Construction of a nomogram prediction model for symptom residue after tonsillectomy and adenoidectomy in children with obstructive sleep apnea-hypopnea syndrome based on lasso-logistic regression analysis

Objective To identify the factors associated with residual symptoms after adenotonsillectomy in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) using LASSO-logistic regression, and to construct a nomogram prediction model. Methods A total of 324 children with OSAHS treated at our hospital from January 2023 to March 2024 were enrolled and randomly divided into a training cohort ( n = 227) and an internal validation cohort ( n = 97) at a ratio of 7:3. According to the 1-year follow-up results, the training cohort was further divided into a recovery group and a residual symptom group. In addition, 175 children with OSAHS treated at our hospital from April 2024 to January 2025 were included as an external validation cohort. LASSO-logistic regression was used to identify independent predictors of postoperative residual symptoms. A nomogram model was then established and evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results Compared with the recovery group, children in the residual symptom group were younger and had higher proportions of males, BMI > the 95th percentile, family history of OSAHS, asthma, rhinitis, >8 spontaneous awakenings per hour before surgery, AHI > 18 events/h before surgery, as well as higher preoperative mYPAS scores and postoperative Wong-Baker scores (all P < 0.05). LASSO-logistic regression identified sex, BMI, asthma, rhinitis, number of spontaneous awakenings before surgery, and preoperative AHI as independent predictors (all P < 0.05). The AUC values of the nomogram in the training, internal validation, and external validation cohorts were 0.874, 0.851, and 0.850, respectively. Calibration curves showed good agreement between predicted and observed outcomes, and DCA demonstrated favorable clinical utility. Conclusion The nomogram showed good predictive performance and may help assess the risk of residual symptoms after adenotonsillectomy in children with OSAHS.