title: Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome.
abstract: Adenotonsillectomy is recommended for children who need surgery for obstructive sleep apnea syndrome (OSAS). Overnight, polysomnography (PSG) is suggested for post-surgery follow-up, but this diagnostic technique is time consuming and inconvenient. Desaturation index (DI) has been reported as a good tool for predicting both the presence and severity of OSAS in children. The purpose of this study was to determine the usefulness of the DI for post-surgery follow-up of children with OSAS. This retrospective study enrolled 42 children, aged 3-12 years, who were snorers diagnosed with OSAS by overnight PSG and who underwent an adenotonsillectomy. Pre- and postoperative PSG parameters, nocturnal pulse oximetry data, and modified Epworth sleepiness scale scores were assessed. Previously determined cut-off DI values (2.05, 3.50, and 4.15 for mild, moderate, and severe OSAS, respectively) were used to predict residual OSAS. Of the 42 children, obvious improvements were observed in apnea-hypopnea index (AHI, decreased 45.5 %), arousal index (decreased 30.5 %), DI (decreased 40.4 %), and snore index (decreased 100.3 %) compared with the preoperative measurements. Among these objective PSG measures, DI had the strongest correlation with AHI both pre- and post-surgeries (r = 0.947 and r = 0.954, respectively; p all <0.001). The DI change, before and after surgery, also had the strongest positive correlation to the AHI change (r = 0.482 and p = 0.001). Using the previously determined DI cut-off values to predict postoperative residual OSAS, there was a good positive predictive value (92.6 %) for mild residual OSAS and a good negative predictive value for moderate and severe residual OSAS (85.2 and 89.7 %, respectively). These findings suggest that DI, as determined using a nocturnal pulse oximeter, may be an alternative tool for postoperative evaluation and follow-up of children with OSAS.
authors.affiliation: Department of Respiratory Care, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors.forename: Jui-Fang
authors.initials: JF
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
authors.forename: Chih-Min
authors.initials: CM
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Mao-Chang
authors.initials: MC
authors.lastname: Su
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lin
authors.affiliation: Department of Otorhinolaryngology, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsin-Ching
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
authors.forename: Chen-Kuang
authors.initials: CK
authors.lastname: Niu
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan. yuu2004taiwan@yahoo.com.tw.
authors.forename: Hong-Ren
authors.initials: HR
authors.lastname: Yu
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010092:Oximetry; D017286:Polysomnography; D011184:Postoperative Period; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012913:Snoring / Q000601:surgery; D014068:Tonsillectomy
keywords: Adenotonsillectomy; Children; Desaturation index; Obstructive sleep apnea syndrome (OSAS); Polysomnography; Pulse oximetry