Procedure Description:

Adenotonsillectomy

Adenotonsillectomy is typically performed on children who have trouble sleeping. Children who suffer from snoring or obstructive sleep apnea should be evaluated to determine whether their tonsils and adenoids should be removed. This assessment includes identifying whether your child appears to stop breathing throughout the night and whether they snore at night. Every night, children snore. We now know that children who snore every night do not obtain adequate quality sleep, and an adenotonsillectomy is recommended.

Disease Overview:

Sleep apnea

Sleep apnea is a potentially serious sleep disease in which breathing repeatedly stops and restarts. If you snore loudly and feel weary despite getting a full night's sleep, you may have sleep apnea.

The primary types of sleep apnea are:

1- Obstructive sleep apnea (OSA), the most prevalent type, occurs when throat muscles relax and impede the flow of air into the lungs.

2- Central sleep apnea (CSA) happens when the brain fails to deliver correct signals to the muscles that govern breathing.

3- Treatment-emergent central sleep apnea, also known as complicated sleep apnea, occurs when someone has OSA (diagnosed with a sleep study) that transforms to CSA when receiving therapy for OSA.

Disease Signs and Symptoms:

The symptoms of obstructive and central sleep apneas sometimes overlap, making it difficult to tell which you have. The most prevalent symptoms of obstructive and central sleep apnea are:

1. Loud snoring.

2- Episodes in which you stop breathing while sleeping—as reported by another person.

3- Gasping for air while asleep.

4- Waking up with a dry mouth.

5. Morning headache.

6- Insomnia, or difficulty falling or staying asleep.

7- Hypersomnia, or excessive daytime sleepiness.

8- Difficulty concentrating when awake.

9- Irritability.

Disease Causes:

1- Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles support the soft palate, the uvula, the tonsils, the throat's side walls, and the tongue.

When your muscles relax, the airway narrows or closes as you breathe in. You don't receive enough air, which reduces the amount of oxygen in your blood. When your brain detects that you are unable to breathe, it briefly wakes you up to allow you to reopen your airway. This awakening is generally so fleeting that you forget it.

2- Central sleep apnea is a less common form of sleep apnea where the brain fails to deliver signals to the breathing muscles. This means you don't make an attempt to breathe for a brief time. You may awaken with shortness of breath or have difficulty falling or staying asleep.

Risk Factor: 

1. Excess weight

2- Measure your neck circumference.

3- A constricted airway.

4- Being a guy.

5- Being Older.

6- Family background.

7- Intake of alcohol, sedatives, or tranquilizers.

8. Smoking.

9- Nasal congestion.

10. Medical conditions.

Disease Diagnosis:

Your healthcare provider may conduct an evaluation based on your symptoms and a sleep history, which you can offer with the assistance of someone who shares your bed or household, if possible.

An evaluation frequently includes nightly monitoring of your breathing and other bodily systems at a sleep facility. Home sleep testing may also be an option. Tests for sleep apnea include:

1. Nocturnal polysomnography. During this test, you are connected to equipment that tracks your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.

2- Home sleep tests. Your doctor may give you simple home tests to identify sleep apnea. These exams often assess your heart rate, blood oxygen levels, airflow, and breathing patterns.

If you have obstructive sleep apnea, your doctor may recommend you to an ear, nose, and throat specialist to rule out any blockages in your nose or throat.

Disease Treatment:

For milder forms of sleep apnea, your doctor may suggest merely lifestyle modifications, such as decreasing weight or quitting smoking. You may need to adjust your sleeping position. Your clinician may recommend therapy for nasal allergies.

If these procedures do not relieve your symptoms, or if your apnea is moderate to severe, there are several alternative options available. Certain devices can assist in opening a clogged airway. In other circumstances, surgery may be necessary.

Treatments for OSA.

Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use.

Surgery for OSA

Surgery may be an option for people with OSA, but usually only after other treatments have failed.

Surgical options might include:

1-Tissue removal. During this procedure (uvulopalatopharyngoplasty), a surgeon removes tissue from the rear of your mouth and top of the throat. Your tonsils and adenoids usually are removed as well.

2- Tissue shrinkage. Another option is to shrink the tissue at the rear of the mouth and the back of the throat using radiofrequency ablation.

3- Jaw repositioning. In this procedure, the jaw is moved forward from the remainder of the face bones.

4- Implants. Soft rods, usually made of polyester or plastic, are surgically implanted into the soft palate after numbing with a local anesthetic. 

5- Nerve stimulation. This requires surgery to insert a stimulator for the nerve that controls tongue movement (hypoglossal nerve).

6- Creating a new air passageway, known as tracheostomy. You may need this form of surgery if other treatments have failed, and you have severe, life-threatening sleep apnea.