For many years the first line of defense for children with sleep apnea and other forms of sleep-disordered breathing has been to remove both their tonsils and adenoids in a procedure known as an adenoidtonsilectomy and follow-up studies normally carried out about six weeks and three months after surgery generally show positive results. However, it has now been suggested that in many cases, if follow-up studies were again conducted one year after surgery, the results would be very different.
Initial studies indicate that two groups of children in particular are showing a relapse or worsening of their original condition a year out from an adenoidtonsilectomy and one of these groups is children who have gained weight rapidly during the period. However, some poor outcomes have also been reported in children who do not gain weight rapidly and this is leading to a conclusion that sleep-disordered breathing may in fact be a chronic condition.
Data at this point is somewhat limited (the study upon which this conclusion is based involved only 40 children) and certainly more studies will need to be carried out before any firm conclusions can be drawn. Nevertheless, the implication at this stage is that the traditional surgical route for children with sleep apnea perhaps needs to be re-thought.
Well, before you start rushing out and looking for alternatives perhaps we should look a little more closely at just what has been found here.
In the vast majority of cases the children whose condition worsened a year out from surgery had also gained weight very rapidly during this period of time and, in fact, were described almost in passing as being ‘obese’. So, is the problem perhaps not the result of an ineffective form of treatment but simply of obesity, which we already know is a major contributory factor in cases of sleep-disordered breathing?
Obesity is now at epidemic proportions but has only recently started spreading like wildfire through our children and is not only leading to increased cases of sleep apnea, but is also being seen in an increasing number of children with diabetes, heart conditions and various other disorders.
We live in an age when we are rightly thankful for advances in medicine but the race to come up with the latest medical breakthrough also often leads to the publication of studies and the expression of opinions without adequate evidence to back up their conclusions. This may well be the case here and so perhaps a cautious approach should be advised until we have more evidence to support some firm conclusions.