title: Predictors of persistent sleep apnea after surgery in children younger than 3 years.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied.
  
  
  OBJECTIVE
  To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nath
authors.forename: Janaki
authors.initials: J
authors.lastname: Emani
authors.forename: Dana L
authors.initials: DL
authors.lastname: Suskind
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Baroody
mesh_terms: D000233:Adenoidectomy; D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome