Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea

Aliva De, Temima Waltuch, Nathan J. Gonik, Ngoc Nguyen-Famulare, Hiren Muzumdar, John P. Bent, Carmen R. Isasi, Sanghun Sin, Raanan Arens

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

Original languageEnglish (US)
Pages (from-to)805-811
Number of pages7
JournalJournal of Clinical Sleep Medicine
Volume13
Issue number6
DOIs
StatePublished - 2017

Fingerprint

Obstructive Sleep Apnea
Sleep
Respiration
Polysomnography
Apnea
Nonparametric Statistics
Pediatric Hospitals
REM Sleep
Arousal
Tertiary Care Centers
Hypertrophy
Analgesics
Anesthetics
Demography
Prospective Studies

Keywords

  • Adenotonsillar hypertrophy
  • Adenotonsillectomy
  • Children
  • Obese
  • Obstructive sleep apnea
  • OSA

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea. / De, Aliva; Waltuch, Temima; Gonik, Nathan J.; Nguyen-Famulare, Ngoc; Muzumdar, Hiren; Bent, John P.; Isasi, Carmen R.; Sin, Sanghun; Arens, Raanan.

In: Journal of Clinical Sleep Medicine, Vol. 13, No. 6, 2017, p. 805-811.

Research output: Contribution to journalArticle

@article{f23cc76e30584ea2b64fbd701e3f4929,
title = "Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea",
abstract = "Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9{\%}, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85{\%} of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7{\%} (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.",
keywords = "Adenotonsillar hypertrophy, Adenotonsillectomy, Children, Obese, Obstructive sleep apnea, OSA",
author = "Aliva De and Temima Waltuch and Gonik, {Nathan J.} and Ngoc Nguyen-Famulare and Hiren Muzumdar and Bent, {John P.} and Isasi, {Carmen R.} and Sanghun Sin and Raanan Arens",
year = "2017",
doi = "10.5664/jcsm.6620",
language = "English (US)",
volume = "13",
pages = "805--811",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "6",

}

TY - JOUR

T1 - Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea

AU - De, Aliva

AU - Waltuch, Temima

AU - Gonik, Nathan J.

AU - Nguyen-Famulare, Ngoc

AU - Muzumdar, Hiren

AU - Bent, John P.

AU - Isasi, Carmen R.

AU - Sin, Sanghun

AU - Arens, Raanan

PY - 2017

Y1 - 2017

N2 - Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

AB - Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

KW - Adenotonsillar hypertrophy

KW - Adenotonsillectomy

KW - Children

KW - Obese

KW - Obstructive sleep apnea

KW - OSA

UR - http://www.scopus.com/inward/record.url?scp=85020518935&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020518935&partnerID=8YFLogxK

U2 - 10.5664/jcsm.6620

DO - 10.5664/jcsm.6620

M3 - Article

VL - 13

SP - 805

EP - 811

JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

SN - 1550-9389

IS - 6

ER -