In children with obstructive sleep apnea the site of airway closure is in fact at the level of the tonsils and adenoids. Lymphoid tissue, especially the adenoids and tonsils, tend to become grossly enlarged in children exposed to second-hand smoke and other environmental irritants. Other factors that have been implicated in adeno-tonsillar hypertrophy are allergies and asthma. Despite the fact that the apnea is often said to be “cured” by adeno-tonsillectomy, the inflamed, enlarged, infected tonsils and adenoids are not the cause of the obstructive sleep apnea.
· Kids with obstructive sleep apnea at night do not obstruct during the day.
· Repeated research studies have not been able to relate the size of the tonsils and adenoids to incidence of obstructive sleep apnea
· There are children with large tonsils and adenoids who do not have obstructive sleep apnea.
· There are children with obstructive sleep apnea and large tonsils and adenoids who are not cured by adeno-tonsillectomy
Large, swollen, inflamed tonsils and adenoids therefore, are associated with obstructive sleep apnea, and possibly a predisposing factor, but not the cause. Obstructive sleep apnea is the result of a complex, dynamic process involving the interaction of specific sleep state, pressure-flow airway mechanics, respiratory drive, dilator muscle status, individual anatomic variations.
THIS PICTURE ILLUSTRATES A CROWDED AIRWAY. THE PHYSICAL OBSTRUCTIONS: LARGE TONGUE WITH SCALLOPED BORDER, LARGE TONSILS AND LARGE SWOLLEN UVULA