Effect of Tonsillectomy on Obstructive Sleep Apnea

Introduction

Obstructive sleep apnea (OSA) is a sleep disorder in which patients suffer from gasping or choking during sleep, excessive daytime sleepiness, morning headaches, irritability, and difficulty concentrating. Large tonsils are a known risk factor for sleep apnea. Obstructive sleep apnea requires medical attention because of snoring and daytime sleepiness. Nasal continuous positive airway pressure during sleep and mandibular advancement devices are the most effective treatments for OSA. However, they require medical follow-ups, and many patients have problems tolerating these treatments. Therefore, tonsillectomy is the treatment of choice for obstructive sleep apnea (OSA), especially in children. This article will discuss the positive and adverse effects of tonsillectomy in patients with obstructive sleep apnea.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep disorder that occurs when the airway is not kept open during sleep by the muscles in the back of the throat. OSA is more prevalent in children with neurodegenerative disorders, syndromes, and craniofacial abnormalities. The most widely studied syndrome showing an association with OSA is Down syndrome. This results in repeated episodes of partial or complete blockage of the airway, causing the person to momentarily stop breathing during sleep. These episodes, known as apneas, can last for a few seconds to a minute or more and can happen repeatedly throughout the course of the night, leading to fragmented and poor-quality sleep. Risk factors for OSA include obesity, aging, male gender, a family history of the disorder, and certain anatomical abnormalities of the upper airway. Untreated obstructive Several health issues, such as high blood pressure, heart disease, stroke, and others, can be brought on by sleep apnea, diabetes, and depression.

The following are the common symptoms of obstructive sleep apnea:

• Loud snoring.

• Gasping.

• Choking during sleep.

• Excessive daytime sleepiness.

• Morning headaches.

• Irritability.

• Difficulty concentrating.

• Dry mouth.

• Sore throat upon waking.

What Are the Roles of Tonsils and Adenoids in the Body?

Adenoids are glands that are situated between the airways in the nose and behind the throat. Patches of tissue will be present in the nasal cavity, which helps to trap the bacteria that a person inhales or swallows. Both tonsils and adenoids have immune cells that help to destroy any harmful bacteria that the person has inhaled.

What Is Tonsillectomy?

The two little masses of tissue known as tonsils, which are located in the back of the throat, are removed during a tonsillectomy. The throat is removed. Two little masses of tissue called tonsils are found near the back of the throat and they can contribute to airway obstruction when they become enlarged. Tonsillectomy is usually recommended for patients with enlarged tonsils who have not responded to other treatments, such as continuous positive airway pressure (CPAP) therapy. The procedure is usually performed to treat recurrent infections of the tonsils, such as tonsillitis, or when the tonsils are enlarged and obstruct the airway, causing breathing problems or sleep apnea.

General anesthesia is frequently used for tonsillectomy procedures and involves removing the tonsils using a scalpel or a specialized surgical instrument. The procedure usually takes about 30 minutes to an hour to complete, and most patients can go home the same day. While a tonsillectomy is generally considered a safe and effective treatment for recurrent tonsil infections or airway obstruction, there are some risks associated with the procedure, including bleeding, infection, and changes in voice or speech. After a tonsillectomy, patients may experience some pain or discomfort in the throat, which can be managed with pain medications and ice packs. They may also need to follow a soft or liquid diet for a few days and avoid strenuous activity until the throat has healed.

Why Is Tonsillectomy Performed?

This procedure is done to manage sleep disorder breathing and also to treat tonsillitis, which occurs very frequently and does not show any improvement on other treatment methods. This is done when a person has frequent throat infections.

What Are the Effects of Tonsillectomy on Obstructive Sleep Apnea?

One of the treatments for obstructive sleep apnea is a tonsillectomy, a surgical treatment that entails tonsil removal. A radical tonsillectomy was performed in all patients under general anesthesia and with oral intubation. All patients were observed overnight at a postoperative care unit, and those with severe sleep apnea were managed with nasal continuous positive airway pressure during sleep. Several studies have investigated the effect of tonsillectomy on OSA, and the results have been generally positive. However, the benefits of the procedure may vary depending on the individual patient's medical history and symptoms, and the decision to undergo tonsillectomy should be made in consultation with a doctor or ENT specialist.

The following are the effects of tonsillectomy on obstructive sleep apnea in patients:

• After tonsillectomy, most of the patients (64 %) no longer had sleep apnea.

• None experienced deterioration in swallowing function after surgery, and few had an improved swallowing function at the postoperative examination.

• Sleep apneas and daytime sleepiness were significantly reduced after tonsillectomy in the present patients suffering from obstructive sleep apnea and large tonsils.

• Daytime sleepiness decreased without any persistent side effects after tonsillectomy.

• One of the adverse effects of tonsillectomy is obesity (weight gain). There was no predilection for weight gain in obese or overweight children alone. However, those children are at the most risk for further complications from excessive weight gain even in a short follow-up period after surgery.

• Major respiratory complications such as pulmonary edema and desaturations of oxygen can occur in children after surgery. The rate of major respiratory complications was 5.8 % with moderate to severe cases.

• Few studies identified a significant reduction in asthma symptoms within six months to one year postoperatively (after surgery).

• The risk of postoperative hemorrhage (bleeding) from tonsillectomy is more life-threatening in children as compared to the adult population. According to several studies, tonsillotomy (partial surgical removal of tonsils) is a safer alternative to tonsillectomy for children with obstructive sleep apnea.

• Tonsillectomy has been considered to be an effective treatment for adults and children with obstructive sleep apnea.

• The literature supports adenotonsillectomy (complete removal of the tonsil and its parts) as the first treatment option for low-risk as well as children with Down syndrome and obesity.

• Tonsillectomy is also responsible for the decrease of the risk of bleeding.

When Is Tonsillectomy Done for Patients With Osa?

Some people can have enlarged tonsils, which can be the causative factor for sleep apnea. The airways get blocked as the tonsils are oversized, which can cause recurrent breathing issues. If a person has oversized tonsils and also experiences sleep apnea, then a tonsil removal procedure is performed to help the person with the sleep pattern.

Conclusion:

Tonsillectomy is performed in children alone, but when combined with an adenoidectomy (surgical removal of the adenoid gland), both procedures have proven to be an effective first line of treatment for the majority of children. Tonsillectomy alone for OSA has a surprising success rate. However, more study is needed to assess the long-term efficacy and the necessity of additional treatments. Adults with OSA and oversized tonsils may be advised to undergo a tonsillectomy.