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Myths About Tonsillectomy, Sleep Apnea, and Bedwetting

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?

Bedwetting And Sleep Apnea

Bedwetting (enuresis) is a very common problem in young children, with many psychological, emotional and social implications. A New York Times article describes this condition and its' various theories about why it happens and the different treatment options. Surprisingly, Dr. Klass doesn't mention sleep apnea, since it's one of the major causes of enuresis. 

A study published last year showed that about 1/3 of children with obstructive sleep apnea have enuresis, with the vast majority being cured or partially cured after adenotonsillectomy. Another study showed that rapid maxillary palatal expansion (which has a similar effect on upper airway breathing as adenotonsillectomy) resulted in significant improvement in nearly 50%. A study from the Journal of Pediatrics showed that an AHI of great than 1 had a higher risk of enuresis compared with children whose AHI was less than 1.

 

Dr. Rack, in his sleepdoctor blog describes 3 possible explanations regarding why children with sleep apnea may wet their beds:

 

1. These children don't wake up easily since sleep apnea may decrease the arousal response

2. Increased abdominal pressure during apnea events may increase bladder pressure

3. OSA affects hormones that produce urine, including atrial natriuretic peptide and antidiuretic hormone.

 

Granted, there are many other reasons for bedwetting, but if your child has this problem, at least consider the possibility of obstructive sleep apnea. If you as a parent snore or have obstructive sleep apnea, then it's even more likely that your child may this condition.

 

If you have sleep apnea, did you wet your bed as a child? You can remain anonymous with your answer in the comments box below.

Interview with Tara Marie Segundo on Children’s Topics

Just reminding everyone about my interview tonight with fitness expert Tara Marie Segundo, host of Hotradio125.com‘s The Time is Now. We’re going to continue our discussion about children’s issues, including snoring, ADHD, bedwetting, tonsils and ear infections. It’s at 8PM Eastern, and you can hear the live stream at http://www.hotradio125.com/showpages/taramariesegundo.htm. You can also download the recording after the show.

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