Pediatria pre prax 5/2023

When obstructive sleep apnea in a child is indication for urgent adenotonsillectomy

Obstructive sleep apnea is characterized by repeated episodes of partial obstruction of the upper airways (hypopnoea) and/or intermittent complete obstruction of the upper airways (obstructive apnea), which results in impaired ventilation during sleep with a subsequent decrease in blood oxygen saturation. It is typical for breath stops, which are longer than the length of two respiratory cycles. Our article presents two interesting case reports of children with adenoid vegetations and hypertrophic tonsils, who developed life- -threatening severe obstructive syndrome during an acute respiratory infection with the need for urgent adenotonsillectomy due to a vital indication. While the postoperative course in one patient was without complications, with prompt relief of clinical signs of airway obstruction and apneic pauses, in the other patient postoperatively significant apnea persisted, requiring non-invasive ventilation during sleep. With these case reports, we would like to point out the fact that adenoid vegetations and hypertrophic tonsils, especially III. and IV. degree, can lead to acute respiratory disorders with the necessity of surgical intervention due to a vital indication.

Keywords: obstructive sleep apnea, hypertrophic tonsils, adenoid vegetations, adenotonsillectomy