Ten cases of adenoidectomy and tonsillectomy for children with achondroplasia and sleep apnea

• Published in: Stomato-pharyngology Vol. 34; no. 1; pp. 53 - 60
• Main Authors: Morimoto, Noriko, Yamaguchi, Sota, Yoshikawa, Mamoru
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Stomato-pharyngology 2021; 日本口腔・咽頭科学会
• Subjects: achondroplasia; adenoidectomy; central sleep apnea; obstructive sleep apnea; tonsillectomy; アデノイド切除術; 中枢性睡眠時無呼吸; 口蓋扁桃摘出術; 軟骨無形成症; 閉塞性睡眠時無呼吸
• ISSN: 0917-5105; 1884-4316
• DOI: 10.14821/stomatopharyngology.34.53

Sleep apnea in childhood is mostly cured by upper airway surgery （adenoidectomy and/or tonsillectomy）. However, sleep apnea with achondroplasia may not be cured even after upper airway surgery due to structural nasopharyngeal stenosis and central sleep apnea. Forty-seven cases of achondroplasia were followed in our hospital, of which we examined 10 cases who underwent upper airway surgery due to suspicion of sleep apnea. Diagnosis of sleep apnea was performed by a sleep test or overnight pulse oxymetry during hospitalization. Symptoms of sleep apnea improved in 7 of the 10 cases （70.0％） including reoperation cases due to upper airway surgery and who did not relapse, but 3 of the 10 cases （30.0％） needed conservative treatment such as CPAP. It was considered that sleep apnea with achondroplasia not only affects obstructive sleep apnea but also involves multiple factors such as central sleep apnea, lower respiratory tract disease and GH replacement therapy. In the perioperative management, it is necessary to manage patients in the PICU to secure the airway with a nasal airway or positive pressure breathing in cases where stenosis of the postoperative upper airway is temporarily exacerbated. When snoring or depressed breathing remains after surgery, CPAP therapy, continuous nasal airway and home oxygen therapy should be considered.