Planning Adenotonsillectomy in Children With Obstructive Sleep Apnea: The Role of Overnight Oximetry

Abstract

ABSTRACT. Objective. Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (T&A). However, there may be a waiting list for T&A, and the procedure is associated with an increased risk of postoperative complications in children with OSA. Needed is a simple test that will facilitate logical prioritization of the T&A surgical list and help to predict children who are at highest risk of postoperative complications. The objective of this study was to develop and validate a severity scoring system for overnight oximetry and to evaluate the score as a tool to prioritize the T&A surgical list.Methods. This study comprised 3 phases. In phase 1, a severity score was developed by review of preoperative overnight oximetry in children who had urgent T&A in 1999 -2000. In phase 2, the score was validated retrospectively in 155 children who had polysomnography (PSG) before T&A in 1992-1998. In a phase 3, a 12-month prospective evaluation of a protocol based on the score was conducted.Results. In phase 1, a 4-level severity score was developed on the basis of the number and the depth of desaturation events (normal to severely abnormal, categories 1-4). In phase 2, the McGill oximetry score correlated with severity of OSA by PSG criteria. In phase 3, a clinical management protocol was developed based on the score. Of 230 children tested, 179 (78%) had a normal/ inconclusive oximetry (category 1) and went on to have PSG. Those with a positive oximetry (categories 2-4; 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score.Conclusions. Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care. Pediatrics 2004;113:e19 -e25. URL: http://www.pediatrics.org/cgi/content/full/113/1/ e19; oximetry, obstructive sleep apnea, child, adenotonsillectomy, postoperative complications.

Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring

“…Diagnosis of moderate-to-severe OSA is important because affected patients can develop respiratory complications or may have persistent disease following AT (12)(13)(14). In the current large cohort of hospital-referred children with habitual snoring, NE was significantly associated with the presence of moderate-to-severe OSA irrespective of gender.…”

“…Furthermore, the potential interaction between NE and female gender regarding the association with obstructive AHI >5 episodes/hour was explored. Obstructive AHI >5 episodes/hour corresponds to moderate-to-severe OSA as proposed by Dayyat et al (10) and it is related to elevated systolic and diastolic blood pressure, increased risk of development of respiratory complications and persistent OSA following adenotonsillectomy as well as low likelihood of spontaneous OSA resolution without treatment interventions (11)(12)(13)(14).…”

Overnight Pulse Oximetry for Evaluation of Sleep Apnea among Children with Trisomy 21

“…[1][2][3] Risk factors for development of OSDB include hypotonia, obesity, adenotonsillar hypertrophy, and craniofacial abnormalities such as macroglossia and retrognathia. 2 Children with trisomy 21 are at a particularly increased risk for OSDB, perhaps due to their relative macroglossia and tendency towards obesity.…”

“…The score, with 4 indicating the most severe desaturations, has been used to direct surgical or medical interventions or suggest the need for full PSG. 1,13 This technique has not been evaluated among a large number of children with trisomy 21.…”

Evaluation of choroidal thickness measurements in pediatric obstructive sleep apnea syndrome patients

“…OSAS is common, affects 1 to 3 percent of children in childhood 3 , and is characterized by recurrent upper airway obstruction (partially or completely) during sleep 4 . The gold standard diagnosis method is full-night polysomnography (PSG), but it is time-consuming and expensive 5 .…”