TY - JOUR
T1 - Influence of Tonsillar Size on OSA Improvement in Children Undergoing Adenotonsillectomy
AU - Tang, Alice
AU - Benke, James R.
AU - Cohen, Aliza P.
AU - Ishman, Stacey L.
N1 - Publisher Copyright:
© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.
PY - 2015/8/25
Y1 - 2015/8/25
N2 - Objective. To determine if pediatric obstructive sleep apnea (OSA) improves after adenotonsillectomy (AT) regardless of tonsil size. Study Design. Case series with chart review. Setting. Pediatric Otolaryngology Department, Johns Hopkins Hospital. Subjects. Seventy children 1 to 18 years of age who underwent polysomnography (PSG) before and after AT. Methods. Tonsil size was evaluated using the Brodsky grading scale. Results. Children were stratified by tonsil size as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). There was a significant improvement in obstructive apnea-hypopnea index (oAHI), apnea index (AI), and saturation nadir across all 3 groups after AT. Preoperative oAHI, AI, and hypopnea index (HI) were similar regardless of tonsil size (P >.05). Overall, oAHI improved from a median of 11.8 6 21.7 to 2.0 6 6.1 events/h, with 40% (28/70) of children having complete resolution. The oAHI (P <.0001-0.02), AI (P <.0001-0.017), HI (P <.0001-0.058), and saturation nadir (P < .0001-0.017) significantly improved for the 2+, 3+, and 4+ groups. Only the HI (P = .058) in the 2+ group did not. The median oAHI improvement was 3.4 6 26.4 events/h in the 2+ group, 8.3 6 16.6 events/h in the 3+ group, and 12.3 6 19.5 events/h in the 4+ group, with 25% (5/20), 50% (18/36), and 36% (5/14), respectively, having complete resolution. There was no correlation between OSA severity and tonsil or adenoid size (P >.32). Conclusion. Tonsil size did not correlate with OSA severity. While a larger proportion of patients classified as 3+ and 4+ had complete resolution after surgery, significant improvement was seen in AI and saturation nadir even in those classified as 2+.
AB - Objective. To determine if pediatric obstructive sleep apnea (OSA) improves after adenotonsillectomy (AT) regardless of tonsil size. Study Design. Case series with chart review. Setting. Pediatric Otolaryngology Department, Johns Hopkins Hospital. Subjects. Seventy children 1 to 18 years of age who underwent polysomnography (PSG) before and after AT. Methods. Tonsil size was evaluated using the Brodsky grading scale. Results. Children were stratified by tonsil size as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). There was a significant improvement in obstructive apnea-hypopnea index (oAHI), apnea index (AI), and saturation nadir across all 3 groups after AT. Preoperative oAHI, AI, and hypopnea index (HI) were similar regardless of tonsil size (P >.05). Overall, oAHI improved from a median of 11.8 6 21.7 to 2.0 6 6.1 events/h, with 40% (28/70) of children having complete resolution. The oAHI (P <.0001-0.02), AI (P <.0001-0.017), HI (P <.0001-0.058), and saturation nadir (P < .0001-0.017) significantly improved for the 2+, 3+, and 4+ groups. Only the HI (P = .058) in the 2+ group did not. The median oAHI improvement was 3.4 6 26.4 events/h in the 2+ group, 8.3 6 16.6 events/h in the 3+ group, and 12.3 6 19.5 events/h in the 4+ group, with 25% (5/20), 50% (18/36), and 36% (5/14), respectively, having complete resolution. There was no correlation between OSA severity and tonsil or adenoid size (P >.32). Conclusion. Tonsil size did not correlate with OSA severity. While a larger proportion of patients classified as 3+ and 4+ had complete resolution after surgery, significant improvement was seen in AI and saturation nadir even in those classified as 2+.
KW - OSA
KW - obstructive sleep apnea
KW - polysomnography
KW - sleep apnea
KW - sleep study
KW - small tonsils
KW - tonsil size
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U2 - 10.1177/0194599815583459
DO - 10.1177/0194599815583459
M3 - Article
C2 - 25940581
AN - SCOPUS:84937706580
VL - 153
SP - 281
EP - 285
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
SN - 0194-5998
IS - 2
ER -