title: Very Severe Obstructive Sleep Apnea in Children: Outcomes of Adenotonsillectomy and Risk Factors for Persistence.
abstract: Objectives (1) To describe the clinical, demographic and polysomnographic (PSG) characteristics of children with very severe obstructive sleep apnea (OSA) without significant comorbidities; (2) to assess the outcomes following tonsillectomy and adenoidectomy (T&A); and (3) to determine predictors of persistence of OSA after T&A. Study Design Case series with chart review. Setting Tertiary-level freestanding children's hospital. Subjects and Methods Seventy-four children aged 2 to 12 years who underwent T&A for very severe OSA (obstructive apnea-hypopnea index [AHI] >30) were included. Children with significant comorbidities were excluded. PSG variables were compared pre- and post-T&A using statistical tests. Factors affecting OSA resolution and persistence were studied. Results The mean (95% confidence interval) age was 4.3 (3.8-4.7) years with the majority black or Hispanic (64/74, 86%). The mean decrease in AHI after T&A was 49 (43-58) ( P < .001). Complete resolution of OSA, defined by an AHI <1, or an AHI <5 was seen in 32% (24/74) and 80% (59/74), respectively. Total sleep time (TST) greater than 5 minutes with end-tidal CO2>50 mm Hg was strongly associated with persistent OSA. The decrease in AHI post-T&A was best predicted by higher preoperative oxygen saturation (SpO2) nadir and lower TST with SpO2<90% ( R2= 0.24, P < .001). Conclusions T&A is associated with a significant improvement but not resolution of very severe OSA. The severity of baseline hypercapnia and hypoxemia may best predict persistent OSA after T&A. The study supports obtaining routine post-T&A PSG in children with very severe OSA.
authors.affiliation: 1 Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
authors.forename: Amal
authors.initials: A
authors.lastname: Isaiah
authors.affiliation: 2 Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
authors.forename: Hisham
authors.initials: H
authors.lastname: Hamdan
authors.affiliation: 1 Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
authors.forename: Romaine F
authors.initials: RF
authors.lastname: Johnson
authors.affiliation: 2 Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Naqvi
authors.affiliation: 1 Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome
keywords: adenotonsillectomy; outcomes; very severe obstructive sleep apnea