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Postoperative respiratory complications in children with obstructive sleep apnoea syndrome

Pálma Benedek1,2, Fanni Keserü1,2, Gabriella Kiss3

  • 1Department of Otolaryngology, Heim Pál National Institute of Paediatrics, Budapest, Hungary.

Acta Otorhinolaryngologica Italica : Organo Ufficiale Della Societa Italiana Di Otorinolaringologia E Chirurgia Cervico-Facciale
|May 25, 2022
PubMed

Insights

Comorbidities significantly increase the risk of postoperative respiratory complications (PoRCs) after adenotonsillectomy in children with obstructive sleep apnoea (OSA). OSA severity is a key factor for PoRCs only in children without comorbidities.

Area of Science:

  • Pediatric Surgery
  • Sleep Medicine
  • Anesthesiology

Background:

  • Obstructive sleep apnoea syndrome (OSA) is common in children undergoing adenotonsillectomy.
  • Postoperative respiratory complications (PoRCs) are a significant concern in this population.
  • The role of comorbidities in PoRCs after adenotonsillectomy for OSA is not fully understood.

Purpose of the Study:

  • To prospectively evaluate the impact of comorbidities on PoRCs in children with OSA after adenotonsillectomy.
  • To determine if children without comorbidities require different postoperative monitoring levels.
  • To compare the influence of comorbidities versus OSA severity on PoRCs.

Main Methods:

  • A prospective study enrolled 577 children with OSA who underwent adenotonsillectomy.
  • Logistic regression analysis was used to investigate the effects of demographics, comorbidities, and OSA severity on PoRCs.
  • Apnoea-hypopnoea index (AHI) was used as a measure of OSA severity.

Main Results:

  • The overall PoRC rate was 4.3%.
  • Comorbidities significantly increased the risk of PoRCs (OR 4.234, p < 0.001) and were associated with more marked postoperative oxygen desaturations (p = 0.005).
  • In children without comorbidities, PoRCs were linked to higher AHI (p < 0.001), whereas AHI did not correlate with PoRCs in comorbid patients (p = 0.37).

Conclusions:

  • Comorbidities are a stronger predictor of PoRCs than OSA severity in children undergoing adenotonsillectomy.
  • In children without comorbidities, PoRCs are associated with OSA severity and typically occur within 2 hours post-intervention.
  • Risk stratification for PoRCs should consider the presence of comorbidities.
Abstract

Keywords:
apnoea-hypopnoea indexcomorbidityobstructive sleep apnoeapostoperative monitoringrespiratory complicationssleep breathing disorders

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