Adenotonsillectomy for Treatment of Obstructive Sleep Apnea in Children

OBJECTIVES: To determine (1) the prevalence of obstructive sleep apnea (OSA) in children with a suggestive history; (2) the effectiveness of surgery in treating OSA in children; and (3) factors that may help the physician select patients who have physiologically significant OSA and are likely to respond to surgery. DESIGN: Prospective study. PATIENTS: Sixty-nine children aged 1 to 14 years who were referred to the otolaryngologist for evaluation of suspected OSA. INTERVENTIONS: Thirty children with a respiratory disturbance index (RDI) greater than 5 underwent adenotosillectomy. Twenty-six of the 30 children had follow-up polysomnography. MAIN OUTCOME MEASURES: Polysomnography after surgery. RESULTS: Thirty-five (51%) of 69 children had an RDI greater than 5 on polysomnography. Twenty-six of the 30 children who underwent adenotonsillectomy for OSA had follow-up polysomnography. All 26 children had a lower RDI after surgery, although four patients still had an RDI greater than 5. A preoperative RDI of 19.1 or less predicted a postoperative RDI of 5 or less. History and physical findings were not useful in predicting outcome. CONCLUSIONS: All patients improved with adenotonsillectomy, but patients with the most severe RDI often had many respiratory events after surgery. History and physical examination alone are not sufficient to assess the severity of OSA or the likelihood of an adequate response to surgical treatment.