Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

Abstract

Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring.

Current Concepts in Pediatric Obstructive Sleep Apnea

“…Adenotonsillectomy (AT) is the first-line treatment in children with enlarged tonsils and adenoids [ 13 ]. The predictors for post AT respiratory complications requiring intervention are children with severe OSA particularly AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO 2 ), and poor nutritional status which was shown in a retrospective review conducted by Saeid et al [ 14 ]. For children where surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy can be an effective treatment [ 15 ].…”

“…Magnusdottir and colleagues performed secondary analyses of the results from the CHAT study to determine if there are factors that could predict which children with mild OSA are likely to have spontaneous resolution of OSA using cardiopulmonary coupling signals based on symptoms and PSG. They showed that those with higher baseline sleep quality, mild OSA, normal body weight, higher executive function score, and better quality of life were more likely to have spontaneous resolution of OSA [ 14 ]. Clearly, this needs to be evaluated prospectively.…”