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 th e physician select patients who have physiologically significant OSA a nd are likely to respond to surgery. Design: Prospective study. Patien ts: Sixty-nine children aged 1 to 14 years who were referred to the ot olaryngologist for evaluation of suspected OSA. Interventions: Thirty children with a respiratory disturbance index (RDI) greater than 5 und erwent adenotonsillectomy. 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 adenot onsillectomy for OSA had follow-up polysomnography. All 26 children ha d a lower RDI after surgery, although four patients still had an RDI g reater than 5. A preoperative RDI of 19.1 or less predicted a postoper ative RDI of 5 or less. History and physical findings were not useful in predicting outcome. Conclusions: All patients improved with adenoto nsillectomy, but patients with the most severe RDI often had many resp iratory events after surgery. History and physical examination alone a re not sufficient to assess the severity of OSA or the likelihood of a n adequate response to surgical treatment.