Original Investigation |

Predictors of Persistent Sleep Apnea After Surgery in Children Younger Than 3 Years

Andrea Nath, MD1; Janaki Emani, MD1; Dana L. Suskind, MD1,2; Fuad M. Baroody, MD1,2
[+] Author Affiliations
1Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
2Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1002-1008. doi:10.1001/jamaoto.2013.4686.
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Importance  Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied.

Objective  To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease.

Design, Setting, and Participants  Retrospective review of medical records at a tertiary academic children’s hospital involving children younger than 3 years who had OSA documented by polysomnogram (PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs.

Main Outcomes and Measures  Effect of T&A on sleep study parameters and predictors of persistent disease after surgery.

Results  A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6% [2.1%] to 97.2% [1.4%]; P = .05), minimum oxygen saturation (77.2% [11.4%] to 89.9% [6.8%]; P < .001), and sleep efficiency (84.7% [14.9%] to 88.7% [9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02).

Conclusions and Relevance  In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.

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Effect of Adenotonsillectomy on the Apnea Hypopnea Index (AHI)

Individual data are shown for 70 children who had preoperative and postoperative polysomnograms. There was a significant decrease in mean AHI (defined as the number of apnea and hypopnea events per hour of sleep) after surgery (P < .001). Horizontal bars represent mean values.

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