TY - JOUR
T1 - Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children
T2 - A multicenter retrospective study
AU - Bhattacharjee, Rakesh
AU - Kheirandish-Gozal, Leila
AU - Spruyt, Karen
AU - Mitchell, Ron B.
AU - Promchiarak, Jungrak
AU - Simakajornboon, Narong
AU - Kaditis, Athanasios G.
AU - Splaingard, Deborah
AU - Splaingard, Mark
AU - Brooks, Lee J.
AU - Marcus, Carole L.
AU - Sin, Sanghun
AU - Arens, Raanan
AU - Verhulst, Stijn L.
AU - Gozal, David
PY - 2010/9/1
Y1 - 2010/9/1
N2 - Rationale: The overall efficacy of adenotonsillectomy (AT) in treatment of obstructive sleep apnea syndrome (OSAS) in children is unknown. Although success rates are likely lower than previously estimated, factors that promote incomplete resolution of OSAS after AT remain undefined. Objectives: To quantify the effect of demographic and clinical confounders known to impact the success of AT in treating OSAS. Methods: A multicenter collaborative retrospective review of all nocturnal polysomnograms performed both preoperatively and postoperatively on otherwise healthy children undergoing AT for the diagnosis of OSAS was conducted at six pediatric sleep centers in the United States and two in Europe. Multivariate generalized linear modeling was used to assess contributions of specific demographic factors on the post-AT obstructive apnea-hypopnea index (AHI). Measurements and Main Results: Data from 578 children (mean age, 6.9 ± 3.8 yr) were analyzed, of which approximately 50% of included children were obese. AT resulted in a significant AHI reduction from 18.2 ± 21.4 to 4.1 ± 6.4/hour total sleep time (P < 0.001). Of the 578 children, only 157 (27.2%) had complete resolution of OSAS (i.e., post-AT AHI < 1/h total sleep time). Age and body mass index z-score emerged as the two principal factors contributing to post-AT AHI (P < 0.001), with modest contributions by the presence of asthma and magnitude of pre-AT AHI (P < 0.05) among nonobese children. Conclusions: AT leads to significant improvements in indices of sleep-disordered breathing in children. However, residual disease is present in a large proportion of children after AT, particularly among older (>7 yr) or obese children. In addition, the presence of severe OSAS in nonobese children or of chronic asthma warrants post-AT nocturnal polysomnography, in view of the higher risk for residual OSAS.
AB - Rationale: The overall efficacy of adenotonsillectomy (AT) in treatment of obstructive sleep apnea syndrome (OSAS) in children is unknown. Although success rates are likely lower than previously estimated, factors that promote incomplete resolution of OSAS after AT remain undefined. Objectives: To quantify the effect of demographic and clinical confounders known to impact the success of AT in treating OSAS. Methods: A multicenter collaborative retrospective review of all nocturnal polysomnograms performed both preoperatively and postoperatively on otherwise healthy children undergoing AT for the diagnosis of OSAS was conducted at six pediatric sleep centers in the United States and two in Europe. Multivariate generalized linear modeling was used to assess contributions of specific demographic factors on the post-AT obstructive apnea-hypopnea index (AHI). Measurements and Main Results: Data from 578 children (mean age, 6.9 ± 3.8 yr) were analyzed, of which approximately 50% of included children were obese. AT resulted in a significant AHI reduction from 18.2 ± 21.4 to 4.1 ± 6.4/hour total sleep time (P < 0.001). Of the 578 children, only 157 (27.2%) had complete resolution of OSAS (i.e., post-AT AHI < 1/h total sleep time). Age and body mass index z-score emerged as the two principal factors contributing to post-AT AHI (P < 0.001), with modest contributions by the presence of asthma and magnitude of pre-AT AHI (P < 0.05) among nonobese children. Conclusions: AT leads to significant improvements in indices of sleep-disordered breathing in children. However, residual disease is present in a large proportion of children after AT, particularly among older (>7 yr) or obese children. In addition, the presence of severe OSAS in nonobese children or of chronic asthma warrants post-AT nocturnal polysomnography, in view of the higher risk for residual OSAS.
KW - Adenoidectomy
KW - Obstructive
KW - Pediatrics
KW - Sleep apnea
KW - Tonsillectomy
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U2 - 10.1164/rccm.200912-1930OC
DO - 10.1164/rccm.200912-1930OC
M3 - Article
C2 - 20448096
AN - SCOPUS:77957716893
SN - 1073-449X
VL - 182
SP - 676
EP - 683
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 5
ER -