Very Severe Obstructive Sleep Apnea in Children: Outcomes of Adenotonsillectomy and Risk Factors for Persistence

作者：Isaiah Amal; Hamdan Hisham; Johnson Romaine F; Naqvi Kamal; Mitchell Ron B^*

来源：Otolaryngology - Head and Neck Surgery, 2017, 157(1): 128-134.

DOI：10.1177/0194599817700370

• very severe obstructive sleep apnea
• adenotonsillectomy
• outcomes

Objectives. (1) To describe the clinical, demographic and polysomnographic (PSG) characteristics of children with very severe obstructive sleep apnea (OSA) without significant comorbidities; (2) to assess the outcomes following tonsillectomy and adenoidectomy (T & and (3) to determine predictors of persistence of OSA after T&A.
Study Design. Case series with chart review.
Setting. Tertiary-level freestanding children's hospital. Subjects and
Methods. Seventy-four children aged 2 to 12 years who underwent T&A for very severe OSA (obstructive apnea-hypopnea index [AHI].30) were included. Children with significant comorbidities were excluded. PSG variables were compared pre-and post-T&A using statistical tests. Factors affecting OSA resolution and persistence were studied.
Results. The mean (95% confidence interval) age was 4.3 (3.8-4.7) years with the majority black or Hispanic (64/74, 86%). The mean decrease in AHI after T&A was 49 (43-58) (P <.001). Complete resolution of OSA, defined by an AHI < 1, or an AHI < 5 was seen in 32% (24/74) and 80% (59/74), respectively. Total sleep time (TST) greater than 5 minutes with end-tidal CO2 <50 mm Hg was strongly associated with persistent OSA. The decrease in AHI post-T&A was best predicted by higher preoperative oxygen saturation (SpO(2)) nadir and lower TSTwith SpO(2) <90% (R-2 = 0.24, P <.001).
Conclusions. T&A is associated with a significant improvement but not resolution of very severe OSA. The severity of baseline hypercapnia and hypoxemia may best predict persistent OSA after T&A. The study supports obtaining routine post-T&A PSG in children with very severe OSA.

• 出版日期2017-7