Outcome of Adenotonsillectomy for Obstructive Sleep Apnea Syndrome in Children

Objectives: We evaluated the outcome of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children using polysomnography (PSG) data and a quality-of-life (QOL) instrument. Methods: We enrolled children (4 to 14 years of age) who had OSAS diagnosed by overnight PSG and who underwent both adenoidectomy and tonsillectomy between January 2003 and February 2008. All of them had completed postoperative PSG and a paired Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire (OSA-18) survey. The statistical analyses were performed with a statistical software package. Results: The study included 84 children with a mean age of 7.1 years. The mean preoperative apnea-hypopnea index (AHI) for the study population was 24.6, and the mean postoperative AHI was 3.8 episodes per hour. The percentage of children who had normal PSG parameters after adenotonsillectomy ranged from 69.0% to 86.9% because of fluctuation of the criteria used to define OSAS. Nine children (30%) with severe preoperative OSAS had persistent OSAS (an AHI of at least 5) after surgery. Improvements in QOL were comparable in the cured and not-cured groups (p > 0.05). Risk factors for persistent OSAS were obesity and a high preoperative AHI, on multiple logistic regression analysis. Conclusions: Adenotonsillectomy is associated with improvements in PSG, behavior, and QOL in children with OSAS. However, it may not resolve OSAS in all children. The efficacy and role of additional therapeutic options require more study.