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Effects on Respiratory Parameters and Clinical Outcome

Neville P. Shine, AFRCS(Ire); Francis J. Lannigan, MD, FRACS, FRCS(ORL); Harvey L. Coates, FRACS; Andrew Wilson, MBBS

Arch Otolaryngol Head Neck Surg. 2006;132:1123-1127.

Objective  To assess the efficacy of adenotonsillar surgery on respiratory sleep parameters and avoiding continuous positive airway pressure (CPAP) treatment in morbidly obese children with obstructive sleep apnea syndrome (OSAS).

Design  Retrospective.

Setting  Tertiary referral institution.

Patients  Children aged 2 to 18 years, with a body mass index (BMI) at or higher than the 95th percentile (adjusted for age and sex), undergoing adenotonsillar surgery for OSAS.

Interventions  Adenotonsillectomy.

Main Outcome Measures  Preoperative and postoperative respiratory disturbance index, oxygen saturation nadir, overall severity of OSAS (mild, moderate, or severe) and candidacy for CPAP treatment were assessed and compared. Variables such as age, severity of disease, adenotonsillar size, and BMI z scores were compared between responders and nonresponders to surgical treatment.

Results  A total of 19 patients with full preoperative and postoperative data for evaluation were identified. The median (SD) age was 78 months (53.3 months). The median (SD) BMI z score was 2.84 (0.94). Eighteen patients (95%) had OSAS preoperatively to warrant CPAP treatment. Surgery reduced the overall median (SD) respiratory disturbance index from 20.7 (24.5) to 7.3 (14.9) (P<.001) and improved the median (SD) oxygen saturation nadir from 77.5% (16.3%) to 88.5 (13.1%) (P<.01). A total of 7 patients (37%) were cured by surgery. Ten patients (53%) had postoperative disease of sufficient severity to require CPAP. Surgery obviated the need for further treatment in only 8 (44%) of the 18 patients with preoperative disease warranting CPAP. No differences were identified between responders and nonresponders to surgical treatment.

Conclusions  Adenotonsillar surgery improves sleep respiratory parameters in morbidly obese children with OSAS. Most patients have residual OSAS requiring further treatment.

Author Affiliations: Departments of Pediatric Otolaryngology (Drs Shine, Lannigan, and Coates) and Pediatric Sleep Medicine (Mr Wilson), Princess Margaret Hospital, Perth, Western Australia.

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