Myths About Tonsillectomy, Sleep Apnea, and Bedwetting

May 23, 2011

One of the biggest myths within the sleep community is that taking out tonsils in children can cure sleep apnea. Yes, it can work to various degrees, sometimes dramatically, but it doesn’t work in all children. In fact, a recent large-scale meta-analysis showed that adenotonsillectomy was found to be significantly effective in about 60% of children. My 11 year old son was one such child. He had a dramatic response initially when he had his tonsils and adenoids taken out at age 5. But now, it’s slowly coming back, as expected.

Two recent studies continue to repeat the same kind of studies showing that removing tonsils and adenoids can help many children with their sleep apnea or bedwetting (sleep apnea is known to cause bedwetting in children as well as having to go often at night in adults). When the press reports on these kind of studies, they imply that surgery can be a “cure” for sleep apnea or bedwetting.

The adenotonsillectomy for sleep apnea article reported significant drops in the AHI in the mild group (2.6 to 1.5) as well as in the severe group (16.3 to 2.7). But notice that if you use the accepted AHI level of 1 as being abnormal, then their results weren’t that good. What they stressed, however, was that left heart enlargement improved with sleep apnea treatment.

The bedwetting article showed that in children who wet their beds only at night, they had about a 50% drop in bedwetting episodes. Those that had problems at night and during the day didn’t see any significant improvement. They went on to list various risk factors such as prematurity, such as prematurity, higher BMI, male sex, severe bedwetting and family history of bedwetting.

The reason why many of these children don’t respond to adenotonsillectomy (as well as those that respond only partially or relapse later on) is that they still continue to have narrow jaws and dental arches. They have various degrees of craniofacial narrowing and underdevelopment. Having smaller jaws and dental crowding can also make your tonsils larger (which causes more obstructed breathing).

I’m not minimizing the importance of these two studies. However, I wanted to point out that these type of solid scientific studies only perpetuate our black and white understanding of any type of intervention for obstructive sleep apnea.

If you had your child’s tonsils and/or adenoids taken out, did his/or problems improve? And if so, did it last?


6 Responses to “Myths About Tonsillectomy, Sleep Apnea, and Bedwetting”

  1. Dana on September 30th, 2011 10:22 am

    My daughter had severe sleep apnea and had the adenotonsillectomy on June 30. It instantly cured her apnea. She started coughing again around a month ago and has had another chronic cough (two months after surgery). We noticed that she is now holding her breath once again. Not as long or as severe, but her behavior is changing again as well. She is not getting proper air when she sleep once again. I am so distressed. I guess the next step is a dental piece?

  2. Steven Park on October 2nd, 2011 6:42 am

    Dental options are a good choice. Palatal expansion, orthodontics, and various jaw expansion appliances are some options.

  3. Lucy Seager on February 24th, 2012 1:40 am

    My 8 year old step son has always snored heavily whilst sleeping and also sleeps with his mouth open.
    He has also always wet the bed – very rarely will he have a dry night at home or at our house. (He stays with myself and his father every weekend).
    He had a tonsillectomy about 2 years ago due to recurrent tonsillitis although they refused to remove his adenoids as they ‘were not large enough’.
    His snoring did markedly improve after the tonsilectomy but did not cease completely, developing to a loud snore rather than a painful rasp. The bedwetting has never relented.
    Although no doctor has ever mentioned Obstructive Sleep Apnea to be the cause or a contributing factor to the bedwetting, research I have conducted certainly suggests that it is.
    Should I return to the doctor and ask for a second opinion on whether his adenoids should be removed or is it unlikely to solve the problem anyway?

  4. Steven Park on February 24th, 2012 5:47 am

    Lucy,

    While persistently enlarged adenoids may be a problem, this alone is unlikely to cause all of your son’s snoring problems and bedwetting. He should definitely be re-examined thoroughly, including an endoscopy in the office. It’s likely that your son will need a formal sleep study to document obstructive sleep apnea and then you can take it from there. While taking out adenoids (or residual tonsils) may help, it’s important to treat the underlying obstructive sleep apnea. In children, this can include adenotonsilectomy, palatal expansion, functional oral appliances, or CPAP. Jaw narrowing and dental crowding is often the main cause of these problems.

    Good luck.

  5. Mel on February 11th, 2013 4:58 am

    My son is 15 and has never really stopped wetting the bed. I have tried everything that has been known to us, including alarms, pullups, medication, more water intake, etc…..nothing has worked. Someone then suggested a sleep study for sleep apnea which had never really crossed my mind, but once I thought about it I realised that he also suffers from low IQ and has learning difficulties as well as betwetting. This to me made alot of sense as lacking of oxygen does alot. He has now been on a sleep apnea machine for the last two months and has stopped wetting the bed and has also become alot more hungrier……my concern is that if you as a mother has concerns get them to a doctor and do not stop until someone listens because I wish that someone had mentioned this to me ten years ago. His whole life could of been changed from what it is…..he could be in a normal class at school and could have comfortably gone on camps, etc over his school years……up until now I really had no more hope…..but only a pinch of hope got me this far.

    Mel

  6. Jessica on October 15th, 2013 3:36 pm

    I was searching for evidence of success with a T&A and found this site. My son had T&A at age 3. He had an AHI of 7.9 with 59 episodes prior. The change was drastic. Within 4 weeks he was sleeping 12 hours over night whereas, he’d never slept more than 2 straight. Over a year later, things haven’t changed yet.
    My daughter, 2, had an adenoids out at 1, her sleep study didn’t changed at all a year later. She just had tonsils out and we’re hopeful that we’ll see some improvement. Nothing so far at one week post-op. her surgeon did tell us that she has a tiny jaw.

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