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We would like to commend Powell et al.(1) on the comprehensive review
article on obstructive sleep apnoea (OSA) in children. We agree that there
is an increasing trend of tonsillectomy performed for OSA. This is likely
to be due to an increased awareness of sleep disordered breathing and its
adverse health effects amongst primary, secondary and tertiary healthcare
workers. It may also in part be related to the increasing prevalence of
overweight and obesity in the paediatric population. Whilst it is hoped
that national drives to promote healthy lifestyle in children will prevent
the UK from experiencing the epidemic seen in the USA, it is undeniable
that OSA bears a significant impact on childhood quality of life where
adeno-tonsillectomy is an effective treatment.
We would like to add that we have noted a reversal in trends in the
indication for adeno-tonsillectomy at our institution (Alder Hey
Children’s Hospital, Liverpool). An internal audit of adeno-
tonsillectomies performed in children under five years old showed that the
number of procedures remained relatively stable; 140 in 2000 and 137 in
2005. In 2000, 59% of adeno-tonsillectomies were performed for recurrent
tonsillitis (Figure 1). This proportion reduced sharply and constituted
only 21% in 2005. Notwithstanding the impact of national guidelines (e.g.
SIGN) on the rate of tonsillectomy for recurrent infection, our data
showed clear evidence that the trend of performing adeno-tonsillectomy for
OSA is increasing. The number of operations performed for OSA increased
119% from 36 in 2000 to 81 in 2005.”
We agree with the conclusion of the authors that high risk children
should have their surgery performed in a hospital with paediatric
intensive care facilities. However, it is important to acknowledge that
this will invariably place a strain on available services given the
increasing number of OSA cases requiring surgery. To the common observer
(and perhaps some healthcare managers), this burden on services may not be
immediately apparent given the relatively stable number of procedures
performed, as shown in our audit. Nevertheless, it must be remembered that
the management of OSA is frequently multi-disciplinary, requiring complex
diagnostic adjuncts such as polysomnography and highly sought after
paediatric high-dependency facilities.
Changing trends of adeno-tonsillectomy for paediatric obstructive sleep apnoea.
We would like to commend Powell et al.(1) on the comprehensive review
article on obstructive sleep apnoea (OSA) in children. We agree that there
is an increasing trend of tonsillectomy performed for OSA. This is likely
to be due to an increased awareness of sleep disordered breathing and its
adverse health effects amongst primary, secondary and tertiary healthcare
workers. It may also in part be related to the increasing prevalence of
overweight and obesity in the paediatric population. Whilst it is hoped
that national drives to promote healthy lifestyle in children will prevent
the UK from experiencing the epidemic seen in the USA, it is undeniable
that OSA bears a significant impact on childhood quality of life where
adeno-tonsillectomy is an effective treatment.
We would like to add that we have noted a reversal in trends in the
indication for adeno-tonsillectomy at our institution (Alder Hey
Children’s Hospital, Liverpool). An internal audit of adeno-
tonsillectomies performed in children under five years old showed that the
number of procedures remained relatively stable; 140 in 2000 and 137 in
2005. In 2000, 59% of adeno-tonsillectomies were performed for recurrent
tonsillitis (Figure 1). This proportion reduced sharply and constituted
only 21% in 2005. Notwithstanding the impact of national guidelines (e.g.
SIGN) on the rate of tonsillectomy for recurrent infection, our data
showed clear evidence that the trend of performing adeno-tonsillectomy for
OSA is increasing. The number of operations performed for OSA increased
119% from 36 in 2000 to 81 in 2005.”
We agree with the conclusion of the authors that high risk children
should have their surgery performed in a hospital with paediatric
intensive care facilities. However, it is important to acknowledge that
this will invariably place a strain on available services given the
increasing number of OSA cases requiring surgery. To the common observer
(and perhaps some healthcare managers), this burden on services may not be
immediately apparent given the relatively stable number of procedures
performed, as shown in our audit. Nevertheless, it must be remembered that
the management of OSA is frequently multi-disciplinary, requiring complex
diagnostic adjuncts such as polysomnography and highly sought after
paediatric high-dependency facilities.
Reference:
1. Powell S, Kubba H, O'Brien C, Tremlett M. Paediatric obstructive sleep
apnoea. BMJ. 2010 ;340:c1918.
Competing interests:
None declared
Competing interests: No competing interests