Predictors of Persistent Sleep Apnea After Surgery in Children Younger Than 3 Years

Abstract

IMPORTANCE: Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied. OBJECTIVE: To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.