Tonsil, Adenoid Removal Results In Better Sleep, Behavior For Children With Sleep Disordered Breathing
Main Category: Sleep / Sleep Disorders / InsomniaAlso Included In: Ear, Nose and Throat; Pediatrics / Children's Health; Respiratory / Asthma
Article Date: 30 May 2006 - 0:00 PDT
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An adenotonsillectomy, or surgical removal of the tonsils and adenoids, leads to an improvement in behavior and sleep for pediatric patients diagnosed with sleep disordered breathing has been revealed in a study from the University of Kansas Medical Center and School of medicine.
Sleep disordered breathing (SDB), is usually caused by enlarged tonsils causing upper airway obstruction during sleep. In children, the terms "obstructive sleep disorders" (OSD) and "sleep disordered breathing" (SDB) are more widely used as opposed to obstructive sleep apnea syndrome (OSAS) because the former two terms recognized that SDB is a spectrum of sleep-related breathing disorders including primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and OSAS (the most severe aspect of the spectrum). Traditionally, OSAS is identified only by a sleep study, and while the prevalence of OSAS has been reported to range from 0.7 to three percent, the prevalence of snoring and clinical suspicion of SDB in children may be high as 11 percent.
How SDB affects childhood development and behavior, specifically hyperactivity and inattention, has been addressed in past research. Using sleep studies or polysomnograph, and parental surveys, one study showed that while SDB was not more likely to occur among children with significant ADHD symptoms, it is significantly highly prevalent among children with mild hyperactive behavior. Habitual snoring and SDB have been associated with ADHD as well as neurocognitive impairment and poor school performance, leading to a suggestion that treating SDB and habitual snoring may eliminate ADHD in a subset of children. Unlike OSAS which is defined by specific apnea-hypopnea index based on polysomnography, SDB may be diagnosed clinically and not consistently meet PSG criteria for an obstructive sleep breathing disorder.
A questionnaire specific for predicting SDB and improvement after surgery, would bridge the gap between objective sleep study data on every child with nocturnal airway obstructions on one hand and clinical suspicion of SDB in children at the other end of the spectrum. Such a questionnaire is the Pediatric Sleep Questionnaire (PSQ), previously developed by Dr. Chervin and colleagues at the University of Michigan, uses subscales in SDB, snoring, sleepiness, and behavioral problems which has shown good validity and reliability for predicting SDB when compared with polysomnography. The PSQ may be used as a tool in clinical research when polysomnography may not be feasible.
The Connor's Parent Rating Scale-Revised Short (CPRS-RS) survey has been proved effective to assess behavior in subjects before and after treatment intervention. Both the CPRS-RS and PSQ were used by Kansas otolaryngologist-head and neck surgeons to determine change in sleep and behavior before surgery and again at six months after adenotonsillectomy, as well as to identify any correlations between sleep and behavior pre and post surgical intervention in children with SDB, without using sleep study or polysomnography. The authors of "Improved Behavior and Sleep After Adenotonsillectomy in Children with Sleep Disordered Breathing," are Julie L. Wei MD, and Robert A. Weatherly MD, both from the Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine; Matthew S. Mayo PhD, and Holly J. Smith, at the Center for Biostatistics and Advanced Informatics, University of Kansas Medical Center; and Matt Reese PhD, with the Developmental Disabilities Center, University of Kansas Medical Center. Their findings will be presented at the 21st Annual Meeting of the American Society of Pediatric Otolaryngology, being held May 20-22, 2006, at the Hyatt Regency Hotel in Chicago, IL.
Methodology: Within a pediatric otolaryngology practice, 117 consecutive children clinically diagnosed with sleep disordered breathing and scheduled for surgical removal of the adenoids and tonsils were enrolled as the research subjects. A convenience sample of caregivers of patients, age two to 17, undergoing adenotonsillectomy for SDB were eligible and asked to participate. Patients were excluded if the primary reason for adenotonsillectomy was recurrent infections. Data were collected on the day of the surgery and at six months following the surgery date. This study was modeled after previous studies examining the quality of life (QOL) improvement after adenotonsillectomy. Caregivers completed two questionnaires at both time intervals: the CPRS-RS as well as the PSQ.
Changes in age appropriate T-scores for all four CPRS-RS behavior categories (oppositional, cognitive problems/inattention, hyperactivity, and Conner's ADHD index) were determined for each subject pre- and post-operatively. Changes in PSQ scores from select 22-item sleep-related breathing disorder (SRBD) subscale were also determined.
Results: The results offered evidence that before surgery, the mean PSQ score for the 117 patient was 0.56, the scale is between 0 and 1, with scores approaching 1 representing the most severe disturbance in sleep. 112/117 (95.73 percent) had a PSQ score of >0.33, which suggests high risk for SDB, and 5/117 (4.27 percent) had a PSQ score of < 0.33. At six-months after adenotonsillectomy, the mean PSQ score for the 71 patients who completed the study was 0.12[0.14]. Of these 71 patients, 7(9.86 percent) still had a PSQ score of >0.33, while 64 (90.14 percent) had a PSQ score of < 0.33. For the CPRS-RS scores, a reduction was noted in aged and sexed norm T-scores for all four behavior categories (oppositional, cognitive problems/inattention, hyperactivity, and ADHD index), close to one standard deviation from their preoperative score which is clinically significant. Also, the researchers found that the higher the baseline T-score, the greater the reduction in T-score after surgery. Correlations were found between behavior and sleep both before and after adenotonsillectomy.
Conclusions: The study supports associations between adenotonsillectomy to alleviate upper airway obstruction and changes in both sleep and behavior, as evidenced by results in the PSQ and CPRS-RS surveys. At six months after adenotonsillectomy, patients experience improvement in both sleep and various behavior categories as measured by these instruments.
American Society of Pediatric Otolaryngology
http://www.aspo.us
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15 Feb. 2012. <http://www.medicalnewstoday.com/releases/44211.php>
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http://www.medicalnewstoday.com/releases/44211.php.
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Visitor Opinions In Chronological Order (2)
We naturally cured our child's sleep apnea
posted by Crystal Przybille on 31 Aug 2010 at 10:53 pmMy 4 year old son had progressively worse sleep apnea for about a year. He always sounded congested, and was a mouth breather. He had night sweats. I saw four doctors, and an ears, throat and nose specialist. All told me to have his tonsils and adenoids removed. They were very swollen, filling about 85% of his throat. I wondered "why are his tonsils and adenoids so large? What is causing it?" this was a question the Doctors were disinclined to delve into, for many reasons.
However, at a friend's suggestion, I eliminated all dairy from my son's diet for two months. This was difficult, because my son loves dairy products and they were a large part of his diet. He is half Dutch, for goodness' sake, and neither his father nor I have a dairy intolerance. Well, after two disciplined months, our son was breathing easy. He slept through the night. His speech "cleared up". And the swelling in his tonsils decreased visibly. It has been a year now, and he has grown substantially, has no more apnea, and is a healthy boy who sleeps well, breathes through his nose, runs and plays and feels altogether better.
In his case, the operation was completely unnecessary. Dairy is a treat he receives now and again, but if he has too much too often, the symptoms begin to return, which he realizes himself. This is very important for people to consider. It is worth a try to eliminate dairy, or other food suspects from the diet, before having your child undergo an operation, which always has risks.
Also, if your child has a food intolerance which causes the tonsils and adenoids to work overtime, think of the favor you will do for the health of your child's body as a whole if you remove the invading "culprit" rather than simply disarming the "alarm system". I would like to tell this to the world somehow, starting here.
GET ANOTHER OPINION FIRST!!
posted by Gayle Hardine on 10 Oct 2010 at 2:02 pmDO NOT GET SURGERY WITHOUT CHECKING FOOD SENSITIVITIES FOR THIS ISSUE!! I agree wholeheartedly with Crystal Przybille. Dairy problems are a very common cause of ear infections, sinus problems, and upper respiratory infections, which can cause snoring and sleep disorders.
Why does the author of this article NOT address what causes the enlarged tonsils and adenoids in the first place? Dairy sensitivity can cause this. Why do we not know who wrote this article? Who is the author? Telling a patient to stop eating an offending food substance is a lot cheaper than surgery. Many doctors have huge expenses to cover paying off exorbitant school loans and funding a high tech medical practice. There is little incentive to recommend a change of diet when surgery is so lucrative. A sleep study may be the only way to diagnosis OSAS, but that does not mean that OSAS, or any of the other diagnoses mentioned, is the only or best diagnosis for these symptoms or that surgery is the real cure for any of the disorders addressed in this article. What good is a diagnosis if it does not lead to a real resolution of the health problem?
Milk and other food sensitivities can also cause hyperactive behavior, inattention, learning disabilities, and fatigue (sleepiness). How were the patients doing one year after surgery? What other illness did they develop? Of course behavior, sleep disorders, sleep apnea and other physical symptoms will improve after the surgery because the irritated tissue is gone. However, the person will have other symptoms down the road because they are still ingesting the offending food substance, and other areas of the immune system will be activated to take over the job of fighting off this substance. Why people are getting so many allergies and food sensitivities is just too complicated to address here and now, but it has to do with how we are destroying our food supply, the environment and living an unsustainable lifestyle.
Therefore, if you haven't clearly thought through all the issues concerning this health problem and go by the advice in this article, you may not realize that you will STILL be dealing with the same health problem in different clothing down the road.
By the way, some people do better with raw dairy because the enzymes to break down the milk are not destroyed by pasteurization and the proteins are not denatured such that the immune system sees them as a foreign invader that it must attack. Raw milk has been unecessarily vilified. If left out raw milk will turn sour due to the beneficial bacteria that have not been killed off; therefore, actually preserving the milk for a longer period. This produces a very healthy drink (clabbered milk) used in cultures around the world and turned into products such as quark and crème fraîche. When dairy cows are feed poorly, not cared for and raised in unsanitary conditions they are sick and have will have pathogens in their milk. Therefore, pasteurization is necessary to kill off pathogenic organisms we would consume from drinking the milk of diseased animals. Makes you want to reach for another glass right? Why not just treat the animals right in the first place and offer healthy raw milk without the pathogens? Pasteurized milk putrifies and is colonized by organisms that can make you sick if left out because the good bacteria has been killed off. So, if you have a problem with dairy try going off it for awhile, healing from your health problems and then try raw milk if you like.
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