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Surgery for obstructive sleep apnea in young children: Outcome evaluated by polysomnograhy and quality of life
Britt Øverland1, Hanne Berdal1, Harriet Akre2
1Pediatric and Adult Sleep Disorder Clinic, Lovisenberg Diaconal Hospital, Oslo, Norway.
Insights
Adenotonsillectomy effectively treats obstructive sleep apnea (OSA) in young children, significantly improving polysomnography and parent-reported outcomes. Higher preoperative apnea-hypopnea index predicts residual OSA post-surgery.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Adenotonsillar hypertrophy is a primary cause of pediatric obstructive sleep apnea (OSA).
- Adenotonsillectomy is the standard treatment for pediatric OSA.
- Limited data exists on surgical outcomes in children under five years old.
Purpose of the Study:
- To assess the efficacy of adenotonsillectomy for OSA in children aged 2-4 years.
- To evaluate surgical impact using objective polysomnography and subjective parent-reported questionnaires.
- To identify predictors of residual OSA after surgery in this age group.
Main Methods:
- Prospective cohort study design.
- Included children aged 2-4 years referred for OSA surgery.
- Collected polysomnography (PSG), Pediatric Sleep Questionnaire (PSQ), and OSA-18 data pre- and post-surgery.
Main Results:
- Post-surgery, 63% of 56 children achieved an obstructive apnea-hypopnea index (OAHI) < 1, with 95% achieving OAHI < 5.
- Significant improvements were observed in parent-reported OSA-18 and PSQ scores.
- Higher preoperative OAHI was the sole significant clinical predictor of residual OSA.
Conclusions:
- Adenotonsillectomy demonstrates a high success rate in young children with OSA.
- Surgery leads to significant objective and subjective improvements in OSA symptoms.
- Preoperative OAHI is a key factor in predicting postsurgical OSA outcomes.
Purpose:
Hypertrophy of adenoid and tonsils is the most common risk factor for OSA in children, and adenotonsillectomy is considered the first-line treatment. The effect of surgery for OSA in children varies considerably between studies, and few studies have focused on the effect in young children under 5 years of age. Thus, the aim of this study was to: 1) evaluate the effect of surgery for OSA in young children using objective data from polysomnography and parent-reported symptoms using questionnaires, and 2) identify predictors of residual OSA following surgery.
Methods:
This is a prospective cohort study of children aged 2-4 years who were referred for surgery to treat OSA. Measures collected before and after surgery included polysomnography (PSG), Pediatric Sleep Questionnaire (PSQ), OSA-18 and clinical data.
Results:
56 children completed a preoperative and postoperative PSG. Their median age was 3.1 (IQR 2.6-3.1) years. After surgery, 63% had an obstructive apnea hypopnea index (OAHI) < 1, 82% had an OAHI < 2 and 95% had an OAHI < 5. Parent-reported OSA-18 and PSQ scores improved significantly after surgery. In logistic regression analyses, higher preoperative OAHI was the only significant clinical predictor of residual OSA after surgery.
Conclusion:
There was a high resolution rate after surgery for OSA in this group of young children, with significant improvements in both the OAHI measured with PSG and parent-reported symptoms. The only clinical predictor of residual OSA after surgery was higher preoperative OAHI.
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