CHEST Guidelines-Rebuttal-From-Drs-Dabbous-and-Mitchell

Rebuttal-From-Drs-Dabbous-and-Mitchell_chest

Pdf Summary

Adenotonsillectomy (AT) is a common treatment for obstructive sleep apnea (OSA) in children, with approximately 300,000 undergoing the procedure annually in the U.S. However, it does not always result in complete resolution; only 27% of children in a study fully resolved their OSA post-AT. Risk factors for persistent OSA include obesity, Black race, asthma, and severe OSA. Furthermore, children under 5 have been underrepresented in studies, indicating less clear benefits for this age group. Complications like adenoid or tonsillar regrowth may necessitate additional surgeries.<br /><br />While generally well-tolerated, AT carries risks like pain, dehydration, respiratory complications, and rare fatalities. There are concerns about long-term outcomes, such as increased risks of respiratory infections and weight gain following the surgery. The Childhood Adenotonsillectomy Trial (CHAT) noted more weight gain in children post-AT compared to those under watchful waiting with supportive care (WWSC), though further studies showed no significant difference in excessive weight gain between the two groups.<br /><br />Children with complex health conditions like Down syndrome or Prader-Willi syndrome may not see OSA resolution from AT and are more prone to complications. A one-size-fits-all treatment approach does not accommodate the complexities of pediatric sleep medicine. An initial WWSC approach can be beneficial, allowing for observation, follow-up testing, and exploration of other treatment options should AT become suitable.<br /><br />AT remains the first-line treatment for pediatric OSA, but WW is a valid strategy, especially for milder cases. It allows families to consider options while lessening immediate treatment burdens on children. WW could potentially help in deciding candidacy for AT more accurately by assessing OSA severity and symptoms over time.

Keywords

Adenotonsillectomy

Obstructive Sleep Apnea

Children

Risk Factors

Complications

Weight Gain

Watchful Waiting

Pediatric Sleep Medicine

Surgery Outcomes

Treatment Options