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Obstructive sleep apnea affects up to 10% of children. Symptoms of OSA 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. However, it is important to emphasize that the signs and symptoms of OSA 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 OSA is a familial problem, it is commonly seen in siblings.

The cause of OSA in children is usually due to enlarged adenoid and tonsillar tissues. However, nasal obstruction due to enlarged turbinates and jaw deformity can also be major contributors to developing OSA.

The primary treatment for OSA in children is adenoidectomy and tonsillectomy. Occasionally, turbinate reduction by radiofrequency may be performed in conjunction with this primary treatment form. A sleep study to confirm the presence of OSA before surgery is often recommended, but is not mandatory when there are obvious signs and symptoms of OSA. A sleep study after surgery is more important in order to determine the extent of improvement from surgery. Although the success rate of surgery is quite high (approximately 80%), many children still exhibit residual problems. Additional treatment options such as nasal CPAP or orthodontic therapy to widen the jaw may be considered.

Adenoidectomy and tonsillectomy is a very common operation. While procedure techniques vary widely, very few surgeon systematically sutures the tonsillar wounds. The author of this website advocates suturing the wounds created by tonsillectomy for the following reasons: 1) Improving the airway by wound closure; 2) Reducing the pain after surgery; and 3) Reducing the risk of bleeding after surgery.

The duration of adenoidectomy and tonsillectomy is approximately 60 minutes and is performed under general anesthesia. The postoperative course consists of pain and swelling of the throat as well as reduction of food intake for a few days. Bleeding is also a risk, with an incidence of approximately 2%.

 
Pediatric OSA Airway
Pediatric OSA Airway
Before tonsillectomy
Before tonsillectomy
  After tonsillectomy
After tonsillectomy
 

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