Is Airway Endoscopy Mandatory in Children Under Three with Obstructive Sleep Apnea?

Abstract

Objective: Cure rates for obstructive sleep apnea (OSA) in children <3 range from 0-35%. Previous studies suggest that these low rates are due to high incidence of synchronous airway lesions (SALs), necessitating intraoperative airway evaluation. This study examines effectiveness of adenotonsillectomy in children <3 and evaluates necessity of laryngoscopy and/or bronchoscopy. Method: Retrospective chart review of children <3 years undergoing tonsillectomy and/or adenoidectomy for OSA from 2005-2011. Only patients who underwent both pre- and postoperative polysomnogram (PSG) were included in analysis. Children with prior airway surgery were excluded. Clinical history, PSG data, intraoperative findings, and SALs were recorded. Results: A total of 243 charts were reviewed; 48 patients met inclusion criteria. Twenty-one of 48 were cured (AHI <1 or AHI <5 and minimum SpO2 >92%) of OSA. Patients failing adenotonsillectomy had significantly higher preoperative AHI and lower minimum SpO2 versus cured patients ( P < .001). No significant difference was noted in age, BMI, or incidence of genetic abnormalities between outcome groups. Eight cured and 11 failed patients underwent office laryngoscopy or intraoperative laryngoscopy and/or bronchoscopy. No statistical difference in frequency of airway evaluation or incidences of SALs was found between outcome groups. Flexible laryngoscopy alone could have diagnosed 79% of SALs identified. No surgery was required for lower airway SALs. Conclusion: Adenotonsillectomy for OSA in children <3 cured 44% of patients. Failure was associated with higher preoperative AHI and lower minimum SpO2, but not incidence of SALs. No lower airway SALs required surgery and none contributed to failure, suggesting that office laryngoscopy is sufficient when intraoperative evaluation is not otherwise needed.