Related Experiment Video
Updated: May 24, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Assessment of Positional Obstructive Sleep Apnea in Children Undergoing Adenotonsillectomy for Obstructive Sleep
Seckin O Ulualp1, Romaine F Johnson1, Ron B Mitchell1
1Department of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center and Division of Pediatric Otolaryngology, Children's Medical Center Dallas Texas USA.
Insights
Positional obstructive sleep apnea (POSA) is common in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea (OSA). While AT resolves POSA in most cases, older and obese children may experience persistent POSA.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Positional obstructive sleep apnea (POSA) is a subtype of obstructive sleep apnea (OSA) influenced by sleep posture.
- Adenotonsillectomy (AT) is a common surgical intervention for pediatric OSA, but its impact on POSA is not fully understood.
Purpose of the Study:
- To determine the prevalence of POSA in children with OSA undergoing AT.
- To assess the effectiveness of AT in resolving POSA in this pediatric population.
Main Methods:
- Retrospective analysis of 1167 children diagnosed with OSA via polysomnography (PSG).
- Data collection included demographics, PSG parameters, and surgical outcomes.
- Statistical analyses (chi-squared, t-tests, Mann-Whitney, Wilcoxon) were used to compare groups and pre/post-AT outcomes.
Main Results:
- 28% of children had POSA, with older children and specific racial groups showing higher prevalence.
- AT resulted in POSA resolution in 76% of cases.
- Persistent POSA after AT was more common in children over 6 years old and those with obesity.
Conclusions:
- POSA is a frequent finding in children with OSA undergoing AT.
- AT is effective in resolving POSA for the majority of pediatric patients.
- Further research is needed on managing persistent POSA in older, obese children post-AT.
Objectives:
To determine the prevalence of positional obstructive sleep apnea (pOSA) in children undergoing adenotonsillectomy (AT) for OSA and to assess whether pOSA improves following AT.
Materials And Methods:
Children with OSA diagnosed by polysomnography (PSG) at a tertiary care children's hospital were included. Data was collected on demographics, PSG parameters, and surgical management. Statistical comparisons between groups for the prevalence of pOSA were performed with the χ2 test or Fisher's exact test, for PSG parameters prior to AT with Student's t-test or Mann-Whitney Rank Sum Test, and for PSG parameters before and after AT with paired t-test and Wilcoxon Signed Rank Test. p < 0.05 was considered significant.
Results:
Of the 1167 children (682 male, 485 female, median age = 5.7 years), 321 (28%) had pOSA. POSA children (median age = 7.4 years) were older than children with no pOSA (median = 5.2) (p ≤ 0.001). The prevalence of pOSA in the subgroups of gender and weight was not different. The prevalence of pOSA was significantly different amongst the race groups (p = 0.005). Compared with the Black/African American race, the white race had 1.4 times the odds of pOSA (95% CI, 1.07-1.98). The prevalence of pOSA was not significantly different between mild, moderate, and severe OSA groups (p = 0.7). Of the 66 POSA children who had PSG pre- and post-TA, 50 (76%) had resolution of pOSA. Children older than 6 years of age and children with obesity had a higher rate of persistent pOSA (p = 0.02 and p = 0.008, respectively).
Conclusion:
POSA occurred frequently in OSA children undergoing AT. POSA is resolved in the majority of children after AT. Persistent pOSA was more prevalent in older and obese children. AT is used as the first-line treatment for pOSA in children. Future studies are needed to determine the role of positional therapy and other OSA therapies in the management of persistent pOSA after AT.
Level Of Evidence:
4.
Related Concept Videos
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...
01:26Tonsillitis II: Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...