Surgical management of obstructive sleep apnea in infants and young toddlers.
OBJECTIVE
Review surgical management of obstructive sleep apnea (OSA) in infants and young toddlers compared with a medically treated group.


METHODS
Case series with chart review of children younger than 24 months treated at a tertiary pediatric hospital between 2000 and 2005.


METHODS
Surgical treatment included adenotonsillectomy, adenoidectomy, and tonsillectomy. Polysomnography results, comorbidities, and major complications were recorded. The change in apnea-hypopnea index (AHI) before and after treatment was analyzed. Logistic regression analysis reviewed effects of comorbidities and OSA severity on complications.


RESULTS
A total of 73 children met inclusion criteria. The surgical treatment group (AHI) improved posttreatment: mean AHI change was 9.6 (95% CI, 5.8-13.4). The medical treatment group did not improve posttreatment: mean AHI change was -3.0 (95% CI, -15.1 to 9.1). The difference in AHI change between surgical and medical groups was 12.56 (95% CI, 2.7-22.4). An independent t test found this difference to be statistically significant (P = 0.01). Eleven (18%) patients suffered significant postoperative surgical complications; 55 surgical patients and 8 medical patients had comorbidities. There were no long-term morbidities or mortalities.


CONCLUSIONS
AHI in the surgically treated group significantly improved. The complication rate for a tertiary pediatric hospital population that included patients with multiple comorbidities was acceptable.
Brigance
Joseph S
JS
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Miyamoto
R Christopher
RC
Schilt
Peter
P
Houston
Derek
D
Wiebke
Jennifer L
JL
Givan
Deborah
D
Matt
Bruce H
BH
D000233:Adenoidectomy; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017286:Polysomnography; D011183:Postoperative Complications; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome