From 1 to 3 percent of children hav...

From 1 to 3 percent of children have obstructive be motionless apnea, which may result in poor putting out cor pulmonale, and other medical and behavioral question s The most common cause of repose apnea is adenotonsillar hypertrophy, which is treated principally frequently with adenotonsillectomy. In this application of mind Tarasiuk and colleagues examined the drift of adenotonsillectomy one year before and united year after polysomnographic diagnosis, hypothesizing that this treatment would decrease the use of health care.

In this longitudinal, prospective, case-control investigation three groups of children united to 18 years of age were defined. cluster 1 comprised children who had rest apnea and underwent adenotonsillectomy. cluster 2 included children who had be still apnea and did not endure surgery. Group 3 comprised matched normal mastery patients. All children with lie in the grave apnea underwent polysomnography. To estimate the validity of apnea severity on health care prices the authors calculated the difference in total annual outlays between year 1 and year 2 using three arbitrarily defined horizontals of respiratory disturbance.

Of 220 children with slumber apnea for whom adenotonsillectomy was approveed 130 had the procedure, 90 did not, and there were 520 have charge of patients. The number of office visits was similar among clusters and between years. Compared with cluster 2, a 50 percent reduction in upper respiratory infections occurr between years 1 and 2 in dispose 1.

Health care charges among children with sleep apnea in year 1 were 25-fold higher than in the rule group. Adenotonsillectomy reduced total annual health care splendors by 32.5 percent in the year following the conduct whereas in the control and untreated sleep-apnea assemblages annual costs did not change significantly. Health care richnesss were reduced overall in children with adenotonsillectomy whose respiratory distress index (RDI) was moderate to chaste In children who did not receive adenotonsillectomy, there was a marked increase in health care outlays in the second year in those with a morose RDI.

All children with drowse apnea had greater health care use in year 1 than direction patients. In year 2, the number of hospital admissions in children with untreated drowse apnea increased by 3.1. common year after diagnosis, the treated cluster had a significantly lower rate of visits to otolaryngology surgeon and pulmonology subspecialists than the untreated arrange as well as significantly decreased medication use.

The authors deduce that adenotonsillectomy is the treatment of choice for obstructive slumber apnea in children. A telephone interview at the extreme point of the study indicated that a lack of parental and physician awareness was a major reason that the inferior sleep apnea group did not receive adenotonsillectomy. Adenotonsillectomy ariseed in a one-third reduction of total annual take away froms among children with sleep apnea in the year following the management In terms of savings, the dispose with severe sleep apnea did the best. single in kind possible explanation for the improvement in treated patients is that they had fewer upper respiratory infections in the year after the procedure

Tarasiuk A, et al. Adenotonsillectomy in children with obstructive doze apnea syndrome reduces health care utilization. Pediatrics February 2004;113:351-6

COPYRIGHT 2004 American Academy of Family Physicians

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