Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Aliva De; Temima Waltuch; Nathan J Gonik; Ngoc Nguyen-Famulare; Hiren Muzumdar; John P Bent; Carmen R Isasi; Sanghun Sin; Raanan Arens

doi:10.5664/jcsm.6620

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

J Clin Sleep Med. 2017 Jun 15;13(6):805-811. doi: 10.5664/jcsm.6620.

Authors

Aliva De¹, Temima Waltuch², Nathan J Gonik^{3

4}, Ngoc Nguyen-Famulare^{5

6}, Hiren Muzumdar^{1

7}, John P Bent³, Carmen R Isasi⁸, Sanghun Sin¹, Raanan Arens¹

Affiliations

¹ Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
² Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
³ Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
⁴ CS Mott Children's Hospital, University of Michigan, Anne Arbor, Michigan.
⁵ Department of Anesthesiology, Montefiore Medical Center, Bronx, New York.
⁶ Department of Anesthesiology, Winthrop-University Hospital, Mineola, New York.
⁷ Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁸ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York.

Abstract

Study objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT.

Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups.

Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO₂ nadir 80.1 ± 7.9%, and sleep fragmentation-arousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO₂ nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017).

Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children.

Commentary: A commentary on this article appears in this issue on page 775.

Keywords: OSA; adenotonsillar hypertrophy; adenotonsillectomy; children; obese; obstructive sleep apnea.

MeSH terms

Adenoidectomy*
Adolescent
Child
Female
Humans
Male
Obesity / complications*
Obesity / physiopathology
Polysomnography
Postoperative Complications / physiopathology*
Postoperative Period
Prospective Studies
Risk Factors
Severity of Illness Index
Sleep Apnea, Obstructive / complications*
Sleep Apnea, Obstructive / physiopathology*
Sleep Apnea, Obstructive / surgery
Tonsillectomy*

Abstract

MeSH terms

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