Resolution Of Obstructive Sleep Apnea Research Articles

Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy

Objectives/BackgroundTonsillectomy and adenoidectomy (T&A) lead to resolution of obstructive sleep apnea (OSA) in most children. However, OSA persists in about 25–40% of children. Cinematic magnetic resonance imaging (cine MRI) can aid the management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol by using a 3 Tesla MRI scanner, and the use of dexmedetomidine for sedation to improve reproducibility, safety, and diagnostic accuracy. Patients/MethodsPatients aged 3–18 years who underwent cine MRI for the evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences. ResultsA total of 36 children were included with a mean age of 9.6 ± 4.6 (SD) years with 40% over 12 years of age. Two-thirds of them were boys. Seventeen out of 36 children (47%) had Down syndrome. Single site and multilevel obstruction were identified in 21 of 36 patients (58%) and in 12 of 36 patients (33%), respectively. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = 0.002). ConclusionsCine MRI is a sensitive, safe, and noninvasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.

Lingual Tonsillectomy for Pediatric Persistent Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Objective To determine the role of lingual tonsillectomy (LT) in pediatric patients with persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (T&A). Data Sources PubMed, OVID-MEDLINE, and Cochrane Central from 2006 to 2017. Review Methods Inclusion criteria included English-language studies containing original data on LT in pediatric patients with persistent OSA. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment using validated tools. Meta-analysis was performed. Results Of the 866 abstracts identified, 5 studies met inclusion criteria. All studies were case series (level of evidence 4). Outcome measures included apnea-hypopnea index (AHI), minimum oxygen saturation (minSaO2), comorbidity status, and adverse events. Qualitatively, all studies demonstrated reduction in AHI and increase in minSaO2 after LT. Comorbidities may not affect the success of LT for lingual tonsil hypertrophy (LTH). LT had similar adverse event rates as T&A. Meta-analysis was performed on 4 studies. LT showed a mean change in reduction of AHI and increase of minSaO2 of -6.64 (95% CI, -8.63 to -4.65) and 4.17 (95% CI, 1.25-7.08), respectively. The overall success rate, defined as postoperative AHI <5, was 52%. Conclusion LT for LTH can be a safe and effective adjunct surgery for persistent OSA in patients after T&A. LT may reduce AHI and increase minSaO2, though complete resolution of OSA is rare. Given the limited number of patients studied, no formal recommendations can be made for the routine use of LT for LTH in persistent pediatric OSA.

Very Severe Obstructive Sleep Apnea in Children: Outcomes of Adenotonsillectomy and Risk Factors for Persistence.

Objectives (1) To describe the clinical, demographic and polysomnographic (PSG) characteristics of children with very severe obstructive sleep apnea (OSA) without significant comorbidities; (2) to assess the outcomes following tonsillectomy and adenoidectomy (T&A); and (3) to determine predictors of persistence of OSA after T&A. Study Design Case series with chart review. Setting Tertiary-level freestanding children's hospital. Subjects and Methods Seventy-four children aged 2 to 12 years who underwent T&A for very severe OSA (obstructive apnea-hypopnea index [AHI] >30) were included. Children with significant comorbidities were excluded. PSG variables were compared pre- and post-T&A using statistical tests. Factors affecting OSA resolution and persistence were studied. Results The mean (95% confidence interval) age was 4.3 (3.8-4.7) years with the majority black or Hispanic (64/74, 86%). The mean decrease in AHI after T&A was 49 (43-58) ( P < .001). Complete resolution of OSA, defined by an AHI <1, or an AHI <5 was seen in 32% (24/74) and 80% (59/74), respectively. Total sleep time (TST) greater than 5 minutes with end-tidal CO2 >50 mm Hg was strongly associated with persistent OSA. The decrease in AHI post-T&A was best predicted by higher preoperative oxygen saturation (SpO2) nadir and lower TST with SpO2 <90% ( R2 = 0.24, P < .001). Conclusions T&A is associated with a significant improvement but not resolution of very severe OSA. The severity of baseline hypercapnia and hypoxemia may best predict persistent OSA after T&A. The study supports obtaining routine post-T&A PSG in children with very severe OSA.

The Effect of OSA Therapy on Glucose Metabolism: It's All about CPAP Adherence!

The Effect of OSA Therapy on Glucose Metabolism: It's All about CPAP Adherence!

Hydroxyurea treatment effect on children with sickle cell disease and obstructive sleep apnea

While hydroxyurea is the mainstay of treatment for many of the comorbidities associated with sickle cell disease, its effect on obstructive sleep apnea has not been fully investigated. The purpose of this project is to help characterize the effects of hydroxyurea on obstructive sleep apnea in children with sickle cell disease and determine its therapeutic role in the condition. Chart review was conducted on two pediatric patients with sickle cell disease who experienced resolution of obstructive sleep apnea following hydroxyurea administration. After undergoing approximately 11months of hydroxyurea therapy, sleep apnea symptoms improved and obstructive sleep apnea resolution was confirmed by repeat polysomnography in both cases. This resolution was largely secondary to a reduction in the obstructive component of the apnea hypopnea index, highlighting a previously unreported association. As adenotonsillectomy is associated with significant risks in patients with sickle cell disease, it appears reasonable to consider a period of observation for improvement of obstructive sleep apnea following hydroxyurea administration rather than directly proceeding with surgery.

Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients.

Background:Obstructive sleep apnea (OSA) is commonly associated with morbid obesity. Weight loss following bariatric surgery results in resolution or improvement of OSA. However, few studies have done objective assessment of the impact of bariatric surgery on OSA.Objective:The aim of this study was to assess the outcome of bariatric surgery on OSA.Setting:The study was conducted in the teaching institution of a tertiary care centre.Methods:Twenty-seven morbidly obese patients seeking bariatric surgery were administered Epworth Sleepiness Scale (ESS) health questionnaire and subjected to overnight polysomnography. Repeat assessment using ESS and polysomnography was done at 3–6 months after surgery.Results:Mean age was 42.4 ± 10.5 years, and majority (77.8%) were female. The mean pre-operative weight and body mass index (BMI) were 126.4 ± 24.9 kg and 48.4 ± 8.2 kg/m2, respectively. Nearly 29.6% patients had symptoms of excessive daytime somnolence based on ESS score and overnight polysomnography detected the presence of OSA in 96.3% patients, of which 51.9% had severe OSA. At mean follow-up of 5.2 ± 2.5 months after surgery, mean weight and BMI decreased to 107.4 ± 24.5 kg and 41.2 ± 8.2 kg/m2, respectively. Mean ESS score and mean apnoea–hypopnea index declined from 8.9 ± 3.2 to 4.03 ± 2.15 (P < 0.001) and from 31.8 ± 20.4 to 20.2 ± 23.1 (P = 0.007), respectively. Number of patients requiring continuous positive airway pressure (CPAP) therapy declined from 15 to 3 and average CPAP requirement came down from 11.3 cm of H2O to 6 cm of H2O.Conclusion:OSA was present in a significant proportion of patients undergoing bariatric surgery. Bariatric surgery resulted in significant improvement in both subjective and objective parameters of OSA.

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis.

To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). PubMed/MEDLINE and eight additional databases. Three authors independently and systematically reviewed the international literature through February 21, 2016. Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea-hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is -1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73-95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5-12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction). Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712-1719, 2017.

Adenoidectomy for Obstructive Sleep Apnea in Children.

Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success

To examine outcomes following midline posterior glossectomy (MPG) plus lingual tonsillectomy (LT) for the treatment of significant obstructive sleep apnea (OSA) in children with Down syndrome (DS). Patients with DS who had persistent OSA following tonsillectomy and adenoidectomy (TA) and were relatively intolerant of positive airway pressure (PAP) therapy were evaluated by physical examination and sleep/CINE magnetic resonance imaging to determine the etiology of upper airway obstruction. Patients with relative macroglossia underwent MPG plus LT if required. Successful surgical outcome was defined as the resolution of OSA or the ability to tolerate PAP. Thirteen children (8 male, 5 female), mean (standard deviation) age 14.2 (4.0) years underwent MPG plus LT. Fifty-four percent of patients were obese (Body mass index [BMI] > 95th centile) and 8% were overweight (BMI 85th-95th centile) preoperatively. All patients underwent pre- and postoperative polysomnography. Postoperatively, the obstructive apnea-hypopnea index fell significantly from 47.0/hour to 5.6/hour (P <.05) in normal weight individuals who did not become obese, but not in obese patients or those who became obese postoperatively. Successful surgical outcome was seen in all (N = 6) children who were normal weight or overweight preoperatively compared with none who were obese preoperatively (N = 7). Midline posterior glossectomy and LT are beneficial in normal weight and overweight children with DS who have persistent OSA following TA and are intolerant of PAP therapy. Obesity pre- or postoperatively portends a worse prognosis following MPG, suggesting that aggressive weight loss initiatives should be considered as an adjunct to surgery in this population. 4. Laryngoscope, 127:757-763, 2017.

Obstructive Sleep Apnea Resolution in Hypopnea‐ versus Apnea‐Predominant Children after Adenotonsillectomy

Given that 30% to 40% of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether children with hypopnea-predominant OSA were more likely to have complete disease resolution after adenotonsillectomy than those with apnea-predominant disease. We also identified risk factors that might modify the relationship between disease resolution and polysomnographic event type (ie, hypopnea vs apnea). Case series with chart review. Tertiary pediatric hospital. Consecutive 1- to 18-year-old typically developing children diagnosed with OSA from March 2011 to December 2012 underwent adenotonsillectomy and completed pre- and postoperative polysomnography within 1 year of surgery. Fifty-eight children were included (27 female; mean ± SD: age, 5.6 ± 3.1 years; body mass index z score, 1.1 ± 1.7). Overall, adenotonsillectomy resulted in significant improvement in obstructive apnea-hypopnea index (oAHI) from 23.3 ± 40.0 to 4.3 ± 8.2 events per hour (P < .001), obstructive apnea index (5.1 ± 7.4 to 0.4 ± 0.8, P < .001), and obstructive hypopnea index (oHI; 18.1 ± 37.5 to 3.7 ± 8.1, P < .001). There was complete response (oAHI <1.0 event/h) in 24 of 58 patients (41%) but no difference by event type (P = .11). On univariate analysis, only race, sex, oxygen saturation nadir, and oHI were predictive of response to adenotonsillectomy, while multivariate analysis found that prematurity, age, oxygen saturation nadir, oHI, obstructive apnea index, and oAHI were predictive. Event type was not significant, even in a model controlling for age, race, sex, prematurity, asthma, body mass index, and baseline polysomnographic variables. This small study demonstrated no difference in disease resolution between children with hypopnea- and apnea-predominant OSA who underwent adenotonsillectomy. Additionally, adenotonsillectomy significantly improved OSA in most children, and high preoperative oAHI was associated with persistent postoperative OSA.

C-reactive Protein as a Potential Biomarker of Residual Obstructive Sleep Apnea Following Adenotonsillectomy in Children.

Adenotonsillectomy (AT) is first-line treatment for pediatric obstructive sleep apnea (OSA), with most children having improvements in polysomnography (PSG). However, many children have residual OSA following AT as determined through PSG. Identification of a biomarker of residual disease would be clinically meaningful to detect children at risk. We hypothesize serum high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker, is predictive of residual OSA following AT. PSG was performed both preoperatively and postoperatively on children undergoing AT for the diagnosis of OSA. HsCRP serum concentrations were determined in all children pre-AT, and in most children post-AT. Resolution of OSA after AT was defined by a post-AT apnea-hypopnea index (AHI) < 1.5/h total sleep time (TST). Residual OSA was defined as a post-AT AHI > 5/h TST, which is considered clinically significant. AT significantly improved the AHI from 15.9 ± 16.4 to 4.1 ± 5.3/h TST in 182 children (P < 0.001). Of 182 children, residual OSA (post-AT AHI > 5) was seen in 46 children (25%). Among children who had hsCRP levels measured pre- and post-AT (n = 155), mean hsCRP levels pre-AT were 0.98 ± 1.91 mg/L and were significantly reduced post-AT (0.63 ± 2.24 mg/dL; P = 0.011). Stratification into post-AT AHI groups corresponding to < 1.5/h TST, 1.5/h TST < AHI < 5/h TST, and AHI > 5/h TST revealed post-AT hsCRP levels of 0.09 ± 0.12, 0.57 ± 2.28, and 1.49 ± 3.34 mg/L with statistical significance emerging comparing residual AHI > 5/h TST compared to post-AT AHI < 1.5/h TST (P = 0.006). Hierarchical multivariate modeling confirmed that pre-AT AHI and post-AT hsCRP levels were most significantly associated with residual OSA. Even though AT improves OSA in most children, residual OSA is frequent. Assessment of post-AT hsCRP levels emerges as a potentially useful biomarker predicting residual OSA.

Tolerance of intragastric balloon and patient's satisfaction in obesity treatment.

IntroductionThe dietary management of obesity is associated with a high failure rate. Methods which enable the long-term reduction of food intake have been developed. Patients treated with an intragastric balloon may experience some unwanted symptoms during therapy. The severity of these symptoms may result in poor tolerance of treatment, while patients who do not experience these symptoms may refuse to follow dietary modifications. In these cases, weight reduction at the end of treatment may be below expectations.AimTo assess the tolerance of intragastric balloon treatment in obese patients as well as their satisfaction with this treatment.Material and methodsFifty-seven gastric balloon procedures were performed in 51 females and 6 males aged 17 to 65 years (39.5 ±10.7 years). Baseline weight was 104 ±14.5 kg (78–140 kg), body mass index 37.2 ±4.1 kg/m2 (29.8–48.1 kg/m2), mean excess body weight 41.2 ±11.5 kg (20.4–63.1 kg). The balloon was filled with 669 ±25.8 ml of saline solution (550–700 ml). Upon balloon removal 6 months later, the patients completed a 12-question survey.ResultsWe obtained 57 surveys. The most common symptoms included vomiting, heartburn, abdominal pain and others. Twenty-two patients reported > 2 symptoms. Two patients were symptom-free. The mean duration of symptoms was 24.8 days. Patients reported better control of hypertension, diabetes and resolution of obstructive sleep apnoea and joint symptoms. Only 14 patients did not observe any significant improvement in their bodily function. Fifty-four patients expressed satisfaction after treatment, 6 patients were dissatisfied with the weight loss, and 5 patients would not opt for balloon re-treatment.ConclusionsThe balloon treatment is a safe and well-tolerated therapy with a low complication rate.

Characteristics and surgical and clinical outcomes of severely obese children with obstructive sleep apnea.

To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA). At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries. A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor. Surgery improved OPSG indices in the majority of obese children with OSA.

Does OSA in Children with Small Tonsils Improve after Adenotonsillectomy?

Objectives: There is conflicting opinion regarding the clinical utility of removing small tonsils in children with obstructive sleep apnea (OSA). We sought to (1) determine if OSA improves after adenotonsillectomy (AT) in children with small tonsils; and (2) investigate the relationship between OSA resolution and tonsil size after AT. Methods: Retrospective study of 1- to 18-year-old consecutive nonsyndromic children with OSA who underwent polysomnography before and after AT. Complete response was defined as obstructive respiratory disturbance index (RDI) &lt; 1.5. Results: Seventy children (36 female) were included; mean age was 5.9 ± 4.3 years. Tonsils were categorized as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). Preoperative RDI, obstructive apnea index (AI), and obstructive hypopnea index (HI) were similar regardless of tonsil size ( P &gt; .05). Overall RDI improved from 18.6 ± 8.6 to 4.0 ± 6.0 with 44% (31/70) complete responders. In the 2+ group, AI and saturation nadir significantly improved ( P = .004-.033) but HI and RDI did not ( P = .08-21). All 4 parameters significantly improved for the 3+ ( P = .001-&lt;.0001) and 4+ ( P = .018-.003) groups. The mean RDI improvement in the 2+ group was 10.8 ± 5.9 events/hour with 25% (5/20) complete responders, 14.8 ± 2.4 with 56% (20/36) responders in the 3+ and 18.7 ± 5.4 with 43% (6/14) responders in the 4+ group. There was no correlation between OSA severity and tonsil or adenoid size ( P &gt; .32). Conclusions: Tonsil size did not correlate with OSA severity. While a larger proportion of patients with 3+/4+ tonsils had complete response after surgery, significant improvement was seen in AI and saturation nadir even in those with 2+ tonsils.

Effects of surgical weight loss for treating obstructive sleep apnea.

Weight loss has been reported to reduce the severity of obstructive sleep apnea (OSA), particularly in the obese population. However, prospective studies with polysomnography (PSG) for the precise evaluation of OSA are lacking especially in Asian countries. We evaluated the effects of surgical weight loss for treating OSA using PSG data obtained before and after surgery. We performed a prospective study analyzing the clinical and PSG data obtained from our cohort of bariatric surgical candidates with moderate to severe OSA, as confirmed by preoperative PSG. The patients underwent follow-up PSG at least 12 months after bariatric surgery (laparoscopic Roux-en-Y gastric bypass). Of the 47 patients (70.1%) with moderate to severe OSA among 67 patients who underwent preoperative PSG, 10 patients underwent postoperative PSG. The mean apnea-hypopnea index (AHI) of these 10 patients significantly reduced from 51.0±34.2 to 9.3±12.9 events/h, while their mean body mass index (BMI) loss was from 39.9±8.3 to 26.9±4.4 kg/m2. Although the severity of OSA improved considerably, OSA resolution was achieved in only five patients (50%). When compared to the patients who achieved OSA resolution, the patients with residual OSA showed a tendency to have lower minimum arterial oxygen saturation (SaO2) levels and higher supine AHI values in preoperative PSG. Surgical weight loss resulted in the significant improvement of OSA associated with obesity. However, OSA remained in a considerable proportion of patients even after substantial weight loss. We recommend that postoperative PSG be considered for the evaluation of residual OSA, especially in patients with low minimum SaO2 levels and high supine AHI in preoperative PSG.

Discrepancy between Objective and Subjective Outcomes after Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome

Adenotonsillectomy (T&A) is the first line therapy for pediatric obstructive sleep apnea (OSA); however, inconsistency between objective and subjective outcomes perplexes physicians. This study investigates changes of objective and subjective outcomes in children with OSA after T&A, in particular, to elucidate correlations and discrepancies between these 2 measures. Case series with record review. Tertiary referral medical center. Symptomatic children with polysomnographic diagnosis of OSA (apnea-hypopnea index [AHI] > 1) were included. All children underwent T&A to treat OSA, along with completely objective (polysomnography) and subjective (Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire [OSA-18]) measures before and 3 months after surgery. One hundred nineteen children were included (mean age, 6.9 ± 3.3 years; 76% boys). Adenotonsillectomy significantly reduced AHI from 15.4 ± 21.2 per hour to 1.6 ± 2.5 per hour (P < .001). The OSA-18 scores were significantly improved after surgery (P < .001). A weak but statistically significant positive correlation was found between AHI and OSA-18 scores preoperatively (ρ = 0.22, P = .016) but not postoperatively (ρ = 0.04, P = .677). Among those cases with residual OSA after surgery, only 6% (3/54) had a residual effect on quality of life (OSA-18 score > 60). Adenotonsillectomy improves both objective and subjective outcomes. After surgery, quality of life significantly improved subjectively, despite an incomplete resolution of OSA objectively, leading to a better correlation between objective and subjective measures before as opposed to after surgery. Discrepancy between the 2 measures warrants an evaluation of a child both objectively and subjectively when treating OSA.

Weight loss through adjustable gastric banding and improvement in daytime sleepiness: 2 year interim results of APEX study

Objective:Obesity is one factor associated with an increased risk of obstructive sleep apnea (OSA). This study reports the investigator-reported resolution or improvement of OSA and improvements in sleep-related quality of life (QOL) 2 years after surgical placement of the LAP-BAND AP (LBAP) system.Research design and methods:The LBAP Experience (APEX) study is an ongoing 5 year, prospective, observational study assessing change in weight, comorbidities, and QOL after LBAP implantation. This is an interim analysis of patients with evaluable data at 24 months who had OSA at baseline.Clinical trial registration:NCT00501085.Results:At baseline, 117 of 395 patients (29.6%; mean body mass index [BMI], 45.0 kg/m2) reported OSA; of these, 57 had evaluable patient-reported outcome data at 2 years. Investigator-reported resolution or improvement of OSA was 69% and 86% at post-operative years 1 and 2, respectively. Patients reporting resolution, improvement, or no change in OSA experienced mean changes in BMI and percentage of weight loss of −9.7 kg/m2/−21.7%, −8.3 kg/m2/−18.7%, and −5.7 kg/m2/−13.2%, respectively (n = 54). Mean 2 year BMI was not statistically different between the groups (p = not significant). Mean scores for all Epworth Sleepiness Scale responses for the OSA population improved by −0.43 from baseline (p < 0.0001; n = 78) compared with −0.29 for patients without OSA at baseline (n = 177; p = 0.037 between groups). In addition, the overall study population experienced resolution and/or improvement in other obesity-related comorbidities, such as type 2 diabetes (96%) and hypertension (91%).Conclusions:These data support that surgically facilitated weight loss can improve sleep-related QOL and may result in resolution or improvement of OSA; the degree of weight loss may be related to these changes.

Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study

To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA. An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence. Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m(2)) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight. Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.

Does weight loss affect the apnea/hypopnea index?

Does weight loss affect the apnea/hypopnea index?

A pilot staging system to predict persistent obstructive sleep apnea in children following adenotonsillectomy

A recent meta-analysis by Friedman et al. found that 66% of children have resolution of obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). However, accurate predictors of persistent OSA in children despite surgery are difficult to identify. We evaluate the utility of staging children with OSA using characteristics predictive of adult palatoplasty success. A retrospective analysis of children who underwent sleep studies before and after TA in a tertiary care center from 2008 through 2011. Tonsil size (TS)/modified Mallampati position score (MMP)/body mass index (BMI) z Score were used to categorize patients into a three- and four-stage tonsillectomy staging system. Stage 1 included patients with low MMP scores/large tonsils; stage 2 with low MMP scores/small tonsils or high MMP scores/large tonsils. Stage 3 included patients with high MMP scores/small tonsils. For the four-stage system, any patient with a BMI z Score ≥2.0 was stage 4. Thirty-five patients (14 females) were included (mean age, 6.8 years; range, 1.0-18.6 years). OSA severity ranged from mild (n = 6), moderate (n = 10), to severe (n = 19), with a mean respiratory disturbance index (RDI) of 20.9 before surgery and 2.4 after. Similar to results seen for adult palatoplasty, staging by TS/MMP/BMI corresponded with response to surgery. In stage 1 to 2, 11/17 (64.7%) children had RDI <1.5 postoperatively, with decreasing TA success rates in stages 3 to 4 at 10/18 (55.5%). Although these results were not statistically significant (P = .14), the trend was similar to the adult analysis. A trend toward a dose-response relationship was seen between physical exam staging and persistent OSA after TA. Further data collection and analysis with a larger sample size are warranted.