POLYSOMNOGRAPHY AFTER ADENOTONSILLECTOMY IN MILD PEDIATRIC OBSTRUCTIVE SLEEP-APNEA

Objectives: a) To determine the need for intensive monitoring on the f irst operative night of surgery in children undergoing adenotonsillect omy for mild obstructive sleep apnea; b) to examine the effect of narc otics on postoperative obstructive sleep apnea. Design: Randomized, pr ospective study. Setting: University hospital. Patients: Children, ran ging in age between 1 and 18 yrs, presented to the Pediatric Otolaryng ology Clinic for adenotonsillectomy for mild obstructive sleep apnea d efined as from one to 15 obstructive apnea events per hour on preopera tive polysomnogram. Interventions: Patients were assigned to receive e ither a narcotic- or a halothane-based anesthetic for adenotonsillecto my, A postoperative polysomnogram was performed in the pediatric inten sive care unit on the first operative night.Measurements and Main Resu lts: Eighteen patients were recruited, 15 of whom met inclusion criter ia: nine patients received a halothane based anesthetic and six patien ts received a fentanyl-based anesthetic, When the data were analyzed b y pooling both groups, the differences between pre and postoperative s leep studies demonstrated a reduction in the number of obstructive eve nts and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 +/- 13 to 304 +/- 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye moveme nt sleep was 78 +/- 5% preoperatively and 92 +/- 1% postoperatively. C onclusions: Our data suggest that children without underlying medical conditions, neuromotor diseases, or craniofacial abnormalities, 1 to 1 8 yrs of age, who suffer from mild obstructive sleep apnea, have impro vements documented by polysomnography on the night of surgery followin g adenotonsillectomy and do not necessarily need to be monitored inten sively, These findings were not significantly affected by the choice o f intraoperative anesthetic.