Persistence of obstructive sleep apnea after adenotonsillectomy

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We have long assumed that surgery is effective for children with obstructive sleep apnea from adenotonsillar hypertrophy. However, from a clinical point of view, this assumption does not always seem valid. The question has been investigated by Tauman, Gozal and colleagues from the University of Louisville who investigated 110 children with polysomnographic evaluations before and after adenotonsillectomy for obstructive sleep apnea and compared the results with 22 controls. Although surgery reduced the amount of sleep disturbance, complete normalization occurred in only 25% of patients. The results were particularly poor in children with obesity. In addition, the degree of improvement was affected by the severity of obstructive sleep apnea on the initial study. The authors raised the question of whether overnight polysomnography should be routinely performed after adenotonsillectomy to ensure that there is not a significant residual abnormality.