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Craniofacial contribution to residual obstructive sleep apnea after adenotonsillectomy in children: a preliminary
Insights
Pediatric obstructive sleep apnea (OSA) often persists after adenotonsillectomy (AT) due to smaller mandible size. Maxillofacial morphology assessment is crucial for treating residual OSA in children.
Area of Science:
- Pediatric Sleep Medicine
- Craniofacial Morphology
- Otolaryngology
Background:
- Pediatric obstructive sleep apnea (OSA) affects many children, with a significant portion experiencing persistent symptoms after adenotonsillectomy (AT).
- This persistence suggests underlying factors beyond adenotonsillar hypertrophy, prompting investigation into other predisposing conditions.
Purpose of the Study:
- To investigate the hypothesis that abnormal maxillofacial morphology is a predisposing factor for residual pediatric OSA post-AT.
- To analyze the correlation between maxillomandibular size and the apnea-hypopnea index (AHI) in pediatric OSA patients before and after AT.
Main Methods:
- Study included 13 pediatric OSA patients (median age 4.7 years) who underwent AT.
- Maxillomandibular dimensions were measured using lateral cephalograms.
- Correlation analysis was performed between maxillomandibular size and pre- and post-AT AHI values.
Main Results:
- Adenotonsillectomy significantly reduced AHI (p < 0.05), but 84.6% of patients had residual OSA.
- Patients with residual OSA exhibited smaller mandible sizes compared to Japanese standards.
- A significant negative correlation was found between maxillomandibular size and post-AT AHI (p < 0.05).
Conclusions:
- Smaller mandibular size in pediatric patients may contribute to the persistence of OSA after adenotonsillectomy.
- Comprehensive evaluation of maxillomandibular morphology is recommended for developing effective treatment strategies for pediatric OSA.
Study Objectives:
Pediatric obstructive sleep apnea (OSA) is frequently associated with adenotonsillar hypertrophy, and the fact that about 30% of affected children continue to show OSA after adenotonsillectomy (AT) suggests the presence of some other predisposing factor(s). We hypothesized that abnormal maxillofacial morphology may be a predisposing factor for residual OSA in pediatric patients.
Methods:
A total of 13 pediatric OSA patients (9 boys and 4 girls, age [median (interquartile range)] = 4.7 (4.0, 6.4) y, body mass index (BMI) z score = -0.3 (-0.8, 0.5)) who had undergone AT were recruited for this study. Maxillomandibular size was measured using an upright lateral cephalogram, and correlations between size and the apnea hypopnea index (AHI) values obtained before (pre AT AHI) and about 6 months after AT (post AT AHI) were analyzed.
Results:
AHI decreased from 12.3 (8.9, 26.5)/h to 3.0 (1.5, 4.6)/h after AT (p < 0.05). Residual OSA was seen in 11 of the 13 patients (84.6%) and their AHI after AT was 3.1 (2.7, 4.7)/h. The mandible was smaller than the Japanese standard value, and a significant negative correlation was seen between maxillomandibular size and post AT AHI (p < 0.05).
Conclusions:
These findings suggest that the persistence of OSA after AT may be partly due to the smaller sizes of the mandible in pediatric patients. We propose that the maxillomandibular morphology should be carefully examined when a treatment plan is developed for OSA children.
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