Adenotonsillectomy in Children With Cerebral Palsy: Obstructive Sleep Apnea Outcomes

Objective To evaluate the effectiveness and safety of adenotonsillectomy in children with cerebral palsy (CP) and obstructive sleep apnea (OSA). Methods A retrospective cohort study was conducted of children with CP and OSA who underwent adenotonsillectomy between 2011 and 2022 at a tertiary pediatric medical center. Inclusion criteria required pre‐ and postoperative polysomnography within 24 months. Data collected included demographics, comorbidities, perioperative complications, and polysomnography parameters. The primary outcome was the change in obstructive apnea‐hypopnea index (OAHI). Secondary outcomes included changes in central apnea index, oxygen nadir, transcutaneous carbon dioxide (TcCO 2 ), and need for noninvasive positive pressure ventilation. Logistic regression identified predictors of postoperative OAHI < 5 events/h. Results Sixty‐five children (median age: 5.0 years) met inclusion criteria. Mean preoperative OAHI was 19.6, which improved to 7.7 postoperatively ( p < 0.001). OAHI was reduced by >50% in 63%; 62% achieved OAHI < 5, and 12% achieved OAHI < 1. Oxygen nadir improved from 84% to 88% ( p < 0.001), TcCO 2 improved from 49.2 mmHg to 45.2 mmHg. No significant change in central apnea index was noted. Postoperatively, 40% required noninvasive positive pressure ventilation, and 55% were electively admitted to the intensive care unit. Complication rate was 12%. Preoperative OAHI was the strongest and most consistently selected predictor of achieving postoperative OAHI < 5 ( p = 0.002). Conclusion Adenotonsillectomy significantly improves OSA severity and oxygenation in children with CP; however, complete resolution is uncommon. Preoperative OAHI severity predicts surgical success. Postoperative polysomnography and multidisciplinary follow‐up are essential due to the high rate of residual disease.