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Published on: December 6, 2016
Polysomnography variables associated with postoperative respiratory issues in children <3 Years of age undergoing
Kathleen R Billings1, Shaan N Somani2, Jennifer Lavin1
1Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.
Insights
Children under 3 with severe obstructive sleep apnea (OSA) undergoing adenotonsillectomy (T&A) rarely experience complications. Preoperative polysomnogram (PSG) variables like high apnea-hypopnea index (AHI) and low SpO2 predict the need for postoperative respiratory support.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Critical Care
Background:
- Obstructive sleep apnea (OSA) is a common condition in young children, often managed with adenotonsillectomy (T&A).
- Postoperative respiratory complications can occur, particularly in children under 3 years old.
- Identifying predictive factors from polysomnography (PSG) is crucial for optimizing perioperative care.
Purpose of the Study:
- To identify polysomnogram (PSG) variables associated with increased postoperative respiratory complications in children younger than 3 years undergoing T&A for OSA.
- To evaluate the predictive value of specific PSG parameters for adverse respiratory outcomes post-T&A.
Main Methods:
- Retrospective case series of 195 children under 3 years old who underwent T&A for OSA.
- Analysis of preoperative PSG data and postoperative hospital courses to identify predictors of respiratory complications.
- Inclusion criteria: children <3 years with OSA undergoing T&A; data collected from 1/1/08-6/1/2018.
Main Results:
- Most patients (79.5%) had no postoperative respiratory interventions.
- Severe OSA was associated with a higher likelihood of requiring oxygen support (17.7%) compared to mild-moderate OSA (5.6%).
- Predictive PSG variables for respiratory interventions included an apnea-hypopnea index (AHI) >12.7 events/hour, >18.5 obstructive apneas, and SpO2 nadir <72.5%.
Conclusions:
- The majority of young children, even with severe OSA, tolerate T&A well with minimal postoperative respiratory issues.
- Severe OSA with preoperative hypoxemia, particularly in patients admitted directly from the sleep lab, predicts a higher need for postoperative CPAP.
- Severe OSA and hypoxemia on preoperative PSG were associated with nearly all cases requiring intubation or developing post-obstructive pulmonary edema (POPE).
Objectives:
To determine the polysomnogram (PSG) variables associated with increased incidence of postoperative respiratory complications in children <3 years of age undergoing adenotonsillectomy (T&A) for the management of obstructive sleep apnea (OSA).
Methods:
Retrospective case series of children <3 years of age who underwent T&A for the management of OSA at a tertiary care children's hospital from 1/1/08-6/1/2018. Postoperative hospital courses were analyzed to determine if certain clinical or PSG variables might have predicted an increased rate of respiratory complications.
Results:
A total of 195 children <3 years of age with OSA on preoperative PSGs underwent T&A. The mean age of patients was 25.8 months (range 9-35 months). Seventeen patients (16.2%) had mild OSA, 35 (17.9%) had moderate, and 141 (72.3%) had severe OSA. Most patients (n = 155, 79.5%) required no respiratory intervention postoperatively. Those with severe OSA were more likely to require oxygen support (n = 25, 17.7%) when compared to those with mild-moderate OSA (n = 3, 5.6%). Patients admitted directly to the pediatric intensive care unit (PICU) from the sleep lab (n = 7) had a mean apnea-hypopnea index (AHI) of 63.6 events/hour (range 23-146/hr.), and a mean SpO2 nadir of 56.3% (range 46-68%). Four of these patients required CPAP after T&A. Of the 7 patients (3.6%) who required intubation after their procedure, only 1 did not have severe OSA, and 2 were intubated to manage post-obstructive pulmonary edema (POPE). Only 4 patients (4.2%) had unplanned PICU admissions. An AHI >12.7 events/hour, >18.5 obstructive apneas, and SpO2 nadir <72.5% were associated with a greater likelihood of requiring postoperative respiratory interventions.
Conclusions:
Most children <3 years of age, even with severe OSA, had no respiratory issues postoperatively. Those with severe OSA and hypoxemia admitted directly from the sleep lab were more likely to require CPAP postoperatively. All but one patient who developed POPE or who required intubation had severe OSA with associated hypoxemia on their preoperative PSGs.
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