title: Total analysis of clinical factors for surgical success of adenotonsillectomy in pediatric OSAS.
abstract: The objective of this study is the total evaluation of most common clinical factors influencing the successful rate of adenotonsillectomy for pediatric obstructive sleep apnea syndrome (OSAS). Retrospectively, 63 pediatric patients ranged from 2 to 16 years old were included. Syndromics and patients who had received orthodontic treatment or orthognathic surgery were excluded. All patients received pre-operative and postoperative polysomnography and cephalometry. Each patient received adenotonsillectomy by single surgeon. Surgical success was defined as apneahypopnea index (AHI) decreased ≧50 % or post-operative AHI <5. Total evaluated clinical factors related to success of adenotonsillectomy for pediatric OSAS include age, gender, body mass index (BMI), tonsil size, adenoid/nasopharynx ratio (A/N Ratio), pre-operative data of polysomnography, including AHI, apnea index (AI), hypopnea index (HI), mean O2saturation and nadir O2saturation, and 18 cephalometry parameters. Mean age of the total 63 patients was 7.78 years old. Mean BMI of the patients was 19.02. The proportion of obese patients was 25.4% (16/63). Surgical success was achieved in 42 out of 63 patients (66.7%). The surgical success was not statistically significant related to all pre-operative cephalometric parameters, age, gender, BMI and adenoid size by multiple logistic regression model. However, the surgical success was significantly related to pre-operative AHI and tonsil size. In addition, all patients who received adenotonsillectomy showed improved polysomnography parameters, including AHI, AI, HI, mean O2saturation and nadir O2saturation which all reached statistically significant improvement. Although adenotonsillectomy cannot cure pediatric OSAS in our research, all patients showed significant improvement of polysomnography parameters after this procedure. Pre-operative cephalometry parameters, BMI and age did not show significant correlation with surgical success, however, pre-op AHI and tonsil size correlated with surgical success. Higher pre-op AHI value and higher tonsil grade showed higher rate of surgical success. Based on the total evaluation of clinical data, surgical success after adenotonsillectomy might be predicted by pre-op AHI severity and tonsil grade.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Taipei Veteran General Hospital, No.201, Shipai Rd. Sec.2, Taipei, Taiwan, ROC. spicychang@hotmail.com.
authors.forename: Ting-So
authors.identifier: http://orcid.org/0000-0001-6553-3172
authors.initials: TS
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Taipei Veteran General Hospital, No.201, Shipai Rd. Sec.2, Taipei, Taiwan, ROC.|Center of Sleep Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.|Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|International Sleep Science and Technology Association, Berlin, Germany.|Sleep Technology Consortium, Ministry of Science and Technology, Taipei, Taiwan.
authors.forename: Rayleigh Ping-Ying
authors.initials: RP
authors.lastname: Chiang
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000473:pathology; D000293:Adolescent; D015992:Body Mass Index; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009305:Nasopharynx / Q000473:pathology; D009765:Obesity / Q000150:complications; D014066:Palatine Tonsil / Q000473:pathology; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014068:Tonsillectomy
keywords: Adenotonsillectomy; Cephalometry; Pediatric OSAS