There are considerable variations in the management of obstructive sleep apnoea in children and this suggests a need for more research and evidence-based information. In this review article, the authors address four key issues. Literature compares tonsillectomy with tonsillotomy, the latter reducing complication rates, but the former has more sustained results and is more effective when there are associated comorbidities. Adenoidectomy alone has been used but studies have had only small numbers. Practices vary widely in the anaesthetic management and more intensive postoperative care is required because OSA deranges many systemic body functions and postoperative respiratory collapse is a threat, the risk involving 16-27% of children with OSA. The minimum time of observation varied from 1-6 hours. There is, however, overwhelming consensus but not fully backed by evidence, that early intervention helps prevent lack of growth and cardiovascular complications. These are seen to resolve after adenotonsillectomy but long-term data is lacking. Finally, there is the question of medical treatments for residual OSA after adenotonsillectomy. Nasal CPAP is better tolerated and considered appropriate if OSA persists after adneotonsillectomy. 

Paediatric obstructive sleep apnoea: is our operative management evidence based?
Pabla L, Duffin J, Flood L, Blackmore K.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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