Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

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.