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Risk Factors of Residual Obstructive Sleep Apnea After Adenotonsillectomy in Children: Systematic Review
Paulina Stockunaite1, Gintare Oboleviciene1, Valdone Miseviciene1
1Pediatric Department, Medical Academy, Lithuanian University of Health Sciences, LT-50103 Kaunas, Lithuania.
Medicina (Kaunas, Lithuania)
|March 28, 2026
Summary
Residual obstructive sleep apnea (OSA) is common in children after adenotonsillectomy (AT). Key predictors for persistent OSA include obesity, age, and comorbidities, highlighting the need for careful patient assessment and follow-up.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Genetics and Rare Diseases
Background:
- Obstructive sleep apnea (OSA) is a prevalent pediatric sleep disorder often linked to adenotonsillar hypertrophy.
- Adenotonsillectomy (AT) is the primary treatment, yet a significant number of children experience residual OSA (rOSA) post-surgery.
Purpose of the Study:
- To systematically review and synthesize evidence on risk factors associated with rOSA in pediatric patients following AT.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searches were conducted on PubMed and Cochrane Library for studies on pediatric rOSA and AT.
- Included studies assessed postoperative OSA persistence and identified associated risk factors.
Main Results:
- Thirteen studies (2010-2024) reported a wide prevalence of rOSA (18.6-85.0%) due to study heterogeneity.
- Obesity was the most consistent risk factor for rOSA.
- Younger (<3 years) and older (>7 years) children, and those with comorbidities like asthma or Down syndrome, showed increased rOSA risk.
Conclusions:
- Residual OSA is a frequent outcome after pediatric AT.
- Obesity, age extremes, and comorbidities are significant predictors of rOSA.
- Comprehensive preoperative risk assessment and structured postoperative follow-up are crucial for managing pediatric rOSA.
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