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Am Fam Physician. 2004;70(7):1374

From 1 to 3 percent of children have obstructive sleep apnea, which may result in poor growth, cor pulmonale, and other medical and behavioral problems. The most common cause of sleep apnea is adenotonsillar hypertrophy, which is treated most frequently with adenotonsillectomy. In this study, Tarasiuk and colleagues examined the effect of adenotonsillectomy one year before and one year after polysomnographic diagnosis, hypothesizing that this treatment would decrease the use of health care.

In this longitudinal, prospective, case-control study, three groups of children one to 18 years of age were defined. Group 1 comprised children who had sleep apnea and underwent adenotonsillectomy. Group 2 included children who had sleep apnea and did not undergo surgery. Group 3 comprised matched normal control patients. All children with sleep apnea underwent polysomnography. To estimate the effect of apnea severity on health care costs, the authors calculated the difference in total annual costs between year 1 and year 2, using three arbitrarily defined levels of respiratory disturbance.

Of 220 children with sleep apnea for whom adenotonsillectomy was recommended, 130 had the procedure, 90 did not, and there were 520 control patients. The number of office visits was similar among groups and between years. Compared with group 2, a 50 percent reduction in upper respiratory infections occurred between years 1 and 2 in group 1.

Health care costs among children with sleep apnea in year 1 were 2.5-fold higher than in the control group. Adenotonsillectomy reduced total annual health care costs by 32.5 percent in the year following the procedure, whereas in the control and untreated sleep-apnea groups, annual costs did not change significantly. Health care costs were reduced overall in children with adenotonsillectomy whose respiratory distress index (RDI) was moderate to severe. In children who did not receive adenotonsillectomy, there was a marked increase in health care costs in the second year in those with a severe RDI.

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

The authors conclude that adenotonsillectomy is the treatment of choice for obstructive sleep apnea in children. A telephone interview at the end of the study indicated that a lack of parental and physician awareness was a major reason that the second sleep apnea group did not receive adenotonsillectomy. Adenotonsillectomy resulted in a one-third reduction of total annual costs among children with sleep apnea in the year following the procedure. In terms of savings, the group with severe sleep apnea did the best. One possible explanation for the improvement in treated patients is that they had fewer upper respiratory infections in the year after the procedure.

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