Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy

Pediatr Pulmonol. 2019 Nov;54(11):1670-1675. doi: 10.1002/ppul.24469. Epub 2019 Aug 2.


Background: Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed.

Methods: We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change.

Results: Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed.

Conclusion: The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.

Keywords: adenotonsillectomy; central sleep apnea; obstructive sleep apnea syndrome; sleep medicine.

MeSH terms

  • Adenoidectomy*
  • Adolescent
  • Airway Obstruction / surgery
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Polysomnography
  • Retrospective Studies
  • Sleep Apnea, Central / complications
  • Sleep Apnea, Central / diagnosis
  • Sleep Apnea, Central / surgery*
  • Sleep Apnea, Obstructive / complications
  • Tonsillectomy*