Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea

Mark A. Helfaer, Susanna A. McColley, Paula L. Pyzik, David E Tunkel, David G. Nichols, Fuad M. Baroody, Max M. April, Lynne G. Maxwell, Gerald M. Loughlin

Research output: Contribution to journalArticle

Abstract

Objectives: a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea. Design: Randomized, prospective study. Setting: University hospital. Patients: Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram. Interventions: Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night. Measurements and Main Results: Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 ± 13 to 304 ± 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 ± 5% preoperatively and 92 ± 1% postoperatively. Conclusions: Our data suggest that children without underlying medical conditions, neuromotor diseases, or craniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.

Original languageEnglish (US)
Pages (from-to)1323-1327
Number of pages5
JournalCritical Care Medicine
Volume24
Issue number8
StatePublished - Aug 1996

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Polysomnography
Obstructive Sleep Apnea
Anesthetics
Pediatrics
Sleep
Narcotics
Halothane
Apnea
Craniofacial Abnormalities
Oxygen
Pediatric Intensive Care Units
REM Sleep
Otolaryngology
Fentanyl
Prospective Studies

Keywords

  • adenotonsillectomy
  • anesthetics
  • children
  • narcotics
  • obstructive sleep apnea
  • pediatric intensive care unit
  • polysomnography
  • surgery, sleep
  • tonsillectomy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Helfaer, M. A., McColley, S. A., Pyzik, P. L., Tunkel, D. E., Nichols, D. G., Baroody, F. M., ... Loughlin, G. M. (1996). Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. Critical Care Medicine, 24(8), 1323-1327.

Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. / Helfaer, Mark A.; McColley, Susanna A.; Pyzik, Paula L.; Tunkel, David E; Nichols, David G.; Baroody, Fuad M.; April, Max M.; Maxwell, Lynne G.; Loughlin, Gerald M.

In: Critical Care Medicine, Vol. 24, No. 8, 08.1996, p. 1323-1327.

Research output: Contribution to journalArticle

Helfaer, MA, McColley, SA, Pyzik, PL, Tunkel, DE, Nichols, DG, Baroody, FM, April, MM, Maxwell, LG & Loughlin, GM 1996, 'Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea', Critical Care Medicine, vol. 24, no. 8, pp. 1323-1327.
Helfaer MA, McColley SA, Pyzik PL, Tunkel DE, Nichols DG, Baroody FM et al. Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. Critical Care Medicine. 1996 Aug;24(8):1323-1327.
Helfaer, Mark A. ; McColley, Susanna A. ; Pyzik, Paula L. ; Tunkel, David E ; Nichols, David G. ; Baroody, Fuad M. ; April, Max M. ; Maxwell, Lynne G. ; Loughlin, Gerald M. / Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. In: Critical Care Medicine. 1996 ; Vol. 24, No. 8. pp. 1323-1327.
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abstract = "Objectives: a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea. Design: Randomized, prospective study. Setting: University hospital. Patients: Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram. Interventions: Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night. Measurements and Main Results: Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 ± 13 to 304 ± 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 ± 5{\%} preoperatively and 92 ± 1{\%} postoperatively. Conclusions: Our data suggest that children without underlying medical conditions, neuromotor diseases, or craniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.",
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