An Objective Study to Establish Incidence of True Obstructive Sleep Apnoea (OSA) in Sleep Disordered Breathing in the Paediatric Age Group and Assessment of Benefit of Surgery (Tonsillectomy and Adenoidectomy) in Non Responders to Medical Treatment in Mild OSA

M S Soumya; V Sreenivas; Malavika S Nadig; Rhea Merin James; Thara Pinheiro; A M Balasubramanyam; Ravi C Nayar; R Regan Charles; Ashwin Kumar

doi:10.1007/s12070-024-04813-6

An Objective Study to Establish Incidence of True Obstructive Sleep Apnoea (OSA) in Sleep Disordered Breathing in the Paediatric Age Group and Assessment of Benefit of Surgery (Tonsillectomy and Adenoidectomy) in Non Responders to Medical Treatment in Mild OSA

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4189-4199. doi: 10.1007/s12070-024-04813-6. Epub 2024 Jun 25.

Authors

M S Soumya¹, V Sreenivas¹, Malavika S Nadig², Rhea Merin James², Thara Pinheiro², A M Balasubramanyam¹, Ravi C Nayar³, R Regan Charles⁴, Ashwin Kumar⁴

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, St. John's Medical College Hospital Bangalore, Bangalore, India.
² St John's Medical College Hospital, Sarjapur-Marathahalli Rd, Beside Bank Of Baroda, John Nagar, Koramangala, Bengaluru, Karnataka 560034 India.
³ Bangalore, India.
⁴ St. John's Research Institute, Bangalore, India.

PMID: 39376431
PMCID: PMC11455801 (available on 2025-10-01)
DOI: 10.1007/s12070-024-04813-6

Abstract

Obstructive sleep apnea (OSA) is identified by instances of either full or partial collapse of the airway during sleep, leading to reduced oxygen levels or awakening from sleep. This disruption causes interrupted and insufficient sleep, impacting cardiovascular well-being, mental health, and overall quality of life. Pediatric OSA is more challenging to diagnose and a single apnoea is considered to be significant in this age group. A hospital based prospective study with 100 children between the ages of 4 and 12 years with sleep disordered breathing. Evaluated for the severity of obstructive sleep apnea and also assessed if surgery was beneficial to treat OSA in mild cases. General physical examination, evaluation of facial/oral features were conducted to rule out adenoid facies. Additionally, ENT examination was conducted. Medical history and lateral neck radiographs were reviewed, and the paediatric sleep questionnaire was administered to evaluate neurobehavioral morbidities associated with OSA. These children were evaluated for sleep disorders by conducting the polysomnography. Pediatric sleep questionnaire was also administered. The scoring and results analysis were conducted according to standardised guidelines provided by the American association for sleep medicine. Furthermore, medical management protocols were outlined, including a 6-week course of intranasal steroids and leukotriene receptor antagonist therapy, with consideration of adenotonsillectomy for patients failing medical therapy. In our study on paediatric obstructive sleep apnea (OSA), medical treatment significantly reduced clinical symptom scores in cases of mild OSA, as evidenced by pre- and post-parental sleep questionnaire scores of 23.62 ± 8.24 and 13.55 ± 6.05, respectively (paired samples test, P = 0.00). Similarly, both the pre- and post-Apnoea/Hypopnoea Index (AHI) scores (2.278 ± 1.5658 and 1.19 ± 1.420) and central sleep apnea index scores (1.252 ± 0.8972 and 0.61 ± 0.815) significantly improved post-treatment (paired samples test, P = 0.03, respectively). Additionally, significant changes were observed in tonsillar grade after the 12-week medication course, and sleep architecture showed notable improvement during the repeat follow-up study. These findings highlight the efficacy of treatment interventions in alleviating symptoms and enhancing sleep efficiency in paediatric OSA. The findings of this study underscore the efficacy of a medical management using intranasal corticosteroids and oral montelukast in mitigating the severity of mild obstructive sleep apnea (OSA) in children. This research substantiates the therapeutic value of corticosteroids and oral montelukast in paediatric patients with mild OSA, offering compelling evidence for their use as beneficial interventions in this population.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-04813-6.

Keywords: Adenotonsillar enlargement; Medical treatment; Mild OSA; Pediatric obstructive sleep apnoea; Sleep disordered breathing.

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