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

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


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.

MeSH terms

  • Adenoidectomy / adverse effects*
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Polysomnography / methods*
  • Postoperative Complications
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / etiology
  • Surveys and Questionnaires
  • Tonsillectomy / adverse effects*