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Utility of Preoperative Cardiac Workup for Children With Very Severe Obstructive Sleep Apnea
Danny A Elias1, Amber D Shaffer2, Zachary Bennett2
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Preoperative cardiac workups for children with severe obstructive sleep apnea (OSA) before adenotonsillectomy have a low yield. A selective approach may reduce costs and delays without impacting patient outcomes.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Cardiology
- Sleep Medicine
Background:
- Severe obstructive sleep apnea (OSA) in children poses significant perioperative risks.
- Adenotonsillectomy (AT) is a common treatment for pediatric OSA.
- The utility of preoperative cardiac evaluations in this high-risk group is not well-defined.
Purpose of the Study:
- To determine the prevalence and diagnostic yield of preoperative cardiac workups in children with very severe OSA.
- To assess the association between cardiac workups and perioperative outcomes.
- To identify risk factors for abnormal cardiac findings in this population.
Main Methods:
- Retrospective review of children aged 2-18 years with very severe OSA (Apnea-Hypopnea Index [AHI] ≥ 25) who underwent AT.
- Statistical analysis using Wilcoxon rank-sum and Spearman's rho tests.
- Evaluation of demographics, cardiac workup results, polysomnography data, and length of stay.
Main Results:
- Only 26.4% of 144 patients with very severe OSA received a preoperative cardiac workup.
- Abnormal findings were rare (7.9%), primarily in obese adolescents with AHI > 50.
- No association was found between cardiac workup and improvement in AHI or length of stay.
Conclusions:
- Preoperative cardiac workups in children with very severe OSA have a low yield.
- Obese adolescents with high AHI may benefit from targeted cardiac assessment.
- A selective approach to preoperative workup can optimize resource utilization and timely care.
Objective:
We aimed to examine the prevalence and utility of obtaining a preoperative cardiac workup in children with very severe OSA prior to adenotonsillectomy (AT).
Methods:
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].
Results:
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).
Conclusion:
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.
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