Associate Professor Oregon Health and Science University Portland, Oregon
Introduction: Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20-30% of children. The role of drug-induced sleep endoscopy (DISE) performed at the time of AT is uncertain. The aim of this study was to determine predictors of AT outcome, including findings of drug-induced sleep endoscopy (DISE).
Methods: This was a prospective cohort study of children ages 2-18 years being treated with AT for OSA with one or more risk factors for failure: age > 7 years, obesity, severe baseline OSA, black race. All underwent DISE at the time of AT. DISE findings were scored using the Sleep Endoscopy Rating Scale and categorized according to combinations of obstruction at different levels. Potential predictors included age, gender, obesity, and DISE patterns. Outcomes were change in obstructive apnea-hypopnea index (oAHI) and Pediatric Sleep Questionnaire (PSQ)/OSA-18 responses. Multivariable linear regression was used to model predictors of AT outcome.
Results: Pre- and post-AT subjective responses were available in 325 and 183 children, respectively. Pre- and post-AT PSG data were available in 128 and 55 children, respectively. Mean age was 9.5 ± 3.6 years, 62% were obese. After AT, mean change in oAHI, PSQ, and OSA18 scores were -14 ± 14, -0.32 ± 0.23, and -30 ± 22 (all p < 0.001), respectively. Pts with oAHI > 1 decreased from 97% to 65% after AT. The proportion with positive PSQ screens decreased from 93% to 37% after AT.Greater tonsillar obstruction was associated with larger oAHI reduction (beta = -8.4, 95%CI [-13.8, -3.0]) while greater tongue base obstruction resulted in less oAHI reduction (beta = 7.0, 95%CI [0.2, 13.7]). MV regression models of PSQ and OSA18 change demonstrated worse subjective outcomes with obesity, male gender, and nasal obstruction during DISE.
Conclusion: Persistent OSA and symptom burden after AT was common in this population with risk factors for AT failure. Tongue base obstruction contributed to less improvement in oAHI, and obesity, male gender, and nasal obstruction during DISE were all associated with worse subjective improvement.