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Title Continuous Positive Airway Pressure Is Not As Effective In Treating Childhood Obstructive Sleep Apnea As Adenotonsillectomies Due To Poor Patient Adherence
Clinical Question Is continuous positive airway pressure more effective than adenotonsillectomies in treating childhood obstructive sleep apnea?
Clinical Bottom Line Continuous positive airway pressure (CPAP) and adenotonsillectomies (AT) are both efficient treatments for childhood obstructive sleep apnea; however, the efficacy of CPAP is limited by poor patient adherence.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22926176Marcus/2012Review of OSA literature from 1999-2011 (350 relevant articles) Systemic review
Key resultsStudies show that the majority of children who undergo AT experience a marked improvement in their OSA afterwards; however, AT does not successfully resolve the symptoms of OSA for all patients. CPAP has been shown to be effective in treating OSA, but because of poor patient adherence, it is not recommended if the patient can instead undergo AT; however, CPAP can be used to treat patients who cannot undergo AT or patients for whom AT did not completely resolve their OSA.
#2) 22334807Marcus/201256 OSA patients (ages 2-16) Randomized controlled trial
Key resultsTreatment with CPAP resulted in an improvement in AHI from 22 ± 21 events/hr to 2 ± 3 events/hr. CPAP adherence was suboptimal, averaging 3.8 ± 3.3 h per night, and declined over time. As a result, current CPAP treatment options for children and adolescents are inadequate due to limitations by poor adherence.
#3) 19467393Friedman/20091079 OSA patients treated with AT (mean age 6.5) Systemic review and meta-analysis
Key resultsChildren treated with AT saw a significantly reduced AHI, with a mean change of 18.6 preoperative to 4.9 postoperative. The success rate of AT was 66.3%, with success being defined as having an AHI <1. AT is recommended as the first line of treatment for the majority of children with OSA.
Evidence Search (“Sleep Apnea, Obstructive/surgery” [Mesh] OR “Sleep Apnea, Obstructive/therapy” [Mesh]) AND “Continuous Positive Airway Pressure” [Mesh] Limits: children
Comments on
The Evidence
Marcus systematically reviewed literature from 1999 through 2011, which resulted in 350 articles that provided relevant data. Animal studies, case reports, and reviews were excluded. Quality assessment was conducted and it was determined that a majority of the relevant articles were level II through IV. Marcus conducted a randomized double-blinded clinical trial comparing treatment with CPAP (sample size of 15) to treatment with Bi-Flex (sample size of 45), a different mode of positive airway pressure. Friedman carried out a systematic review using inclusion and exclusion criteria to identity literature concerning treatment of OSA with solely AT. Only studies with both preoperative and postoperative polysomnographic data and in which all patients were under the age of 20 were included. Studies concerning patients with medical conditions not commonly found in the general population were excluded. The possibility of publication bias, in which authors do not publish studies with negative results, was mentioned. As a result, the actual success rate of AT may be lower than that calculated in this review. Perspective: AT is widely considered to be an effective treatment for OSA with a low risk of complications, and treatment with AT can decrease health care costs by one third.
Applicability Adenotonsillectomies are recommended as the first line of treatment for children with obstructive sleep apnea due to the fact that adherence to CPAP may be difficult for children. For cases in which surgery does not completely resolve the obstructive sleep apnea, CPAP may be recommended.
Specialty/Discipline (Public Health) (General Dentistry) (Oral Surgery) (Pediatric Dentistry)
Keywords Sleep apnea, obstructive; CPAP; adenotonsillectomy
ID# 2353
Date of submission: 02/19/2013spacer
E-mail link4@livemail.uthscsa.edu
Author Kevin Lin
Co-author(s) Paul McLornan, DDS
Co-author(s) e-mail drmclornan@gmail.com
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Faculty mentor/Co-author e-mail
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