Resolution of Obstructive Sleep Apnea-Associated Hypercapnia in Children After Tonsillectomy and Adenoidectomy

Abstract

PURPOSE: It has been observed that there is persistence of hypercapnia in children after treatment of OSA by T&A. Although it is believed that hypercapnia in these children is due to the OSA, the persistence post-surgical treatment raises the question whether this is due to mechanisms other than airway obstruction. We are undertaking this study to assess the prevalence and magnitude of hypercapnia in children with OSA before and after surgical treatment by T&A. METHODS: Oobservational study: review of medical charts of all children that had nocturnal polysomnography and children who had a T&A and both pre- and post-operative NPSGs performed from January 2006 through June 2011. Data Analysis Descriptive data analysis will be used to describe both demographic and clinical variables. Unpaired tests (t-tests, Wilcoxon-Mann-Whitney) and contingency tests (Fisher’s, ChiÂ2) will be used to compare differences in clinical parameters after stratification by demographic and other categorical variables. Paired tests (t-tests for parametric continuous data, Wilcoxon signed-rank test for non-parametric data or McNemar’s test for categorical data) will be used to compare differences within a patient before and after T&A. Multivariable regression models and stratified analysis will be used to adjust for potential confounders. Statistical significance will be assumed at p<0.05. All analysis will be performed using STATA (v10, College Station, TX). RESULTS: At this stage preliminary( though limited), data suggests that: i) A majority of patients with obstructive sleep apnea in whom T& A was suggested or recommended, surgery was not performed. ii) In patients who has T&A performed, majority of them did not have a post-op polysomnogram performed. iii) In patients with OSA/hypoventilation, there is persistence of OSA/hypoventilation in a significant number of patients who had undergone T& A and a post op polysomnogram. CONCLUSIONS: Further well designed prospective studies in which all patients who have undergone T&A for obstructive sleep apnea /hypoventilation should have a post surgery polysomnogram performed, in order to prove and confirm this hypothesis should be undertaken. CLINICAL IMPLICATIONS: It is important to identify such a subset, if it does exist, so that an unnecessary physical and financial burden is not placed on these patients. In addition, it may lead to changes in clinical practice to include post-operative NPSGs to identify and prevent serious complication of OSA in these children.