Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy

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Abstract

Objectives/Background: Tonsillectomy and adenoidectomy (T&A) lead to resolution of obstructive sleep apnea (OSA) in most children. However, OSA persists in about 25–40% of children. Cinematic magnetic resonance imaging (cine MRI) can aid the management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol by using a 3 Tesla MRI scanner, and the use of dexmedetomidine for sedation to improve reproducibility, safety, and diagnostic accuracy. Patients/Methods: Patients aged 3–18 years who underwent cine MRI for the evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences. Results: A total of 36 children were included with a mean age of 9.6 ± 4.6 (SD) years with 40% over 12 years of age. Two-thirds of them were boys. Seventeen out of 36 children (47%) had Down syndrome. Single site and multilevel obstruction were identified in 21 of 36 patients (58%) and in 12 of 36 patients (33%), respectively. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = 0.002). Conclusions: Cine MRI is a sensitive, safe, and noninvasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.

Original languageEnglish (US)
Pages (from-to)79-86
Number of pages8
JournalSleep Medicine
Volume50
DOIs
StatePublished - Oct 1 2018

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Obstructive Sleep Apnea
Airway Obstruction
Magnetic Resonance Imaging
Cine Magnetic Resonance Imaging
Dexmedetomidine
Adenoidectomy
Pressure
Tonsillectomy
Apnea
Down Syndrome
Body Mass Index
Regression Analysis
Safety
Therapeutics

Keywords

  • Adenotonsillectomy
  • Magnetic resonance imaging
  • Pediatric obstructive sleep apnea

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{16aa69dfedad4a2fb295f5d34d5e372e,
title = "Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy",
abstract = "Objectives/Background: Tonsillectomy and adenoidectomy (T&A) lead to resolution of obstructive sleep apnea (OSA) in most children. However, OSA persists in about 25–40{\%} of children. Cinematic magnetic resonance imaging (cine MRI) can aid the management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol by using a 3 Tesla MRI scanner, and the use of dexmedetomidine for sedation to improve reproducibility, safety, and diagnostic accuracy. Patients/Methods: Patients aged 3–18 years who underwent cine MRI for the evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences. Results: A total of 36 children were included with a mean age of 9.6 ± 4.6 (SD) years with 40{\%} over 12 years of age. Two-thirds of them were boys. Seventeen out of 36 children (47{\%}) had Down syndrome. Single site and multilevel obstruction were identified in 21 of 36 patients (58{\%}) and in 12 of 36 patients (33{\%}), respectively. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = 0.002). Conclusions: Cine MRI is a sensitive, safe, and noninvasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.",
keywords = "Adenotonsillectomy, Magnetic resonance imaging, Pediatric obstructive sleep apnea",
author = "Amal Isaiah and Edgar Kiss and Patrick Olomu and Korgun Koral and Mitchell, {Ron B.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1016/j.sleep.2017.10.006",
language = "English (US)",
volume = "50",
pages = "79--86",
journal = "Sleep Medicine",
issn = "1389-9457",
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T1 - Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy

AU - Isaiah, Amal

AU - Kiss, Edgar

AU - Olomu, Patrick

AU - Koral, Korgun

AU - Mitchell, Ron B.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Objectives/Background: Tonsillectomy and adenoidectomy (T&A) lead to resolution of obstructive sleep apnea (OSA) in most children. However, OSA persists in about 25–40% of children. Cinematic magnetic resonance imaging (cine MRI) can aid the management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol by using a 3 Tesla MRI scanner, and the use of dexmedetomidine for sedation to improve reproducibility, safety, and diagnostic accuracy. Patients/Methods: Patients aged 3–18 years who underwent cine MRI for the evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences. Results: A total of 36 children were included with a mean age of 9.6 ± 4.6 (SD) years with 40% over 12 years of age. Two-thirds of them were boys. Seventeen out of 36 children (47%) had Down syndrome. Single site and multilevel obstruction were identified in 21 of 36 patients (58%) and in 12 of 36 patients (33%), respectively. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = 0.002). Conclusions: Cine MRI is a sensitive, safe, and noninvasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.

AB - Objectives/Background: Tonsillectomy and adenoidectomy (T&A) lead to resolution of obstructive sleep apnea (OSA) in most children. However, OSA persists in about 25–40% of children. Cinematic magnetic resonance imaging (cine MRI) can aid the management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol by using a 3 Tesla MRI scanner, and the use of dexmedetomidine for sedation to improve reproducibility, safety, and diagnostic accuracy. Patients/Methods: Patients aged 3–18 years who underwent cine MRI for the evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences. Results: A total of 36 children were included with a mean age of 9.6 ± 4.6 (SD) years with 40% over 12 years of age. Two-thirds of them were boys. Seventeen out of 36 children (47%) had Down syndrome. Single site and multilevel obstruction were identified in 21 of 36 patients (58%) and in 12 of 36 patients (33%), respectively. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = 0.002). Conclusions: Cine MRI is a sensitive, safe, and noninvasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.

KW - Adenotonsillectomy

KW - Magnetic resonance imaging

KW - Pediatric obstructive sleep apnea

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