Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography

Abstract

Objective: Evaluate the effectiveness of surgical treatment of obstructive sleep apnea in a diverse population of children. Design: A retrospective case series of pre and post operative polysomnograms (PSG) of pediatric patients with obstructive sleep apnea (OSA). Setting: Tertiary care children's hospital. Patients: 48 patients in whom sleep studies were performed pre-operatively for either an unclear history and/or physical findings or complicated OSA. Thirteen patients had no complicating medical factors, 35 patients had various associated medical problems, including 20 with morbid obesity, five with Down syndrome, four with asthma, two with cerebral palsy, and four other. The average age was 7.5 years with a range of 1.5–20 years. Interventions: Thirty-one patients had a tonsillectomy and adenoidectomy (T and A) only, 13 had T and A with uvulopalatopharyngoplasty (UPPP), and three had tonsillectomy and UPPP. Main outcome measures: Pre and postoperative PSG results including apnea/hypopnea index (AHI), percent of sleep with oxygen saturation below 90%, and percent sleep time with end-tidal pCO 2 > 50. Results: The mean pre-operative (AHI) was 27 ± 4 (mean + S.E.M.) and post operatively was 6 ± 1 ( P < 0.001). Twenty six of 48 (54%) had a postoperative AHI of less than five. Pre-operative percent of sleep with oxygen saturation below 90% was 17.9 ± 4.5%, post-operatively it was 1.4 ± 0.1% ( P < 0.001). Pre-operative percent sleep time with end-tidal pCO 2 > 50 was 22.3 ± 3.4%, post operatively it was 12.6 ± 2.9% ( P < 0.01). UPPP was performed more commonly in patients with Down syndrome. There was a trend toward more improvement in patients who had T and A performed than those undergoing UPPP (post op AHI of 4.7 vs. 7.4 respectively). Conclusions: Tonsillectomy, adenoidectomy and UPPP are effective in the treatment of OSA in a diverse group of pediatric patients. Patients with asthma, cerebral palsy, Down syndrome, morbid obesity, and hereditary syndromes all improved significantly with surgical management.