AGE-RELATED OUTCOMES OF SLEEP-APNEA SURGERY IN INFANTS AND CHILDREN

This study was designed to determine whether age at the time of surger y is an important influencing factor on outcomes following surgical co rrection of severe refractory obstructive sleep apnea (OSA) in infants and children. Data were collected prospectively on 55 children, all w ith severe OSA refractory to conservative medical and surgical measure s, who underwent combinations of soft-tissue and skeletal procedures a imed at relieving their airway obstruction, The study population was s ubdivided for analysis into three groups based on age at the time of s urgery (>36 months, >12 to <36 months, and less than or equal to 12 mo nths), Each child was assessed for clinical outcomes, polysomnography results, and complications. Children in the >36 months group demonstra ted a significant improvement in respiratory disturbance index (RDI), apnea index, and lowest overnight oxygen saturation postoperatively, O nly RDI improved significantly in the >12 to <36 months group, Althoug h there was a trend toward improvement in the respiratory indices for the children less than or equal to 12 months of age, they had a signif icantly longer intensive care and hospital stay, a greater mean number of extubation attempts, and the highest surgical failure rate (29%). Other complications such as infection, atelectasis, or temporary posto perative nasopharyngeal tube dependence occurred most frequently in th e >36 months group, Surgical management of severe refractory OSA in ch ildren age less than or equal to 12 months is more difficult and less likely to succeed. The reasons for this are discussed and recommendati ons for management are given.