchers then assessed various outcomes, including neurodevelopmental, behavioral, health, and sleep-related measures.

Both groups showed improvements in cognition and attention over the study period. However, the adenotonsillectomy group exhibited several beneficial changes not observed in the non-surgery group. These changes included the following: 

• Reduced daytime sleepiness
• Less snoring
• Lower blood pressure

The children who underwent surgery were also less likely to progress to full-blown sleep apnea.

Despite these positive findings, the researchers urge parents to carefully consider all all treatment options before choosing adenotonsillectomy. While the surgery can benefit some children with mild SDB, it may not be suitable for all children. Therefore, parents should talk with their pediatricians to determine the best treatment option for their children. 

What are the benefits of adenotonsillectomy for children?

Improved sleep quality: By addressing the underlying cause of sleep apnea, adenotonsillectomy can improve affected children’s sleep quality. These children experience fewer breathing disruptions and achieve deeper, more restful sleep.

Enhanced daytime functioning: With better sleep quality comes improved daytime functioning. Children who undergo adenotonsillectomy often exhibit increased alertness, concentration, and energy levels during the day, all of which can lead to better academic performance and health.

Symptom resolution: Adenotonsillectomy can reduce symptoms associated with sleep apnea, such as snoring, mouth breathing, and restless sleep. This benefits the child, and it can improve other family members’ sleep quality, which may have been disturbed by the child’s snoring.

Complication prevention: Addressing pediatric sleep apnea can prevent potential complications associated with untreated sleep-disordered breathing, such as cardiovascular problems, cognitive deficits, and behavioral issues.

Adenotonsillectomy is a valuable treatment option for children with mild to moderate sleep apnea caused by enlarged adenoids and tonsils. By removing the obstruction in the upper airway, this surgical procedure can improve sleep quality, enhance daytime functioning, and reduce symptoms associated with sleep apnea. 

If you think your child may have sleep apnea, consult a healthcare provider for proper evaluation and management. Prioritizing your child’s sleep health is essential for their growth, development, and well-being.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website: MeghnaDassani.com.