555 Role of X-Ray Soft Tissue Neck in Children with Obstructive Sleep Apnea with a Previous History of Adenotonsillectomy

Abstract

Abstract Introduction Adenoid recurrence in children after adenotonsillectomy can be an etiology for obstructive sleep apnea (OSA). The aim of this study was to assess the role of x-ray soft tissue neck (XR-STN) in evaluating adenoid recurrence from a sleep physician perspective and to assess the polysomnographic findings of pre and post revision adenoidectomy. Methods This was a single center retrospective study that included children <18 years old with a history of adenotonsillectomy who underwent sleep study that confirmed the diagnosis of OSA and had XR- STN to evaluate for adenoidal tissue recurrence at the University of Louisville/Norton Pediatric Sleep Disorders clinic from July 2012 to September 2020. XR-STN level of adenoidal obliteration, baseline and post revision adenoidectomy PSG data were analyzed. Results A total of 160 subjects were included in the study with a mean age of 9.71±3.5 years, 59.4% were male, 54.4% were Caucasians, and the mean z-score was 1.77±1.15. XR-STN was normal in 39.4% of the subjects and it showed mild, moderate, and complete adenoidal obliteration in 20.6%, 32.5% and 7.5% of the subjects, respectively. Multiple regression analysis showed that the total AHI, the mean for the moderate and complete adenoidal obliteration are significantly higher than children with no obstruction (p-value=000). However, mild obliteration, Z score, age, gender, and race were not significantly associated with an increased total AHI. Pre- and post- adenoid revision PSGs were available in 20 subjects and they showed significant improvement in AHI (10.4±12.9 vs. 21.1±23.9, p=0.04), arousal index (15.4 ±10.6 vs. 21.1± 14.9, p=0.04), and nadir SaO2 (86.7%±8.1 vs. 76.58% ±18.44, p=0.04). Conclusion Soft tissue neck x-ray was useful in assessing adenoid recurrence in our study. Revision adenoidectomy resulted in an overall improvement in several PSGs parameters of OSA. Pediatric sleep physicians may consider XR-STN in the evaluation of children with OSA with a previous history of adenotonsillectomy. Support (if any) None