Removal of the tonsils and adenoids usually results in the cure of OSAS. In as much as OSAS results from the relative size and structure of the upper airway components rather than the absolute size of the tonsils and adenoids, it is vital that both tonsils and adenoids should be removed even if one or the other seems to be the only one enlarged. This procedure may be considered a minor surgery but may be associated with significant complications. Thus, snoring without OSAS is not an indication for surgery.
Children with OSAS are at risk for postoperative complications such as upper airway swelling, pulmonary edema, and respiratory failure. High-risk patients, who include those less than 3 years of age, patients with severe OSAS, and other medical conditions should be monitored as inpatients after the operation.
Emergency admissions may be required of some children with OSAS. Cardiac monitors alone may not be sufficient because these will not detect obstructive apnea until the heart rate slows down. Hence, a pulse oximeter should be used to measure the patient’s oxygen saturation. Obstructive episodes can be ended by awakening the patient, but this is only a temporary solution. Nasopharyngeal tubes may be placed to bypass the obstruction pending definitive treatment. A special mask delivering continuous positive airway pressure (CPAP) can also be used.
Some patients with OSAS may not respond to the removal of the tonsils and adenoids. Nasal CPAP can be used successfully as long as both the parents and the child are motivated and the health care providers are well-versed in pediatric CPAP use. Behavioral and psychological support may be important. When applicable, specific craniofacial surgery may be done. For the obese patients, weight loss should be encouraged but a CPAP may be applied pending weight loss.
Majority of the children will experience a dramatic response with adenotonsillectomy. The long-term prognosis or outcome of pediatric OSAS, however, is unknown. There is some evidence to suggest that children with treated OSAS are at risk for recurrence during adulthood. This has been reported by Guillemenault and associates.
Do not take snoring for granted since this may be a clue that your child may have obstructive sleep apnea syndrome. When in doubt, bring your child to a doctor.