title: Changes in central apnea index following pediatric adenotonsillectomy.
abstract: OBJECTIVE
  To determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Two tertiary children's hospitals.
  
  
  METHODS
  Children between 1 and 16 years of age who underwent adenotonsillectomy for OSA and had both preoperative and postoperative full-night polysomnography (PSG) with CAI greater than 1 on preoperative PSG were eligible for inclusion. Central apnea was defined as the absence of both inspiratory effort and chest wall movement lasting longer than 20 seconds. Criteria for diagnosis of central sleep apnea (CSA) was CAI greater than 1.
  
  
  RESULTS
  A total of 101 children with OSA had preoperative and postoperative PSG. Fifteen of these patients had a preoperative CAI greater than 1. The mean age was 67.7 months (SD, 62.7 months). The CAI ranged from 1.1 to 11.1. The mean preoperative CAI was 3.9 (SD, 2.9), while the mean postoperative CAI was 1.9 (SD, 4.8). There was significant improvement (P = .008) of the CAI following adenotonsillectomy. Ninety percent of subjects with mild CSA (CAI between 1 and 5) had postoperative resolution of their disease. There was also significant improvement (P = .004) in the obstructive apnea hypopnea index (AHI), with the mean preoperative AHI of 22.8 (SD, 19.8) decreasing to an AHI of 5.5 (SD, 6.5) postoperatively.
  
  
  CONCLUSIONS
  Children with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia 23507, USA. cristina.baldassari@chkd.org
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Baldassari
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepchar
authors.forename: Lucas
authors.initials: L
authors.lastname: Bryant
authors.forename: Hind
authors.initials: H
authors.lastname: Beydoun
authors.forename: Sukgi
authors.initials: S
authors.lastname: Choi
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D020182:Sleep Apnea, Central / Q000175:diagnosis / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome