Age criteria for polysomnography and inpatient management for adenotonsillectomy.

OBJECTIVE: Clinical practice guidelines (CPG) by the American Academy of Otolaryngology recommend that children <2yo with sleep disordered breathing (SDB) undergo preoperative polysomnography (PSG) and children <3yo be admitted following adenotonsillectomy (TA) for inpatient management. As the rationale for preoperative PSG and postoperative admission in the CPG are the same, there is an inconsistency in the age recommendations between <2yo and two to three-years-old (2-3yo). This study compared the characteristics of <2yo versus 2-3yo patients undergoing workup and treatment for SDB, with the goal of determining whether 2-3yo should be classified with <2yo. STUDY DESIGN: Case series with retrospective review. SETTING: Boston Medical Center, a tertiary academic hospital. METHODS: Patients ≤3yo who underwent PSG 2015 to 2019 were identified using a filter through the electronic medical record. 448 patients underwent PSG. Bivariate analysis via Pearson chi-square test and multivariate analysis via multinomial logistic regression were performed using SPSS. RESULTS: Of the 427 patients included in this study, 217 patients were in the age group of <2yo while 210 patients were in the age group of 2-3yo. Severity of OSA (p = 0.069) and surgical outcomes (defined by presence or resolution of OSA on follow-up PSG) (p = 0.260) were similar between the two groups. Children <2yo were more likely to have smaller tonsils (p < 0.024) than 2-3yo. CONCLUSION: Characteristics, such as severity of OSA, were similar between the age groups. Further studies should be conducted to determine if consideration should be taken for routine preoperative PSG children <3yo. LEVEL OF EVIDENCE: IV.

Severe Versus Very Severe Pediatric Obstructive Sleep Apnea Outcomes After Adenotonsillectomy.

OBJECTIVES/HYPOTHESIS: Adenotonsillectomy (AT) is generally considered the first line treatment for pediatric patients with obstructive sleep apnea (OSA). Pediatric patients with severe OSA have worse outcomes after AT than patients with milder OSA. It is currently unclear if this group of higher morbidity patients should be subdivided further. This study investigates patients with severe pediatric OSA to determine if there are differences in postsurgical outcomes based on initial severity of sleep disordered breathing, medical comorbidities, or demographic factors. STUDY DESIGN: Retrospective cohort study at a single tertiary referral center. METHODS: Patients aged 2-18 who underwent polysomnogram (PSG) from October 2012 to January 2019, had an apnea-hypopnea index (AHI) >10, and subsequently underwent AT were identified using a filter through electronic medical record. A total of 112 patients underwent both pre- and postoperative PSG. Bivariate analysis was conducted via Pearson chi-square test. Univariate and multivariate analyses via binary logistic and multinomial linear regressions were performed using SPSS. RESULTS: Of the 112 patients included in this study, 68 patients were identified as having severe OSA (AHI = 10-20) and 44 as having very severe OSA (AHI > 20). Very severe OSA patients were significantly less likely to be cured of sleep disordered breathing or have their OSA reduced to mild OSA. Obese patients were found to have less reduction in AHI after AT. CONCLUSIONS: The postsurgical outcomes of patients with severe and very severe OSA are significantly different indicating that patients traditionally categorized as having severe OSA may need to be further subcategorized. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:1855-1860, 2022.