Although individual sleep laboratories define their own treatment criteria, there is still a lack of consensus on the level of severity of SDB that justifies treatment in children. Recently, Chervin and col-leagues demonstrated that children with symptoms of SDB who were treated with adenotonsillectomy (T&A) improved in assessments of hyperactivity, inattention, and sleepiness, and even in the diagnosis of attention deficit-hyperactivity disorder after a 1-year follow-up. Importantly, polysomnographic parameters did not predict which children would have neuropsychological problems or which children would improve, but children were referred for T&A for clinical symptoms regardless of the diagnosis of apnea obtained by polysomnogram. These findings demonstrate the need for alternative technologies to detect SDB and the need to define treatment criteria in children.
Surgical Treatment of SDB
T&A is generally considered to be the standard treatment of childhood sleep apnea in children with normal craniofacial features and uncomplicated medical status. T&A is curative of sleep apnea in the majority of pediatric cases. The success rate of T&A was recently analyzed in a metaanalysis of14 studies evaluating polysomnographic cure rates before and after surgery. While the definition of success varied (AHI range, 0.5 to 5 events per hour), the overall cure rate was 82.9% (95% confidence interval, 76.2 to 89.5%; p < 0.001). For those studies that defined success as an AHI of 1, the cure rate ranged from 53 to 100%. It is important to note that the method of T&A was not addressed in this study, and the T&A technique may have confounded these results as the use of a partial vs total tonsillectomy or tonsillar pillar manipulation may affect success and cure rates offered by Canadian Health&Care Mall.