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Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea
S A McColley1, M M April, J L Carroll
1Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Insights
Pediatric patients undergoing adenotonsillectomy for obstructive sleep apnea face risks of respiratory compromise. Young age and severe obstruction are key risk factors, necessitating in-hospital monitoring.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Adenotonsillectomy is a primary treatment for pediatric OSA.
- Postoperative respiratory compromise is a known complication.
Purpose of the Study:
- To determine the frequency of postoperative respiratory compromise in pediatric OSA patients after adenotonsillectomy.
- To identify risk factors associated with the development of this compromise.
Main Methods:
- Retrospective study of 69 pediatric patients (<18 years) with polysomnographically confirmed OSA.
- Patients underwent adenotonsillectomy between 1987 and 1990.
- Postoperative monitoring in a pediatric intensive care unit.
Main Results:
- 23% (16/69) of patients experienced severe respiratory compromise requiring intervention.
- Patients with compromise were younger (3.4 vs 6.1 years) and had higher obstructive event indices (49 vs 19).
- Significant risk factors included age <3 years (OR 5.1), abnormal ECG/echocardiogram (OR 4.5), craniofacial abnormality (OR 6.2), and obstructive event index >10.
Conclusions:
- Children with OSA are at risk for respiratory compromise after adenotonsillectomy.
- Younger age and severe upper airway obstruction are significant predictors of risk.
- In-hospital postoperative monitoring is recommended for these high-risk pediatric patients.
Abstract:
A retrospective study of pediatric patients with obstructive sleep apnea who underwent adenotonsillectomy between 1987 and 1990 was undertaken to determine the frequency of postoperative respiratory compromise and to determine if risk factors for its development could be identified. Sixty-nine patients less than 18 years old had polysomnographically documented obstructive sleep apnea and were observed postoperatively in the pediatric intensive care unit. Of these, 16 (23%) had severe respiratory compromise, defined as intermittent or continuous oxygen saturation of 70% or less, and/or hypercapnia, requiring intervention. Compared with patients without respiratory compromise, these patients were younger (3.4 +/- 4 vs 6.1 +/- 4 years) and had more obstructive events per hour of sleep on the polysomnogram (49 +/- 41 vs 19 +/- 30). They were more likely to weight less than the fifth percentile for age (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.4 to 18.7), to have an abnormal electrocardiogram and/or echocardiogram (OR, 4.5; 95% CI, 1.3 to 15.1), and to have a craniofacial abnormality (OR, 6.2; 95% CI, 1.5 to 26). Multiple logistic regression analysis revealed the most significant risk factors were age below 3 years and an obstructive event index greater than 10. Children with obstructive sleep apnea are at risk for respiratory compromise following adenotonsillectomy; young age and severe sleep-related upper airway obstruction significantly increase this risk. We recommend in-hospital postoperative monitoring for children undergoing adenotonsillectomy for obstructive sleep apnea.