Prevalence of severe obstructive sleep apnea in pediatric adenotonsillectomy patients

Objectives/Hypothesis To determine the prevalence of severe obstructive sleep apnea (OSA) in a pediatric population who underwent indicated surgery for sleep disordered breathing (SDB). Study Design Retrospective chart review. Methods We reviewed the charts of patients aged 2 to 18 years who underwent tonsillectomy or adenotonsillectomy over a 4-year period. Indications for preoperative polysomnography (PSG), PSG results, and perioperative complications were recorded. Results Two hundred and thirty-five patients were included in the final analysis. Of these, 160 patients had preoperative PSG performed. The overall prevalence of severe OSA was 38%. The prevalence in patients for whom preoperative PSG was indicated or for which it should have been advocated according to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) clinical practice guideline was 45% and 40%, respectively, whereas the prevalence in patients with no indication for preoperative PSG was 34%. There was no significant difference between groups (P=0.39). The overall complication rate was 11%, with the rate being significantly lower (P=0.0022) in patients who did not have preoperative PSG performed (0%) when compared to those who did (16%). Conclusions The prevalence of severe OSA in this pediatric population was high. Specifically, a significant percentage of children who would not have received preoperative PSG under the AAO-HNS recommendations had severe OSA and were consequently admitted for overnight observation. Our results suggest that preoperative PSG should be obtained for all pediatric patients with sleep disordered breathing.