title: Effectiveness of Powered Intracapsular Tonsillectomy in Children With Severe Obstructive Sleep Apnea.
abstract: OBJECTIVE
  Powered intracapsular tonsillectomy and adenoidectomy (PITA) is an increasingly common pediatric procedure. Few studies have examined its effectiveness in children with severe obstructive sleep apnea (OSA).
  
  
  OBJECTIVE
  To assess the effectiveness of PITA in patients with severe OSA as evidenced by change in polysomnographic parameters.
  
  
  METHODS
  We performed a case series study with medical record review of 70 children with severe OSA who underwent PITA at a tertiary care pediatric hospital from January 1, 2010, through December 31, 2014.
  
  
  METHODS
  Preoperative and postoperative polysomnographic parameters.
  
  
  RESULTS
  Of the 70 children with severe OSA who underwent PITA, 39 (56%) were boys, and the median age at surgery was 3.7 years. There were significant mean (SD) decreases in the postoperative apnea-hypopnea index (32.4 [28.4] vs 5.8 [9.7], P < .001), obstructive apnea index (20.4 [17.97] vs 2.55 [5.9]), obstructive apnea-hypopnea index (25.5 [22.4] vs 3.9 [7.3], P < .001), arousal index (53.7 [33.9] vs 27.4 [22.6], P < .001), percentage of total sleep time spent snoring (28.6 [30.5] vs 13.6 [20.8], P = .001), and oxygen desaturation index of 4% or more (22.9 [26.4] vs 4.5 [9.9], P < .001). Mean (SD) oxygen saturation (96.8 [2.0] vs 98.2 [1.3], P < .001) and oxygen saturation nadir (75.5 [13.1] vs 88.4 [8.1], P < .001) increased significantly. A significant decrease in time was observed with an end-tidal carbon dioxide greater than 55 mm Hg (49.67 [97.5] vs 19.1 [73.9] minutes, P = .01).
  
  
  CONCLUSIONS
  Powered intracapsular tonsillectomy and adenoidectomy improved OSA in this series of pediatric patients by reducing obstructive apneas and hypopneas, oxygen desaturation, arousal index, carbon dioxide level, and snoring, as well as increasing oxygen saturation nadir. Results are comparable to those described for traditional electrocautery tonsillectomy and support the use of PITA for the treatment of severe OSA in children with adenotonsillar hypertrophy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Nadia
authors.initials: N
authors.lastname: Mostovych
authors.affiliation: Office of Health Equity and Inclusion, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
authors.affiliation: University of Maryland, College Park.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ruszkay
authors.affiliation: Office of Health Equity and Inclusion, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Alexandra
authors.initials: A
authors.lastname: LaHurd
authors.affiliation: Division of Pulmonary Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Robert
authors.initials: R
authors.lastname: Heinle
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania5Division of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Heather
authors.initials: H
authors.lastname: Nardone
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002675:Child, Preschool; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome