Improvement in Central Sleep Apnea Following Adenotonsillectomy in Children

Abstract

Objective: Previous studies examining changes in central sleep apnea (CSA) following adenotonsillectomy (T&A) performed for obstructive sleep apnea (OSA) in children have been limited by sample size and analysis of only certain populations. The aim of this study was to determine whether CSA improves following T&A and what factors mediate this change.Methods: This was a retrospective case series from 1994 to 2020 of children undergoing primary T&A for OSA (obstructive apnea-hypopnea index ≥1) with CSA (central apnea index [CAI] ≥1) and preoperative and postoperative polysomnograms within 12 months of T&A. Polysomnograms were analyzed for improvement in CSA, defined as: 1) if preoperative CAI >5, a postoperative CAI <5; or 2) if preoperative CAI <5, a postoperative CAI <1.Results: One hundred twenty-three patients were included. Median age was 5.5 years (interquartile range, 2.9-8.4). Most patients were overweight/obese (58.5%). Nineteen (15.4%) had a syndromic condition. Preoperative CAI was ≥5 in 21 (17.1%) patients. CAI significantly decreased following T&A (preoperative 2.1, postoperative 0.4; P < .001). Thirty-two (26.0%) patients had CSA postoperatively. Improvement in the microarousal index and older age were significantly associated with improvement in CSA.Conclusions: T&A led to resolution of CSA in most children with OSA. Improvement in the microarousal index was associated with improvement in CAI, suggesting that preoperative central apneas may be postarousal and thus resolve following T&A.

Multidimensional symptoms and comprehensive diagnosis of pediatric narcolepsy combined with sleep apnea and two years follow-up: a case report

“…Typically, unstable respiratory control will cause the patient's body to gradually establish a new, higher PaCO 2 setting during sleep, with relative hypercapnia, leading to awakening after hyperventilation. However, as the patient returns to sleep and ventilation during awakening causes PaCO 2 to fall below the apnea threshold, central sleep apnea occurs, which is the cause of most central events in patients with OSA 20 .…”

Assessment of Central Sleep Apnea Events in Children with Sleep-Disordered Breathing

“…The PSG criteria used to define CSA influence the rate of CSA. Conventionally, a CAI equal or greater than 1 event/hr is used to define CSA; however, a CAI ≥ 5/h has been suggested to define CSA as healthy children who had CAI ≤ 6 h in previous studies [ 8 , 9 ]. The optimum CAI threshold needs to be determined to better identify clinically significant CSA in children with SDB.…”

The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

“…The studies were conducted in the United State 15,16,22,28,29 , Japan 30 , Belgium 31 , Brazil 32 , Spain 33 , Germany 34 , and Sweden 35 . There were 6 retrospective studies 14,15,20,29,30,32 , 2 prospective cohort studies 28, 34 , 2 case series 16,22 , and 1 randomized control trial 35 . The postoperative evaluation of PSG ranged from 1 day to 108 months.…”

“…Numerous underlying medical disorders, including brain defects such as Chiari malformation, Prader-Willi syndrome, Down syndrome, gastroesophageal re ux disease (GERD), obesity, and hypothyroidism, can be linked to this condition. However, CAI is frequently found to be higher in pediatric patients with OSA compared to healthy children 13,14 as shown by its prevalence of 14.9-16.9% using criteria of CAI ≥ 1 event/h 15, 16 , and prevalence of 3.3-5.4% using criteria of CAI ≥ 5 events/h 12, 15 . This factor may be contributing to the higher incidence of respiratory complications after airway surgery in patients with OSA compared to healthy children 13 .…”