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Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children
Lena Xiao1,2, Nicholas Barrowman2,3, Franco Momoli2,3,4
1Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
The McGill oximetry score (MOS) and age can help predict major respiratory adverse events (PRAEs) after adenotonsillectomy in children. Nocturnal oximetry offers key insights for postoperative monitoring.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Anesthesiology
Background:
- Adenotonsillectomy is the primary treatment for obstructive sleep apnea syndrome in children.
- Perioperative respiratory adverse events (PRAEs) are a significant risk following this procedure.
- Predictive tools for PRAEs are crucial for optimizing patient safety.
Purpose of the Study:
- To determine if the McGill oximetry score (MOS) and other polysomnography parameters can predict major PRAEs in children undergoing adenotonsillectomy.
- To assess the interrater reliability of the MOS.
- To evaluate the correlation between MOS and other polysomnography parameters.
Main Methods:
- Retrospective study of 106 children (aged 0-18 years) who underwent preoperative polysomnography before adenotonsillectomy.
- Oximetry data from polysomnograms were used to calculate the MOS.
- Multivariable models were developed to predict major PRAEs, and MOS interrater reliability was assessed.
Main Results:
- A multivariable model combining MOS and age predicted major PRAEs (AUC 0.68).
- Increased MOS and younger age were associated with PRAEs; the apnea-hypopnea index was not a significant predictor.
- MOS demonstrated excellent interrater reliability (κ = 0.95) and correlated strongly with oxygen saturation nadir.
Conclusions:
- The MOS, in conjunction with age, may effectively predict PRAEs after adenotonsillectomy in pediatric patients.
- Nocturnal oximetry, as reflected by the MOS, provides essential information for guiding postoperative monitoring.
- This finding supports the utility of MOS in risk stratification and management planning.
Study Objectives:
The first-line treatment of obstructive sleep apnea syndrome in children is adenotonsillectomy, but this may result in perioperative respiratory adverse events (PRAEs). The primary aim of this study is to examine whether the McGill oximetry score (MOS) and other polysomnography parameters can predict major PRAEs following adenotonsillectomy. We secondarily evaluated the MOS interrater reliability and correlation with other polysomnography parameters.
Methods:
This retrospective study included all children aged 0-18 years who underwent preoperative polysomnography between June 2010 and January 2016 prior to adenotonsillectomy at a tertiary pediatric institution. Oximetries from polysomnograms were assigned an MOS. Univariable and multivariable models for prediction of major PRAEs were constructed. MOS was correlated with polysomnography parameters and interrater reliability was evaluated.
Results:
This study included 106 children; 15 had a major PRAE. A multivariable prediction model that combined MOS and age showed evidence for the ability to predict major PRAEs with an area under the receiver operating characteristic curve of 0.68 (95% confidence interval: 0.52, 0.84), whereby increased MOS and younger age were associated with PRAEs, but apnea-hypopnea index was not. MOS had excellent interrater reliability (κ = 0.95) and was highly correlated with oxygen saturation nadir and cumulative time percentage with oxygen saturation less than 90%.
Conclusions:
A prediction model including MOS and age may predict PRAEs following adenotonsillectomy. This suggests that nocturnal oximetry provides the most essential information of polysomnography measures to direct postoperative monitoring following adenotonsillectomy.
Citation:
Xiao L, Barrowman N, Momoli F, et al. Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children. J Clin Sleep Med. 2021;17(11):2215-2223.
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