Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study.
OBJECTIVE
To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA.


METHODS
An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence.


RESULTS
Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m(2)) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight.


CONCLUSIONS
Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.
Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan ; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Yu-Shu
YS
Huang
Stanford University Sleep Medicine Division, Stanford, CA ; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Christian
C
Guilleminault
Department of Otolaryngology and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan.
Li-Ang
LA
Lee
Department of Cranio-Facial Center and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan.
Cheng-Hui
CH
Lin
Department of Education, National Chia-Yi University, Chiayi, Taiwan.
Fan-Ming
FM
Hwang
D000233:Adenoidectomy; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D053206:Nocturnal Enuresis; D017286:Polysomnography; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy; D016896:Treatment Outcome
adenotonsillectomy; comorbidity; obstructive sleep apnea; polysomnography; treatment outcomes