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Am J Otolaryngol. 2014 Jul-Aug;35(4):487-95. doi: 10.1016/j.amjoto.2014.02.010. Epub 2014 Feb 26.

Clinical indicators that predict the presence of moderate to severe obstructive sleep apnea after adenotonsillectomy in children.

Author information

1
Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Otolaryngology Head & Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
2
Sleep Medicine Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pulmonary Medicine, Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL.
3
Department of Biostatistics, Northwestern University, Chicago, IL.
4
Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Otolaryngology Head & Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: jschroeder@luriechildrens.org.

Abstract

OBJECTIVE:

To determine if clinical indicators can predict the presence of moderate to severe Obstructive Sleep Apnea (OSA) after Adenotonsillectomy (T&A) in children.

STUDY DESIGN:

Retrospective study.

SETTING:

Urban Tertiary Care Pediatric Hospital.

METHODS:

Parents of children (<18 yrs.) with OSA completed a 55-item questionnaire based on their child's symptoms at the time of preoperative polysomnography and then again at the follow up polysomnography completed 3 to 6 months after T&A.

MAIN OUTCOME MEASURES:

55 item questionnaire, polysomnography variables.

RESULTS:

97 children were included (59 Male and 38 Female). The mean preoperative apnea hypopnea index (AHI) was 30.5±31.6/h and the mean postoperative AHI was 4.4±6.0/h. After T&A, all 97 children had reduction in AHI, and 35 (36.1%) no longer had OSA (AHI<1/h). The total symptom scores decreased from 15.8±9.4 to 11.3±8.7 after T&A (p<.0001). Fourteen symptoms highly predictive of moderate to severe OSA were identified in the univariate analysis (p<0.1). Using a cut-point of 4, this 14-item subscale illustrated an overall predictability of 72.2% (73.7% sensitivity and 70.0% specificity) for identifying children with moderate to severe OSA.

CONCLUSION:

A cluster of 14 clinical sleep symptoms are highly predictive of moderate to severe OSA and can serve as clinical predictor for the presence of moderate to severe OSA after T&A.

PMID:
24746328
DOI:
10.1016/j.amjoto.2014.02.010
[Indexed for MEDLINE]

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