Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study

Abstract

). Written informed consent was obtained from each participant after the aim and potential risks were fully explained.The Japanese patients enrolled in this study were diagnosed as having OSA based on the following criteria: (1) an apnea hypopnea index (AHI) ≥ 1 (/h) on overnight polysomnogram Study Objectives: Pediatric obstructive sleep apnea (OSA) is frequently associated with adenotonsillar hypertrophy, and the fact that about 30% of affected children continue to show OSA after adenotonsillectomy (AT) suggests the presence of some other predisposing factor(s). We hypothesized that abnormal maxillofacial morphology may be a predisposing factor for residual OSA in pediatric patients. Methods: A total of 13 pediatric OSA patients (9 boys and 4 girls, age [median (interquartile range)] = 4.7 (4.0, 6.4) y, body mass index (BMI) z score = -0.3 (-0.8, 0.5)) who had undergone AT were recruited for this study. Maxillomandibular size was measured using an upright lateral cephalogram, and correlations between size and the apnea hypopnea index (AHI) values obtained before (pre AT AHI) and about 6 months after AT (post AT AHI) were analyzed.Results: AHI decreased from 12.3 (8.9, 26.5)/h to 3.0 (1.5, 4.6)/h after AT (p < 0.05). Residual OSA was seen in 11 of the 13 patients (84.6%) and their AHI after AT was 3.1 (2.7, 4.7)/h. The mandible was smaller than the Japanese standard value, and a signifi cant negative correlation was seen between maxillomandibular size and post AT AHI (p < 0.05). Conclusions: These fi ndings suggest that the persistence of OSA after AT may be partly due to the smaller sizes of the mandible in pediatric patients. We propose that the maxillomandibular morphology should be carefully examined when a treatment plan is developed for OSA children. Keywords: obstructive sleep apnea, pediatric, small mandible Citation: Maeda K, Tsuiki S, Nakata S, Suzuki K, Itoh E, Inoue Y. Craniofacial contribution to residual obstructive sleep apnea after adenotonsillectomy in children: a preliminary study. J Clin Sleep Med 2014;10(9):973-977. S C I E N T I F I C I N V E S T I G A T I O N ST he prevalence of obstructive sleep apnea (OSA) in children has been estimated to be 1% to 3%, 1,2 and unstable sleep brought about by this disorder may cause decreased neurocognitive performance and behavioral impairments, both of which may lead to degraded school performance.3-8 Most cases of OSA in children have been believed to be associated with adenotonsillar hypertrophy, and adenotonsillectomy (AT) has been widely accepted as the fi rst choice of treatment. However, many reports have suggested that 20% to 40% of pediatric OSA patients continue to show OSA after AT. [9][10][11][12] This phenomenon implies that other predisposing factors may be present in patients with pediatric OSA.An abnormality of the maxillofacial morphology, especially small mandibular size relative to oropharyngeal soft tissue, has been revealed to play an important role in the development of OSA in adults. 13 Similarly, a small mandible has been reported...

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