Very severe childhood OSA: routine cardiac work-up before adenotonsillectomy found little

The edition in brief

A single-centre review of 144 children with very severe obstructive sleep apnoea (AHI 25 or more) undergoing adenotonsillectomy found that 38 had a preoperative cardiac work-up, and three of those (7.9%) had abnormal findings. All three were obese adolescents aged 13 to 16 with an AHI above 50, and none had their management changed. The authors suggest targeting cardiac evaluation to that group rather than all children with very severe OSA, which could shorten delays to surgery; the study is retrospective and small. A review of 214 adults referred with neck 'compressive' symptoms attributed to thyroid disease found that only 38% had surgery, with 83% improving afterwards, and orthopnoea had the best surgical response (91%). Among those not operated on, reflux and laryngeal muscle tension were the commonest alternative explanations, particularly for globus and dysphagia. A systematic review of 11 studies found frailty consistently associated with more medical complications, longer stays, non-home discharge and slower swallowing recovery after free flap reconstruction for head and neck cancer, with nutritional and sarcopenia measures predicting complications better than frailty indices alone. The pearl covers overnight monitoring after adenotonsillectomy in high-risk children.