Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2002 Jan;86(1):34–37. doi: 10.1136/adc.86.1.34

Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy

C Tasker 1, J Crosby 1, J Stradling 1
PMCID: PMC1719063  PMID: 11806880

Abstract

Aims: To establish whether subjects with previous evidence of sleep apnoea prior to adenotonsillectomy continue to have evidence of narrower upper airways during sleep, 12 years later.

Methods: Twenty subjects (median age 16 years) underwent repeat sleep studies at home, 12 years after such studies had shown significant sleep apnoea in many of them prior to an adenotonsillectomy. Twenty control subjects, also studied 12 years ago, underwent repeat home sleep studies as well. The sleep studies provided information on snoring, hypoxia, and inspiratory effort (from measures of pulse transit time). A questionnaire was also administered, the subjects were weighed, and their heights measured.

Results: There was more reported snoring in the previous adenotonsillectomy group (50% versus 20%) and also during the sleep study (80 versus 31 snores per hour). The measure of inspiratory effort overnight was higher in the previous adenotonsillectomy group (15.6 versus 12.3 ms). Allowance for potentially confounding variables (obesity and nasal congestion) partially reduced the statistical significance of the difference in snoring, but not that of the measure of inspiratory effort.

Conclusion: Results suggest that a narrower upper airway during sleep, to the point of snoring, persists 12 years after adenotonsillectomy, and may partly account for the occurrence earlier of preoperative sleep apnoea while adenotonsillar hypertrophy was present. It is not known if this narrowing is one of the risk factors for later development of adult sleep apnoea.

Full Text

The Full Text of this article is available as a PDF (95.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ali N. J., Pitson D. J., Stradling J. R. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child. 1993 Mar;68(3):360–366. doi: 10.1136/adc.68.3.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andersson L., Brattström V. Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg. 1991 Jun;20(3):159–162. doi: 10.1016/s0901-5027(05)80007-4. [DOI] [PubMed] [Google Scholar]
  3. Argod J., Pépin J. L., Lévy P. Differentiating obstructive and central sleep respiratory events through pulse transit time. Am J Respir Crit Care Med. 1998 Dec;158(6):1778–1783. doi: 10.1164/ajrccm.158.6.9804157. [DOI] [PubMed] [Google Scholar]
  4. Argod J., Pépin J. L., Smith R. P., Lévy P. Comparison of esophageal pressure with pulse transit time as a measure of respiratory effort for scoring obstructive nonapneic respiratory events. Am J Respir Crit Care Med. 2000 Jul;162(1):87–93. doi: 10.1164/ajrccm.162.1.9907086. [DOI] [PubMed] [Google Scholar]
  5. Bennett L. S., Langford B. A., Stradling J. R., Davies R. J. Sleep fragmentation indices as predictors of daytime sleepiness and nCPAP response in obstructive sleep apnea. Am J Respir Crit Care Med. 1998 Sep;158(3):778–786. doi: 10.1164/ajrccm.158.3.9711033. [DOI] [PubMed] [Google Scholar]
  6. Brodsky L., Adler E., Stanievich J. F. Naso- and oropharyngeal dimensions in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 1989 Feb;17(1):1–11. doi: 10.1016/0165-5876(89)90288-7. [DOI] [PubMed] [Google Scholar]
  7. Brodsky L., Moore L., Stanievich J. F. A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 1987 Aug;13(2):149–156. doi: 10.1016/0165-5876(87)90091-7. [DOI] [PubMed] [Google Scholar]
  8. Davies R. J., Ali N. J., Stradling J. R. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992 Feb;47(2):101–105. doi: 10.1136/thx.47.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Davies R. J., Belt P. J., Roberts S. J., Ali N. J., Stradling J. R. Arterial blood pressure responses to graded transient arousal from sleep in normal humans. J Appl Physiol (1985) 1993 Mar;74(3):1123–1130. doi: 10.1152/jappl.1993.74.3.1123. [DOI] [PubMed] [Google Scholar]
  10. Davies R. J., Vardi-Visy K., Clarke M., Stradling J. R. Identification of sleep disruption and sleep disordered breathing from the systolic blood pressure profile. Thorax. 1993 Dec;48(12):1242–1247. doi: 10.1136/thx.48.12.1242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gislason T., Benediktsdóttir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest. 1995 Apr;107(4):963–966. doi: 10.1378/chest.107.4.963. [DOI] [PubMed] [Google Scholar]
  12. Harvold E. P., Tomer B. S., Vargervik K., Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981 Apr;79(4):359–372. doi: 10.1016/0002-9416(81)90379-1. [DOI] [PubMed] [Google Scholar]
  13. Huggare J., Kylämarkula S. Morphology of the first cervical vertebra in children with enlarged adenoids. Eur J Orthod. 1985 May;7(2):93–96. doi: 10.1093/ejo/7.2.93. [DOI] [PubMed] [Google Scholar]
  14. Hultcrantz E., Larson M., Hellquist R., Ahlquist-Rastad J., Svanholm H., Jakobsson O. P. The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology. Int J Pediatr Otorhinolaryngol. 1991 Sep;22(2):125–134. doi: 10.1016/0165-5876(91)90032-7. [DOI] [PubMed] [Google Scholar]
  15. Jamieson M. J., Webster J., Witte K., Huggins M. M., MacDonald T. M., de Beaux A., Petrie J. C. An evaluation of the A&D UA-751 semi-automated cuff-oscillometric sphygmomanometer. J Hypertens. 1990 Apr;8(4):377–381. doi: 10.1097/00004872-199004000-00012. [DOI] [PubMed] [Google Scholar]
  16. Johns M. W. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest. 1993 Jan;103(1):30–36. doi: 10.1378/chest.103.1.30. [DOI] [PubMed] [Google Scholar]
  17. Linder-Aronson S., Woodside D. G., Lundström A. Mandibular growth direction following adenoidectomy. Am J Orthod. 1986 Apr;89(4):273–284. doi: 10.1016/0002-9416(86)90049-7. [DOI] [PubMed] [Google Scholar]
  18. McNamara F., Sullivan C. E. Pediatric origins of adult lung diseases. 3: the genesis of adult sleep apnoea in childhood. Thorax. 2000 Nov;55(11):964–969. doi: 10.1136/thorax.55.11.964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Ryan F. S., Gallagher D. M., LaBanc J. P., Epker B. N. The relation between nasorespiratory function and dentofacial morphology: a review. Am J Orthod. 1982 Nov;82(5):403–410. doi: 10.1016/0002-9416(82)90189-0. [DOI] [PubMed] [Google Scholar]
  20. Penzel T., Amend G., Meinzer K., Peter J. H., von Wichert P. MESAM: a heart rate and snoring recorder for detection of obstructive sleep apnea. Sleep. 1990 Apr;13(2):175–182. doi: 10.1093/sleep/13.2.175. [DOI] [PubMed] [Google Scholar]
  21. Pitson D. J., Sandell A., van den Hout R., Stradling J. R. Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnoea. Eur Respir J. 1995 Oct;8(10):1669–1674. doi: 10.1183/09031936.95.08101669. [DOI] [PubMed] [Google Scholar]
  22. Pitson D. J., Stradling J. R. Autonomic markers of arousal during sleep in patients undergoing investigation for obstructive sleep apnoea, their relationship to EEG arousals, respiratory events and subjective sleepiness. J Sleep Res. 1998 Mar;7(1):53–59. doi: 10.1046/j.1365-2869.1998.00092.x. [DOI] [PubMed] [Google Scholar]
  23. Pitson D. J., Stradling J. R. Value of beat-to-beat blood pressure changes, detected by pulse transit time, in the management of the obstructive sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998 Sep;12(3):685–692. doi: 10.1183/09031936.98.12030685. [DOI] [PubMed] [Google Scholar]
  24. Pitson D., Chhina N., Knijn S., van Herwaaden M., Stradling J. Changes in pulse transit time and pulse rate as markers of arousal from sleep in normal subjects. Clin Sci (Lond) 1994 Aug;87(2):269–273. doi: 10.1042/cs0870269. [DOI] [PubMed] [Google Scholar]
  25. Pollak M. H., Obrist P. A. Aortic-radial pulse transit time and ECG Q-wave to radial pulse wave interval as indices of beat-by-beat blood pressure change. Psychophysiology. 1983 Jan;20(1):21–28. doi: 10.1111/j.1469-8986.1983.tb00895.x. [DOI] [PubMed] [Google Scholar]
  26. Shapiro G. G., Shapiro P. A. Nasal airway obstruction and facial development. Clin Rev Allergy. 1984 Aug;2(3):225–235. doi: 10.1007/BF02991102. [DOI] [PubMed] [Google Scholar]
  27. Steptoe A., Smulyan H., Gribbin B. Pulse wave velocity and blood pressure change: calibration and applications. Psychophysiology. 1976 Sep;13(5):488–493. doi: 10.1111/j.1469-8986.1976.tb00866.x. [DOI] [PubMed] [Google Scholar]
  28. Stradling J. R., Barbour C., Glennon J., Langford B. A., Crosby J. H. Which aspects of breathing during sleep influence the overnight fall of blood pressure in a community population? Thorax. 2000 May;55(5):393–398. doi: 10.1136/thorax.55.5.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Stradling J. R., Crosby J. H. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991 Feb;46(2):85–90. doi: 10.1136/thx.46.2.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Stradling J. R., Crosby J. H. Relation between systemic hypertension and sleep hypoxaemia or snoring: analysis in 748 men drawn from general practice. BMJ. 1990 Jan 13;300(6717):75–78. doi: 10.1136/bmj.300.6717.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stradling J. R., Thomas G., Warley A. R., Williams P., Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990 Feb 3;335(8684):249–253. doi: 10.1016/0140-6736(90)90068-g. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES