Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA

Abstract

IMPORTANCEEarly intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life.OBJECTIVE To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI Ն1) were recruited. Data analysis was performed from March to July 2021.EXPOSURES All participants underwent CBCT and PSG before and after adenotonsillectomy. MAIN OUTCOMES AND MEASURESChanges in PSG and CBCT parameters after adenotonsillectomy were analyzed.RESULTS A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, −10.24 events per hour; 95% CI, −13.84 to −6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm 3 ; mean difference, 3896.6 mm 3 ; 95% CI, 2788.0 to 5005.2 mm 3 ), nasopharyngeal volume (from 2366 to 3826 mm 3 ; mean difference, 1459.7 mm 3 ; 95% CI, 1122.9 to 1796.5 mm 3 ), minimal nasopharyngeal airway area (from 128 to 191 mm 2 ; mean difference, 63.1 mm 2 ; 95% CI, 47.4 to 78.8 mm 2 ), mean nasopharyngeal airway area (from 144 to 231 mm 2 ; mean difference, 86.8 mm 2 ; 95% CI, 67.0 to 106.5 mm 2 ), oropharyngeal volume (from 8898 to 11 335 mm 3 ; mean difference, 2436.9 mm 3 ; 95% CI, 1477.0 to 3396.8 mm 3 ), minimal oropharyngeal airway area (from 82 to 158 mm 2 ; mean difference, 76.2 mm 2 ; 95% CI, 57.0 to 95.4 mm 2 ), and mean oropharyngeal airway area (from 182 to 234 mm 2 ; mean difference, 52.5 mm 2 ; 95% CI, 33.6 to 71.4 mm 2 ). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI Ն1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI.CONCLUSIONS AND RELEVANCE These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

Computational fluid dynamics study in children with obstructive sleep apnea

“…The CBCT was obtained using i-CAT ® imaging system (Imaging Sciences International, LLC, 1910 N Penn Road, Hatfield, PA 19440) at National XX University Hospital. 14,18 Before entering the CBCT chamber, children sit upright holding their heads still onto the chin supporter wearing lead suits with thyroid shields. The upper airway protocol applied was 120 kV, 5 mA, 0.25-mm voxel size, for a scanning time of 20 seconds.…”

“…The authors thank the technical support of the Soteria Biotech in computational fluid dynamics simulation and the Staff of the Center of Sleep Disorder, National Taiwan University Hospital for their support in sleep studies. Parts of children in this study are derived from our previous study (see references [14,18]). We are grateful for the cooperation and participation of all of the children and their parents.…”

Pediatric pulmonology year in review 2022: Sleep medicine

“…CBCT has several advantages over MRI in terms of time efficiency and low radiation exposure. Moreover, it can be used to assess response to treatment after the use of maxillomandibular advancement or dental appliances, and it provides a 3D view of the airway structures, which may be more useful than classic craniofacial analysis, which is only 2D 33 …”

“…32 Cone-beam computed tomography (CBCT) is an alternative imaging approach for airway measurement. Liu et al 33 conducted a prospective study to investigate changes in CBCT parameters before and after adenotonsillectomy, as well as their association with reduction in AHI. They found that although large changes in CBCT were measured after the procedure, only the minimal airway area of the oropharynx and total airway volume were associated with AHI reduction.…”

Clinical Characteristics Combined with Craniofacial Photographic Analysis in Children with Obstructive Sleep Apnea

“…In children, lymphoid tissue hyperplasia is the most common anatomical abnormality associated with OSA, and adenotonsillectomy is an effective treatment for reducing upper airway collapse. 5 Some patients show incomplete or worsening resolution after surgical intervention. 6 , 7 Upper airway volume in children undergoes dynamic changes due to the inter-reactions of maxillofacial growth, fat deposition, lymphoid tissue hyperplasia, and respiratory patterns.…”