Surgical management of obstructive sleep apnea in children with cerebral palsy

Objectives: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy. Study Design: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea, Methods: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome. Results: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea, Three of these children also had a uvulectomy, Six children had an adenoidectomy alone as their initial procedure, Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow-up was 34 months. Seventy-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy, Four children ultimately required a tracheotomy. Conclusions: Eighty-four percent of these children were successfully managed without a tracheotomy, We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.