Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study.
BACKGROUND
The overall efficacy of adenotonsillectomy (AT) in treatment of obstructive sleep apnea syndrome (OSAS) in children is unknown. Although success rates are likely lower than previously estimated, factors that promote incomplete resolution of OSAS after AT remain undefined.


OBJECTIVE
To quantify the effect of demographic and clinical confounders known to impact the success of AT in treating OSAS.


METHODS
A multicenter collaborative retrospective review of all nocturnal polysomnograms performed both preoperatively and postoperatively on otherwise healthy children undergoing AT for the diagnosis of OSAS was conducted at six pediatric sleep centers in the United States and two in Europe. Multivariate generalized linear modeling was used to assess contributions of specific demographic factors on the post-AT obstructive apnea-hypopnea index (AHI).


RESULTS
Data from 578 children (mean age, 6.9 +/- 3.8 yr) were analyzed, of which approximately 50% of included children were obese. AT resulted in a significant AHI reduction from 18.2 +/- 21.4 to 4.1 +/- 6.4/hour total sleep time (P < 0.001). Of the 578 children, only 157 (27.2%) had complete resolution of OSAS (i.e., post-AT AHI <1/h total sleep time). Age and body mass index z-score emerged as the two principal factors contributing to post-AT AHI (P < 0.001), with modest contributions by the presence of asthma and magnitude of pre-AT AHI (P < 0.05) among nonobese children.


CONCLUSIONS
AT leads to significant improvements in indices of sleep-disordered breathing in children. However, residual disease is present in a large proportion of children after AT, particularly among older (>7 yr) or obese children. In addition, the presence of severe OSAS in nonobese children or of chronic asthma warrants post-AT nocturnal polysomnography, in view of the higher risk for residual OSAS.
Bhattacharjee
Rakesh
R
Department of Pediatrics, University of Chicago, Comer Children's Hospital, 5721 S. Maryland Avenue, Chicago, IL 60637, USA.
Kheirandish-Gozal
Leila
L
Spruyt
Karen
K
Mitchell
Ron B
RB
Promchiarak
Jungrak
J
Simakajornboon
Narong
N
Kaditis
Athanasios G
AG
Splaingard
Deborah
D
Splaingard
Mark
M
Brooks
Lee J
LJ
Marcus
Carole L
CL
Sin
Sanghun
S
Arens
Raanan
R
Verhulst
Stijn L
SL
Gozal
David
D
D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome