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Polysomnographic parameters and clinical risk factors predicting postoperative respiratory complications in children

Sawita Kanavitoon1, Pornswan Ngamprasertwong2, Aisaku Nakamura3

  • 1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Sleep Medicine
|March 29, 2025
PubMed

Insights

Congenital heart disease is the primary risk factor for postoperative respiratory complications after lingual tonsillectomy in children. Preoperative polysomnography findings like higher apnea-hypopnea index also indicate increased risk.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Respiratory Physiology

Background:

  • Postoperative respiratory complications (PORC) are a concern following lingual tonsillectomy (LT).
  • Limited data exist on clinical risk factors and polysomnogram (PSG) parameters predicting PORC in children undergoing LT.
  • Identifying these factors is crucial for optimizing postoperative care and resource allocation.

Purpose of the Study:

  • To identify clinical risk factors and preoperative polysomnogram (PSG) parameters that predict postoperative respiratory complications (PORC) in children undergoing lingual tonsillectomy (LT).

Main Methods:

  • A retrospective cohort study was conducted.
  • Included 107 children who underwent LT with available preoperative PSG data.
  • Analyzed clinical data and PSG parameters to identify predictors of PORC.

Main Results:

  • 20 patients (18.7%) experienced PORC.
  • Children with PORC had higher rates of congenital heart disease (65.0% vs 39.5%).
  • Significant differences in PSG parameters were observed: higher apnea-hypopnea index (AHI), higher obstructive AHI, lower SpO2 nadir, and higher EtCO2 percentage in the PORC group.
  • Congenital heart disease was the only independent risk factor for PORC (OR 2.84).
  • Severe obstructive sleep apnea (OSA) showed a trend toward being a risk factor (aOR 2.76, P=0.054).

Conclusions:

  • Congenital heart disease is a significant independent predictor of PORC after LT.
  • Preoperative PSG parameters, including AHI and SpO2 nadir, are associated with increased PORC risk.
  • These findings emphasize the importance of considering clinical and PSG data for perioperative planning in pediatric LT patients.
Abstract

Keywords:
Children apneaDesaturationLingual tonsil hypertrophyLingual tonsillectomyObstructive sleep apneaPolysomnography

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