Utility of Preoperative Cardiac Workup for Children With Very Severe Obstructive Sleep Apnea

We aimed to examine the prevalence and utility of obtaining a preoperative cardiac workup in children with very severe OSA prior to adenotonsillectomy (AT).

We conducted a review of children 2-18 years with very severe OSA (Apnea-Hypopnea Index [AHI] ≥ 25) who underwent AT between 2018 and 2024. Wilcoxon rank-sum and Spearman's rho (ρ) tests were performed to determine associations between demographics, cardiac workup, polysomnography parameters, and length of stay [LOS].

Of 144 patients with very severe OSA, 38 patients (26.4%) underwent a preoperative cardiac workup. Three of 38 (7.9%) had abnormal findings; all three were obese, aged 13-16 years, and had preoperative AHI > 50. None underwent additional testing or were started on CPAP preoperatively. There was no association between a cardiac workup, obesity, sex, or age and improvement in AHI. Higher preoperative AHI and younger age correlated to longer LOS (p = 0.040, ρ = 0.17 and p = 0.0007, ρ = -0.28, respectively).

In children with very severe OSA, obtaining a preoperative cardiac workup had a low yield of positive findings and was not associated with perioperative course. Adolescent patients with obesity and preoperative AHI > 50 events/h may be at highest risk for abnormal cardiac findings. Our study suggests that a more selective approach to preoperative cardiopulmonary workup may decrease healthcare expenses and minimize delays in care without deleterious effects on patient outcomes and management.