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Published on: December 6, 2016
Analysis of outcomes in treatment of obstructive sleep apnea in infants
Jacob G Robison1, Caleb Wilson, Todd D Otteson
1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Insights
This study reviewed infant obstructive sleep apnea (OSA) treatments, finding adenotonsillectomy most common and subjectively effective. Tracheostomy offered the greatest objective improvement in OSA severity.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Otolaryngology
Background:
- Infants with obstructive sleep apnea (OSA) present unique diagnostic and treatment challenges.
- Understanding the efficacy of various interventions is crucial for optimizing infant care.
Purpose of the Study:
- To investigate and compare the effectiveness of different treatment interventions for obstructive sleep apnea (OSA) in infants.
- To analyze intervention patterns based on patient age and intervention type.
Main Methods:
- Retrospective review of medical records for 295 infants diagnosed with OSA via polysomnography (PSG).
- Data collected included demographics, PSG results, intervention details, and outcomes.
- Interventions analyzed included observation, adenotonsillectomy, adenoidectomy, oxygen, CPAP/BiPAP, tonsillectomy, and tracheostomy.
Main Results:
- Adenotonsillectomy was the most frequent overall intervention (31.8%), particularly in older infants.
- Observation was common in younger infants (3-5 months), while surgical rates increased with age.
- Adenotonsillectomy showed the highest subjective improvement; tracheostomy demonstrated the greatest objective efficacy (apnea-hypopnea index reduction).
Conclusions:
- Intervention strategies for infant OSA vary significantly with age, with a shift from non-surgical to surgical approaches.
- Adenotonsillectomy is the leading intervention for subjective symptom relief, while tracheostomy provides the most significant objective improvement.
Objectives/Hypothesis:
To investigate interventions used for treatment of obstructive sleep apnea (OSA) in infants.
Study Design:
Retrospective medical record review.
Methods:
Patients 3 to 24 months old at the time of diagnosis of OSA by polysomnography (PSG) were studied at a tertiary care children's hospital. The main outcome measures were demographic data, PSG data, intervention data, subjective results of interventions, and medical comorbidities.
Results:
Of the 295 patients included, 196 (66%) were males and 99 (34%) were females. The most common interventions with average age at the time of intervention were: adenotonsillectomy, 115 patients (31.8%, 22.3 months); adenoidectomy, 82 patients (22.5%, 17.7 months); observation, 76 patients (20.9%, 12.8 months); supplemental oxygen, 27 patients (7.4%, 11.7 months); continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BiPAP), 18 patients (4.9%, 15.6 months); tonsillectomy, 16 patients (4.4%, 25.7 months); and tracheostomy, six patients (1.7%, 15.3 months). In the youngest patients (3-5 months of age), 89.3% of interventions were nonsurgical and 10.7% were surgical. In the oldest patients (older than 24 months), 17.5% of interventions were nonsurgical and 82.5% were surgical. Subjective improvement following intervention was highest after adenotonsillectomy. The intervention with the greatest percentage decrease in apnea-hypopnea index (objective efficacy) was tracheostomy, followed by CPAP/BiPAP. Average time from diagnosis to intervention was 35.5 days for nonsurgical interventions and 92.4 days for surgical interventions.
Conclusions:
Observation was the most common nonsurgical intervention and the most common intervention in patients younger than 12 months. Adenotonsillectomy was the most common surgical and overall intervention. Adenotonsillectomy had the greatest subjective efficacy, and tracheostomy had the greatest objective efficacy.
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