title: Surgical management of obstructive sleep apnea in infants and young toddlers.
abstract: 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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Brigance
authors.forename: R Christopher
authors.initials: RC
authors.lastname: Miyamoto
authors.forename: Peter
authors.initials: P
authors.lastname: Schilt
authors.forename: Derek
authors.initials: D
authors.lastname: Houston
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wiebke
authors.forename: Deborah
authors.initials: D
authors.lastname: Givan
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Matt
mesh_terms: 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