Adenotonsillectomy in a two-year-old boy with extremely severe obstructive sleep apnea

Abstract

While there is a variety of surgical and non-surgical treatment options for obstructive sleep apnoea (OSA) in adults, surgery remainsthe option of choice in paediatric patients due to the fact that more than 90% of childhood OSA is associated with adenotonsillarhypertrophy. Age under three years is often described as one of the most common risk factors for developing postoperative complications.The most important additional risk factor is severity of the disease as measured by polysomnography (PSG). The authorsreport a case of a 20-month-old boy with extremely severe OSA and a history of repeated respiratory cessation during sleep lastingfor up to 30 seconds and lowest recorded saturation during PSG of 67% with the apnoea-hypopnoea index 58.43/h. As classical adenotonsillectomyis recommended only after the child has reached three years, due to the small circulating volume of the blood,several solutions were considered but, ultimately, classical ‘cold steel’ adenotonsillectomy was performed when the child reachedtwo years. This case shows the importance of surgical treatment in severe cases of OSA even in very small children, despite the recommendations,due to the increased risks in neurocognitive and behavioural development.