Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study

Abstract

Objective: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

Keywords: adenotonsillectomy; comorbidity; obstructive sleep apnea; polysomnography; treatment outcomes.

Figure 1

Change of apnea-hypopnea index (AHI) after adenotonsillectomy using Multivariate generalized linear modeling (GLM) and the hierarchical linear model (HLM); the straight thin line indicates the significant linear increase. Period 1 (from before AT -AHI_0- to 6 months post AT surgery-AHI₆): results showed a significant improvement in AHI (from a mean AHI₀ = 13.54 to a mean AHI₆ = 3.47 events/h). Period 2 (from 6 mo postsurgery-AHI₆ to 36 mo postsurgery -AHI₃₆): the mean AHI significantly increased between 6 mo postsurgery to 36 mo postsurgery (mean AHI₆ = 3.47 to mean AHI₃₆ = 6.48 events/h). This increase was associated with recurrence in 68% of subjects followed for 36 mo postsurgery.