Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children

Derek J. Lam, Natalie A. Krane, Ron B Mitchell

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1 Citation (Scopus)

Abstract

Objective: (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design: Retrospective case series with chart review. Setting: Tertiary care children’s hospital. Subjects and Methods: Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results: Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P =.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P >.05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P <.05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P <.001). Conclusions: In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StateAccepted/In press - Jan 1 2019

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Palatine Tonsil
Endoscopy
Sleep
Pharmaceutical Preparations
Polysomnography
Adenoids
Apnea
Tertiary Healthcare
Linear Models
Analysis of Variance
Retrospective Studies

Keywords

  • adenotonsillectomy
  • drug-induced sleep endoscopy
  • obstructive sleep apnea
  • pediatric
  • polysomnography

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{4991544b5f0847339d9307fbf4e13309,
title = "Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children",
abstract = "Objective: (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design: Retrospective case series with chart review. Setting: Tertiary care children’s hospital. Subjects and Methods: Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results: Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68{\%} male, 44{\%} obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P =.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P >.05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P <.05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P <.001). Conclusions: In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.",
keywords = "adenotonsillectomy, drug-induced sleep endoscopy, obstructive sleep apnea, pediatric, polysomnography",
author = "Lam, {Derek J.} and Krane, {Natalie A.} and Mitchell, {Ron B}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0194599819860777",
language = "English (US)",
journal = "Otolaryngology - Head and Neck Surgery (United States)",
issn = "0194-5998",
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TY - JOUR

T1 - Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children

AU - Lam, Derek J.

AU - Krane, Natalie A.

AU - Mitchell, Ron B

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design: Retrospective case series with chart review. Setting: Tertiary care children’s hospital. Subjects and Methods: Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results: Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P =.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P >.05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P <.05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P <.001). Conclusions: In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

AB - Objective: (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design: Retrospective case series with chart review. Setting: Tertiary care children’s hospital. Subjects and Methods: Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results: Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P =.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P >.05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P <.05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P <.001). Conclusions: In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

KW - adenotonsillectomy

KW - drug-induced sleep endoscopy

KW - obstructive sleep apnea

KW - pediatric

KW - polysomnography

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