Surgical management of obstructive sleep apnea in infants and young toddlers

OBJECTIVE: Review surgical management of obstructive sleep apnea (OSA) in infants and young toddlers compared with a medically treated group. STUDY DESIGN: Case series with chart review of children younger than 24 months treated at a tertiary pediatric hospital between 2000 and 2005. SUBJECTS AND METHODS: Surgical treatment included adenotonsillectomy, adenoidectomy, and tonsillectomy. Polysomnography results, comorbidities, and major complications were recorded. The change in apnea-hypopnea index (AHI) before and after treatment was analyzed. Logistic regression analysis reviewed effects of comorbidities and OSA severity on complications. RESULTS: A total of 73 children met inclusion criteria. The surgical treatment group (AHI) improved posttreatment: mean AHI change was 9.6 (95% Cl, 5.8-13.4). The medical treatment group did not improve posttreatment: mean AHI change was -3.0 (95% CI, -15.1 to 9.1). The difference in AHI change between surgical and medical groups was 12.56 (95% Cl, 2.7-22.4). An independent t test found this difference to be statistically significant (P = 0.01). Eleven (18%) patients suffered significant postoperative surgical complications; 55 surgical patients and 8 medical patients had comorbidities. There were no long-term morbidities or mortalities. CONCLUSIONS: AHI in the surgically treated group significantly improved. The complication rate for a tertiary pediatric hospital population that included patients with multiple comorbidities was acceptable. (C) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.