Comparison of surgical treatments for obstructive sleep apnea syndrome in children with adenotonsillar disease

Objective. To evaluate the safety of the use of cold plasma for the surgical treatment of obstructive sleep apnea syndrome in children with adenotonsillar pathology. Patients and methods. The subjects of the study were 60 children diagnosed with grade 3 chronic adenoiditis and grade 3 hypertrophy of the palatine tonsils. The age range of the children was from 2 to 14 years, 5.17 ± 8.58 years. The patients were divided into 2 groups: in the 1st group there were 30 children who underwent cold plasma adenotomy and tonsillotomy, age 5.4±5.79; in the 2nd group, 30 children who underwent standard adenotomy and tonsillotomy, age 5.2±5.02. Before surgery and 14 days later, OSAS (obstructive sleep apnea syndrome) was diagnosed, and the following parameters were assessed: the risk of developing cardiovascular diseases, the risk of sleep fragmentation, oxygen, heart rate. The average blood loss and duration of surgery were compared between the two groups of children. Results. In patients of both groups, risk indicators for sleep-disordered breathing RDI (breathing disorder index) 2.11±1.41 (p = 1.00), sleep fragmentation disorder (arousal and awakening index, AAI) 1.85±0.71 (p = 1.00) correspond to the risk of developing cardiovascular diseases as average. The desaturation index was 15.76 ± 13.78 (p = 0.80), which was regarded as the average degree of OSA. Minimum SpO2 saturation was 81 ± 2.82% (p = 1.00); average saturation, 93% (p = 1.00); average heart rate, 72/min (p = 1.00). The results obtained indicate that hypertrophy of the adenoids and palatine tonsils was a high factor in the development of sleep apnea and upper airway obstruction. Intraoperative and postoperative bleeding as well as the time spent on the operation itself was lower in children from the first group who underwent adenotonsillotomy using cold plasma 5.4 ± 5.7 mL of blood and t = 7.9 ± 2.12 min versus 20.3 ±3.5 mL and t = 34.2 min versus adenotonsillotomy performed by the classical method p <0.001 (mL). In the first group, healing was faster, and no delayed bleeding was observed in the postoperative period. Conclusion. The cold plasma energy used to remove adenoids and correct hypertrophied palatine tonsils has a number of advantages over standard methods of treating children with obstructive sleep apnea.