0859 Predictors of Residual Obstructive Sleep Apnea in Children Following Adenotonsillectomy

Introduction Obstructive sleep apnea (OSA) is the most frequently diagnosed pediatric sleep disorder, affecting 3-6% of the 74 million children in the US. Children with moderate to severe sleep apnea, defined by an Apnea-Hypopnea Index (AHI) score of 5.1 or higher, are candidates for adenotonsillectomy. Follow-up polysomnograms (PSG) are frequently ordered following adenotonsillectomy to determine further treatment. The objective of this study was to identify patient and PSG characteristics of children likely to have residual OSA (AHI>5) following adenotonsillectomy who benefit from repeat PSG. Methods In this single-center retrospective study, data was collected by reviewing the medical records and PSG REDCap database from 2021-2024. Patients aged 2-18 with two sleep studies; before and after adenotonsillectomy, and a baseline AHI of 5.1 or higher were included. The following variables: age, sex, race, BMI, neck circumference (NC), SpO2 Time< 90%, Total & REM AHI, desaturation index (DI), average and peak CO2 were evaluated. Results 370 patients met the criteria for the study, including 206 males and 164 females (median age of 6 years). BMIs pre-adenotonsillectomy ranged from 11-62.4 with a median of 18.6. Preliminary analysis shows that patient and pre-op PSG characteristics that predict AHI>5 post-op are older age, female sex, non-caucasian race, higher BMI, larger NC, higher total AHI and REM AHI, higher DI, lower nadir saturation, higher time< 90% SpO2, and higher peak CO2. Logistic regression models (adjusted for age, sex, and race) showed increased Odds Ratio of having AHI>5 with BMI, NC, Total and REM AHI, O2 nadir, SpO2 T< 90, DI, average and peak CO2. Further analysis is being performed to identify the AHI on pre-op PSG that will predict AHI>5 in the post-op PSG. Conclusion Follow-up PSGs are frequently ordered following adenotonsillectomy due to the absence of a standardized protocol that elucidates when follow-up PSGs are warranted with clinical benefit. This study helps determine if follow-up PSGs are warranted in children with OSA following adenotonsillectomy to reduce unnecessary repeat PSGs. As PSGs are expensive to perform and with limited access to Pediatric Sleep Centers across the country, this study will help reduce healthcare costs and improve access for all children. Support (if any)