Predictors of sleep-disordered breathing in children with a history of tonsillectomy and/or adenoidectomy.

ABSTRACT

STUDY OBJECTIVES: To identify predictors of sleep-disordered breathing (SDB) in children who have undergone self-reported tonsillectomy and/or adenoidectomy (TA). DESIGN: Observational study of pediatric participants in a longitudinal genetic-epidemiological cohort study of SDB. SETTING: Community-based; studies conducted at participants' homes PARTICIPANTS: 577 children age <18 (10.8+/-4.2 SD) years; 53% female; 48% Black; 76% with a family member identified with SDB. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Medical history assessed by questionnaire. Physical measures made directly. SDB was assessed with overnight inhome cardio-respiratory monitoring. 10% of children (n=60) had had aTA 5.5+/-4.6 yrs previously. An Apnea-Hypopnea Index (AHI, events/hr) > or =5 was found in a higher proportion of children with a reported TA than in children with no history of out surgery (35% vs. 13.7%, p<.001). A TA was reported more frequently for non-Blacks than for Blacks (13.6% non-Blacks, 6.9% Blacks, p=.02). Among children who had a TA, significant predictors of SDB (AHI> or =5) were Black ethnicity (SDB in 57% vs. 24% of Blacks vs. non-Blacks; adjusted odds ratio (OR) 3.85; 95% CI 1.11, 13.33) and obesity (OR 3.98; 95% Cl 1.05, 15.08). SDB also tended to be greater in children with a family member with SDB (OR 2.87; 95% CI 0.65, 12.07). CONCLUSIONS: Black children were less likely to have undergone TA but more likely to have SDB after TA surgery. These findings underscore the need to follow children post-TA and for evidence-based studies that define the role of TA in the management of pediatric adenotonsillar disease.