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Management and outcome of extreme pediatric obstructive sleep apnea. | LitMetric

Management and outcome of extreme pediatric obstructive sleep apnea.

Sleep Med

Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3030 Children's Way, San Diego, CA, 92123, USA.

Published: November 2021

AI Article Synopsis

  • The study aimed to classify the need for respiratory support after adenotonsillectomy (AT) in children with severe obstructive sleep apnea (OSA) and identify predictors for these interventions.* -
  • Researchers analyzed the medical records of 41 children, finding that 68.3% underwent AT, with significant associations between younger age, lower BMI, and higher apnea severity leading to surgery, while 39.3% required respiratory support afterward.* -
  • Despite some children needing respiratory support post-surgery, there were no reintubations or serious complications, supporting the idea that AT can be a beneficial first-line treatment for children with extreme OSA.*

Article Abstract

Objectives: Classify post-adenotonsillectomy (AT) respiratory support, identify variables that predict these interventions, and evaluate outcomes in children with extreme obstructive sleep apnea (OSA).

Methods: Retrospective chart analysis was performed on patients found to have apnea/hypopnea index (AHI) > 100 events/h. Patients with chronic diseases other than obesity were excluded.

Results: Forty-one subjects were studied, average age of 11.4 ± 4.3 years, majority (73.1%) were Hispanic, with a mean total AHI (TAHI) of 128.1 ± 22.9/h. Twenty-eight (68.3%) patients underwent AT. Lower age (P < 0.001), lower BMI Z-score (P < 0.01), higher OAHI (P < 0.05) were associated with having surgery. Eleven out of 28 (39.3%) surgical patients required respiratory support (oxygen or positive airway pressure) postoperatively. Longer % total sleep time SO <90% during PSG (P < 0.05) and lower SO nadir (P < 0.05) were associated with requiring airway support. No patients experienced mortality, reintubation, or hospital readmission following AT, with majority (71.4%) discharged 1 day post-operatively. Eleven (57.9%) of the 19 patients who had a postoperative PSG had residual OSA, defined as AHI >5 events/h, but there was a significant improvement in TAHI (P < 0.01).

Conclusion: Our findings confirm the need for postoperative observation in a controlled setting for patients with extreme OSA undergoing AT. Although at higher risk of needing respiratory support, those patients undergoing AT for extreme OSA did not require re-intubation post-operatively or suffer serious harm. Barring contraindications to AT, surgery may still be a first-line therapy for some children with extreme OSA.

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Source
http://dx.doi.org/10.1016/j.sleep.2021.09.006DOI Listing

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