Association of adenoid hypertrophy and clinical parameters with preoperative polygraphy in pediatric patients undergoing adenoidectomy.

Background: Adenotonsillar hypertrophy is the most frequent cause for obstructive sleep apnea (OSAS) in children. In patients with small tonsils and where adenoid size cannot be assessed, the indication for adenoidectomy often relies on clinical symptoms. However, data on the association of clinical parameters and adenoid hypertrophy with OSAS severity in children undergoing an adenoidectomy is sparse.

Aim: To investigate the correlation of patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity in pediatric patients indicated for an adenoidectomy.

Methods: We performed a retrospective chart review of all pediatric patients at our tertiary referral center between 2018 and 2023 who underwent polygraphy (PG) for OSAS diagnostics. Adenoid hypertrophy was assessed as adenoid-choanal ratio (AC-ratio) via nasal endoscopy and clinical symptom score (CS) via physical examination and parental survey. We included all symptomatic children with mild to severe OSAS (apnea-hypopnea index (AHI) ≥ 1). Exclusion criteria were obesity according to BMI and/or the presence of systemic diseases. The patients were divided according to age in a preschool and school cohort. Patient characteristics and PG data were compared between both groups. Linear regression analysis was used to investigate the association of AC-ratio, CS and BMI with the AHI.

Results: A total of 121 patients were identified of which 81 were included in our study, resulting in 42 and 39 patients from 3-5 and 6-14 years of age, respectively. We observed a significant correlation between CS and BMI (p = 0.026) and the CS and AC-ratio (p < 0.001). Univariable regression analysis showed significant association of the AC-ratio and CS with AHI-score for the total (p < 0.001), the preschool (p < 0.001), and the school cohort (p < 0.001). In multivariable regression analysis, the significant association of AC-ratio and CS remained in the total (p = 0.014; p < 0.001), and the preschool cohort (p = 0.029; p = 0.002). However, only the CS remained as positive predictor in the school cohort.

Conclusion: AC-ratio and clinical symptoms seem to be reliable predictors for OSAS severity in patients between 3-14 years of age. Moreover, only clinical symptoms were associated with OSAS severity in schoolchildren. Future investigation should contribute to the validation of our results.