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Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea
Nancy Saied1, Roberto Noel Solis2, Jamie Funamura2
1Department of Anesthesiology and Pain Medicine, University of California, Davis, CA 95817, USA.
Children (Basel, Switzerland)
|September 23, 2022
Summary
Children with very severe obstructive sleep apnea (OSA) face frequent post-operative respiratory events after tonsillectomy and adenoidectomy (T&A). Younger children, those with higher apnea-hypopnea index (AHI), and lower oxygen saturation are at higher risk, requiring close monitoring.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Critical Care
Background:
- Information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited.
- Very severe OSA is defined as an apnea-hypopnea index (AHI) exceeding 25 events/hr.
Purpose of the Study:
- To evaluate clinical features and polysomnographic (PSG) variables predicting post-operative outcomes in children with very severe OSA.
- To identify risk factors for post-operative respiratory events following tonsillectomy and adenoidectomy (T&A).
Main Methods:
- Retrospective chart review of 50 children with AHI > 25/hr who underwent T&A between January 2016 and September 2021.
- Analysis of pre-operative clinical data, polysomnography (PSG) variables, and post-operative outcomes, including respiratory events and need for ventilatory support.
Main Results:
- 26% of children experienced post-operative respiratory events, with 4 requiring intubation.
- Risk factors for post-operative events included younger age (p=0.04), higher pre-operative AHI (p<0.01), lower oxygen nadirs (p<0.01), and lower BMI Z-scores (p<0.04).
- Moderate to severe residual OSA was found in 70% of post-operative PSGs, with younger children showing better outcomes.
Conclusions:
- Post-operative respiratory events are common in children with very severe OSA, especially those with AHI > 40/h, younger than 2 years, low SpO2, and poor nutritional status.
- Close post-operative monitoring is crucial for these high-risk pediatric patients.
- Younger children may have better post-operative PSG outcomes despite initial risks.
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