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Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA
Chin-Nung Liu1, Kun-Tai Kang1,2,3, Chung-Chen Jane Yao4,5,6
1Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Adenotonsillectomy significantly improved airway measurements in children with obstructive sleep apnea (OSA). Increased airway volume and area correlated with reduced apnea-hypopnea index (AHI), suggesting CBCT
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Medical Imaging
Background:
- Obstructive sleep apnea (OSA) in children can lead to significant health issues, including impaired growth and cardiovascular problems.
- Early intervention with adenotonsillectomy is a common treatment for pediatric OSA.
- Cone-beam computed tomography (CBCT) can visualize airway anatomy, but its role in assessing treatment outcomes for OSA is still being defined.
Purpose of the Study:
- To evaluate changes in airway dimensions using CBCT after adenotonsillectomy in children with OSA.
- To determine the correlation between these CBCT-measured airway changes and the reduction in the apnea-hypopnea index (AHI).
Main Methods:
- A prospective cohort study involving 49 children (aged 7-13 years) with confirmed OSA.
- Participants underwent CBCT and polysomnography (PSG) before and after adenotonsillectomy.
- Analysis focused on changes in PSG parameters (AHI) and CBCT airway measurements (volume, area).
Main Results:
- Adenotonsillectomy led to a significant decrease in AHI (from 11.4 to 1.2 events/hour).
- Significant increases were observed in total airway volume, nasopharyngeal volume and area, and oropharyngeal volume and area.
- Total airway volume and minimal oropharyngeal airway area showed a significant correlation with AHI reduction.
Conclusions:
- Adenotonsillectomy improves airway dimensions in children with OSA, as measured by CBCT.
- Improvements in specific airway volumes and areas are associated with reduced OSA severity (AHI).
- Further research is warranted to establish CBCT's role in the pre-operative evaluation of pediatric OSA.
Importance:
Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life.
Objective:
To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction.
Design, Setting, And Participants:
This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021.
Exposures:
All participants underwent CBCT and PSG before and after adenotonsillectomy.
Main Outcomes And Measures:
Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed.
Results:
A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI.
Conclusions And Relevance:
These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.
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