Polysomnography outcomes for partial intracapsular versus total tonsillectomy

Objective

To demonstrate similar improvement in pediatric sleep-disordered breathing (SDB) as determined by polysomnography (PSG) with microdebrider-assisted partial intracapsular tonsillectomy and adenoidectomy (PITA) versus Bovie electrocautery complete tonsillectomy and adenoidectomy (T&A).

Methods

In this retrospective cohort study, 30 children found to have SDB by PSG who have undergone either PITA (15 participants) or T&A (15 participants) as treatment were evaluated with standardized history and physical examination and unattended home overnight PSG.

Results

Median change in apnea-hypopnea index (AHI) was 1.7 (−4.9 to 29.8) for the PITA group and 2.3 (−10.9 to 64.1) for the T&A group, although there was substantially more variability in the T&A group. A mixed linear model evaluating the relation of surgical group with change in AHI demonstrated no significant differences in group means (F[1,13] = 0.31, P = .590) but the variances differed significantly (residual likelihood ratio chi-square = 5.24, df = 1, P = .022). Five of 15 (33%) PITA patients and 4 of 15 (27%) T&A patients had postoperative AHI scores of ≤5; this difference was not statistically significant (Fisher exact test P = 1.000). There was no significant interaction or substantial confounding effect of age, sex, race, preoperative tonsil size, preoperative AHI, or body mass index in the model relating surgery type to reduction of postoperative AHI to ≤5.

Conclusions

Our study demonstrates no clinically or statistically significant differences in PSG and clinical outcomes between PITA and T&A for treatment of pediatric SDB in otherwise healthy children.     

Quality of life after adenotonsillectomy for children with sleep-disordered breathing: A linear mixed model analysis

Objective

To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity.

Materials and methods

Children aged 2–18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model.

Results

In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥6 years vs. <6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring.

Conclusions

Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity.     

Age criteria for polysomnography and inpatient management for adenotonsillectomy

ObjectiveClinical practice guidelines (CPG) by the American Academy of Otolaryngology recommend that children <2yo with sleep disordered breathing (SDB) undergo preoperative polysomnography (PSG) and children <3yo be admitted following adenotonsillectomy (TA) for inpatient management. As the rationale for preoperative PSG and postoperative admission in the CPG are the same, there is an inconsistency in the age recommendations between <2yo and two to three-years-old (2-3yo). This study compared the characteristics of <2yo versus 2-3yo patients undergoing workup and treatment for SDB, with the goal of determining whether 2-3yo should be classified with <2yo.Study designCase series with retrospective review.SettingBoston Medical Center, a tertiary academic hospital.MethodsPatients ≤3yo who underwent PSG 2015 to 2019 were identified using a filter through the electronic medical record. 448 patients underwent PSG. Bivariate analysis via Pearson chi-square test and multivariate analysis via multinomial logistic regression were performed using SPSS.ResultsOf the 427 patients included in this study, 217 patients were in the age group of <2yo while 210 patients were in the age group of 2-3yo. Severity of OSA (p = 0.069) and surgical outcomes (defined by presence or resolution of OSA on follow-up PSG) (p = 0.260) were similar between the two groups. Children <2yo were more likely to have smaller tonsils (p < 0.024) than 2-3yo.ConclusionCharacteristics, such as severity of OSA, were similar between the age groups. Further studies should be conducted to determine if consideration should be taken for routine preoperative PSG children <3yo.Level of evidence: IV.     

Complications of adenotonsillectomy in children with OSAS younger than 2 years of age

The most common sleep disorder in children is obstructive sleep apnea syndrome (OSAS). The majority of children with OSAS improve following tonsillectomy and adenoidectomy (T&A). T&A as an outpatient procedure in children is very common. Young age in considered risk factors for postoperative respiratory complications. The purpose of this study is to analyze our experience with postoperative T&A complications in patients younger than 2 years of age. A total of 39 T&A were performed in children younger than 2 years of age. OSAS diagnosis was confirmed by overnight polysomnography (PSG). All the patients were hospitalized and monitored by overnight pulse oximetry monitoring. Post-operatively there was marked improvement in respiratory function in all the patients comparing pre- and post-operative nadir oxygen saturation (P<0.05). Complications were documented in seven patients (20%). Five of the complications occurred in children older than 1 year of age. Bleeding occurred in two patients (5.7%). Three patients (8.6%) had dehydration, one patient (2.9%) had hypercarbia and one patient had laryngospasm. In this study there was a low incidence of peri- and post- operative respiratory complications in children younger than 2 years of age who undergo T&A for OSAS. Identification of OSAS severity may be an important factor in determining the risk of T&A in a young child.     

Changes of sleep-disordered breathing after laryngeal surgery in patients with bilateral vocal fold paralysis

Snoring is the most obvious symptom of sleep-disordered breathing (SDB). Vibratory sound usually originates from the pharynx; however, in some circumstances, the narrowing of glottic structures can also cause nighttime breathing noise. This clinical study investigated the role of laryngeal obstruction in patients with SDB. Nine female patients with paralysis of bilateral vocal folds were enrolled in this study. All the patients received unilateral laser arytenoidectomy as the only treatment. Nocturnal polysomnography (PSG) was performed at baseline and 6 months after the operation. Parameters of PSG including the respiratory disturbance index (RDI) and snoring index (SI) were recorded, as well as the subjective Epworth Sleepiness Scale (ESS). Before surgery, six patients (66.6%) were identified as having obstructive sleep apnea (OSA, RDI>5). After the operation, the SI improved significantly (P=0.02). The RDI (P=0.07) and ESS (P=0.11) showed no significant improvement. The success rate of surgery in OSA patients was 66% (4/6) according to the criteria of a greater than 50% reduction of the preoperative RDI and less than 20 events per hour. The mechanism, outcomes and causes of failure are discussed in this unusual larynx-related SDB.     

Comparison of treatment modalities in syndromic children with Obstructive Sleep Apnea—A randomized cohort study

Introduction

Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention.

Objective

To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA).

Materials and methods

In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year.

Observation and results

Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year.

Conclusion

On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children.     

Is day stay adenotonsillectomy safe in children with mild to moderate obstructive sleep apnoea? A retrospective review of 100 patients

Objective

This study explored the perioperative course of 100 children with polysomnogram (PSG) proven mild to moderate OSA to evaluate if day stay adenotonsillectomy is safe.

Methods

A retrospective chart review of patients who had undergone tonsillectomy with or without adenoidectomy following an overnight PSG at The Children's Hospital at Westmead Sleep Laboratory. 263 records were reviewed. Patients with apnoea hypopnea index (AHI) ≥1 and <15/h and/or a final sleep study report of mild to moderate OSA were included. Exclusion criteria were age <3 years, weight <10 kg, or any significant co-morbidities or other surgery that would preclude day stay surgery. Demographic, PSG and post-operative data was analyzed.

Results

No major respiratory complications occurred. No patient required an unplanned medical review for respiratory concerns, or admission to a high care facility. Eleven children left recovery with oxygen prescribed. One child had a desaturation to 88% in recovery, and one child had laryngospasm. The nine other children required oxygen to maintain saturation >90%.Supplemental oxygen was prescribed to 7 patients on the ward. Of these, three patients received supplemental oxygen beyond 6 h. The other 97 patients had an uncomplicated post-operative course and would have been suitable for day-stay surgery. Increasing severity of OSA grade on pre-operative PSG was significantly associated with post-operative supplemental oxygen use (p = 0.003; Cochrane-Armitage test for trend).

Conclusions

Children who are otherwise well with mild to moderate OSA have a sufficiently low risk of respiratory complications following adenotonsillectomy to permit day-stay surgery in the setting of appropriate facilities with careful post-operative monitoring for the first 6 h to identify a small sub-group who require overnight observations.     

Tonsillectomies and respiratory complications in children: A look at pre-op polysomnography risk factors and post-op admissions

ObjectiveTo identify predictors of post-operative respiratory complications in children undergoing tonsillectomy.MethodsConsecutive case series with chart review of children who underwent polysomnography (PSG) and subsequent tonsillectomy with or without adenoidectomy for obstructive sleep apnea (OSA). Patients with craniofacial anomalies or significant cardiopulmonary comorbidities were excluded. Rates of post-surgical respiratory complication were reviewed and compared to patient specific factors and PSG findings to identify possible risk factors.ResultsEighty-six patients (mean age 5.3 ± 2.2 years) were included. There was a statistically significant (p = 0.03) relationship between an AHI ≥40 (AHI40) and post-operative respiratory complications. AHI40 also had the greatest magnitude of association with postoperative respiratory complications (OR = 5.313). An AHI ≥25 (AHI25) was marginally significant (p = 0.067). No significant difference in outcome occurrence was found when analyzing rates of complication in patients with BMI above and below 18 (p = 0.20) or oxygen (O2) nadir above and below 80% (p = 0.09). The AHI ranged from 0 to 112.2, and no postoperative respiratory complications were identified in children with an AHI less than 10.ConclusionsOur results indicate an association between an AHI ≥40 and respiratory complications following an adenotonsillectomy, but we were not able to observe any significant difference at a cutoff of 25. An association between BMI or O2 nadir and postoperative respiratory complication was not able to be identified. Our results support the importance of AHI as a predictor of postoperative respiratory complications in children undergoing tonsillectomy for OSA.     

The safety of preoperative sedation in children with sleep-disordered breathing

OBJECTIVE: To prospectively monitor children who received preoperative sedation with midazolam hydrochloride prior to adenotonsillectomy (T&A) for treatment of sleep-disordered breathing with continuous pulse-oximetry to detect potential respiratory compromise. DESIGN: Prospective, observational study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Seventy children, aged 1-12 years, diagnosed with sleep-disordered breathing by clinical evaluation or polysomnography (PSG), with a median RDI of 14.25, undergoing T&A. METHODS: Children underwent a standardized anesthesia protocol including preoperative oral midazolam hydrochloride 0.5mg/kg, standard American Society of Anesthesiologists (ASA) monitoring, mask induction with sevoflurane, muscle relaxant with reversal if indicated, and intravenous dexamethasone sodium phosphate 0.5mg/kg. Children were monitored in the hospital until discharge criteria were met. Selected children with severe OSA were monitored overnight on the pediatric floor or the pediatric intensive care unit. Adverse respiratory events were defined as upper airway obstruction, hypoventilation, desaturation, bradycardia, or sustained lethargy. MAIN OUTCOME MEASURES: Incidence of pre and postoperative obstructive complications. RESULTS: During the study period only two patients (2.9%) had a measurable adverse event directly related to the administration of the sedation. CONCLUSION: Based on sporadic reports of adverse airway events in children with obstructive sleep apnea receiving sedation, these children frequently do not receive preoperative sedation. Given the low morbidity of preoperative sedation in our population, many children with sleep-disordered breathing may safely be pre-medicated.     

The effect of adenotonsillectomy on obstructive sleep apnea in children with Down syndrome*

Objective: Children with Down syndrome (DS) are liable to develop obstructive sleep apnea (OSA) due to many anatomical airway abnormalities. The tonsils and adenoid occupy part of the airway space, and their removal may be helpful in relieving airway obstruction. The aim of this study was to assess the effectiveness of adenotonsillectomy in the treatment of OSA in those children.

Methods: Fifty DS children with difficult breathing were recruited, and they were subjected to polysomnographic examination (PSG). Patients with apnea-hypopnea index (AHI)?>?1 were considered to have OSA. Adenotonsillectomy was performed for patients who had OSA and adenotonsillar hypertrophy, and after 3 months PSG was done for them with recording of the same preoperative parameters.

Results: Forty-three children demonstrated OSA on PSG, and they were included in the study. The preoperative mean AHI was 9.18 (±?6.17) that improved postoperatively to 2.72 (±?3.80) with its normalization in 72% of patients. Also, significant improvement of arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO₂ was achieved postoperatively.

Conclusion: Adenotonsillectomy is an effective method for the treatment of OSA in children with DS. However, the condition may persist in some children who usually have airway narrowing at multiple levels.     

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

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.     

Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing

Objective

The aim of this study was to determine the changes in insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-3 (IGFBP-3) and ghrelin levels following adenotonsillectomy (T&A) in children with sleep disordered breathing (SDB).

Methods

Forty children (mean age 4.85 ± 2.15 years) clinically diagnosed with adenotonsillar hypertrophy (ATH) related SDB were enrolled. All children underwent T&A. Serum levels of IGF-I, IGFBP-3 and ghrelin were measured before and 6 months after T&A.

Results

Serum levels of IGF-I and IGFBP-3 were significantly higher after T&A (p < 0.001). Serum ghrelin levels showed a significant decrease after T&A (p < 0.001).

Conclusion

Children with ATH related SDB who underwent T&A showed significant increases in IGF-I and IGFBP-3 levels indicating an increase in diurnal growth hormone secretion as well as a significant decrese in ghrelin levels indicating an increased oral food intake in the postoperative period.     

Recurrent aspiration pneumonia precipitated by obstructive sleep apnea

ObjectiveThe clearance of the pharynx by deglutition and the respiratory phase patterns associated with deglutition are important in protecting airways and lungs against aspiration. The deglutition and respiratory phase patterns during sleep in patients (without swallowing disorders while awake) with obstructive sleep apnea (OSA) precipitating recurrent intractable aspiration pneumonia were investigated.MethodsAfter videoendoscopic and videofluorographic examinations of swallowing showed subjects had no swallowing disorders while awake, two adults with recurrent intractable aspiration pneumonia precipitated by severe OSA were examined via time-matched digital recordings of polysomnography and surface electromyography of the muscles (thyrohyoid and suprahyoid muscles) related to swallowing and compared with the same patients before and under CPAP therapy.ResultsCPAP therapy cured recurrent intractable aspiration pneumonia. Swallows following and/or followed by inspiration (uncoordinated deglutition with respiration), which were frequently observed before CPAP therapy, were markedly reduced under CPAP therapy. On the other hand, swallows following and/or followed by expiration (coordinated deglutition with respiration) markedly increased under CPAP therapy. Deglutition was related to the sleep stage. The deeper the sleep stage, the lower the deglutition frequency. Before and under CPAP therapy, swallowing was infrequent and absent for long periods. However, respiratory phase patterns associated with sleep-related deglutition in patients with OSA under CPAP therapy markedly improved.ConclusionsIn patients (without swallowing disorders while awake) with OSA precipitating recurrent intractable aspiration pneumonia, the high rate of uncoordinated deglutition with respiration (swallows following and/or followed by inspiration) during sleep were markedly reduced and the rate of coordinated deglutition with respiration (swallows following and/or followed by expiration) was markedly increased under CPAP therapy.Sleep-related deglutition and respiratory phase patterns are likely to adversely influence aspiration pneumonia in patients with OSA. CPAP therapy improved not only apnea-hypopnea during sleep and sleep quality but also sleep-related deglutition, especially respiratory phase patterns associated with deglutition in patients with OSA. CPAP therapy may decrease the risk of aspiration and greatly improve aspiration-related diseases such as aspiration pneumonia.     

Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea

Objective It has been hypothesized that nasal obstruction causes an increase in negative pressure in the upper airway and induces an inspiratory collapse at the pharyngeal level. We used portable polysomnography (PSG) to assess the efficacy of nasal surgery for snoring and obstructive sleep apnea (OSA).

Material and Methods We reviewed 21 patients who presented with nasal obstruction and snoring. Septal surgery with or without inferior turbinectomy was performed. Each patient was assessed pre- and postoperatively using PSG. We measured the respiratory distress index (RDI), apnea index (AI), oxygen saturation index (OSI) and the duration of snoring. Selection criteria were an RDI of >15 as determined by PSG and clinical nasal obstruction and a deviated nasal septum as determined by physical examination.

Results Nasal surgery had the following effects: RDI decreased from 39 to 29 (p=0.0001), AI decreased from 19 to 16 (p=0.0209), OSI decreased from 48 to 32 (p=0.0001) and the duration of snoring decreased from 44% to 39% (p=0.1595). Snoring and OSA were completely relieved in 4 patients (19%) who did not require any additional surgical therapy.

Conclusion Snoring and OSA may be corrected merely by septal surgery in some patients, and secondary surgery (uvulopalatoplasty) may be considered after a thorough evaluation by means of postoperative PSG.     

Palatopharyngeal muscle suspension suture technique for patients with obstructive sleep apnea

PurposePalatal surgery remains a major option for patients with obstructive sleep apnea (OSA). We sought to evaluate the therapeutic outcomes of the palatopharyngeal muscle suspension suture technique (PSST) as a novel palatal surgery for patients with OSA.Materials and methodsOf the 816 patients who underwent polysomnography (PSG) from February 1, 2017, to June 30, 2020, 30 patients with OSA who underwent PSST were retrospectively reviewed. The medical records of the patients were also recorded. Among the 30 patients with OSA, nine who underwent preoperative and postoperative PSG were analyzed.ResultsOf the 30 patients with OSA, 28 (93.3 %) were male. The mean (SD, standard deviation) age was 43.3 (12.7) years, and the mean (SD) body mass index was 27.3 (3.2). As objective parameters, the mean (SD) apnea-hypopnea index was significantly decreased from 45.9 (21.20) to 29.03 (21.62) (p < 0.05) and the mean (SD) lowest oxygen saturation improved significantly from 77.6 % (7.14 %) to 84.6 (5.17 %) (p < 0.05). As a subjective parameter, the mean (SD) Epworth Sleepiness Scale score decreased significantly from 10 (4.95) to 6.9 (4.57) (p < 0.05), and the mean (SD) visual analog scale score for snoring decreased significantly from 6.3 (1.8) to 3.1 (1.9) (p < 0.001). No complications, such as upper airway obstruction, intractable postoperative bleeding, or velopharyngeal insufficiency, were observed in any of the patients postoperatively.ConclusionsA novel palatal surgery, PSST, has numerous advantages as a useful surgical option for patients with OSA. It is minimally invasive, easy, time-saving, and relatively reversible.     

Diagnosis of obstructive sleep apnea in children based on the XGBoost algorithm using nocturnal heart rate and blood oxygen feature

PurposeObstructive sleep apnea (OSA) is a serious type of obstructive sleep-disordered breathing (SDB) that can cause a series of adverse effects on children's cardiovascular, growth, cognition, etc. The gold standard for diagnosis is polysomnography (PGS), which is used to assess the prevalence of OSA by obtaining the apnea-hypopnea index (AHI), but this diagnosis method is expensive and needs to be performed in a specialized laboratory, making it difficult to be of benefit to children with suspected OSA on a large scale. Our goal was to use a machine learning method to identify children with OSA of varying severity using data on children's nighttime heart rate and blood oxygen data.MethodsThis study included 3139 children who received diagnostic PSG with suspected OSA. Age, sex, BMI, 3 % oxygen depletion index (ODI), average nighttime heart rate and fastest heart rate were used as predictive features. Data sets were established with AHI ≥ 1, AHI ≥ 5, and AHI ≥ 10 as the diagnostic criteria for mild, moderate and severe OSA, and the samples of each data set were randomly divided into a training set and a test set at a ratio of 8:2. An OSA diagnostic model was established based on the XGBoost algorithm, and the ability of the machine learning model to diagnose OSA children with different severities was evaluated through different classification ability evaluation indicators. As a comparison, traditional classifier Logistic Regression was used to perform the same diagnostic task. The SHAP algorithm was used to evaluate the role of these features in the classification task.ResultsWe established a diagnostic model of OSA in children based on the XGBoost algorithm. On the test set, the AUCs of the model for diagnosing mild, moderate, and severe OSA were 0.95, 0.88, and 0.88, respectively, and the classification accuracy was 90.45 %, 85.67 %, and 89.81 %, respectively, perform better than Logistic Regression classifiers. ODI is the most important feature in all classification tasks, and a higher fastest heart rate and ODI make the model tend to classify samples as positive. A high BMI value caused the model to tend to classify samples as positive in the mild and moderate classification tasks and as negative in the classification task with severe OSA.ConclusionUsing heart rate and blood oxygen data as the main features, a machine learning diagnostic model based on the XGBoost algorithm can accurately identify children with OSA at different severities. This diagnostic modality reduces the number of signals and the complexity of the diagnostic process compared to PSG, which could benefit children with suspected OSA who do not have the opportunity to receive a diagnostic PSG and provide a diagnostic priority reference for children awaiting a diagnostic PSG.     

The influence of sex on anthropometric methods and four scales for screening obstructive sleep apnea

ObjectivesObstructive Sleep Apnea (OSA) is a kind of respiratory disease that occurs apnea repeatedly during sleep. The purpose of this study was to investigate the influence of sex on anthropometric methods and four scales for screening OSA.MethodsThe basic data and PSG data of 2108 patients who underwent PSG examination at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from July 2017 to December 2020 were continuously included. Then the sensitivity, specificity, positive predictive value, negative predictive value, AUC and DOR of the anthropometric method and the four scales were calculated.Results2108 OSA patients were enrolled from the Sleep Medicine Center, including 1644 males (78.0%). The average neck circumference and waist circumference of male and female patients were respectively (39.4±3.4) cm and (96.7±13.8) cm,(34.6±3.5) cm and (90.1±11.6) cm. In female patients. the AUC of NoSAS was the largest. When AHI was 5, 15, and 30 evens/h as the cut-off point, in male patients, the sensitivity of NHR was the highest,in female patients, the sensitivity of WHR was the highest.ConclusionsNHR and WHR are good tools for screening OSA in male and female patients respectively. They are worthy of promotion.     

Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down Syndrome and obstructive sleep apnea?

Abstract

Background: Children with Down Syndrome (DS) and obstructive sleep apnea (OSA) are difficult to treat, as first line therapies may not lead to significant improvement. Drug-induced sleep endoscopy (DISE) directed surgery may be particularly beneficial for these patients.

Objective: To assess change in polysomnography (PSG) measures of patients with DS who underwent DISE-directed surgery.

Methods: Retrospective chart review was performed on patients with DS who underwent DISE-directed surgery and had pre- and post-surgery PSG. Patients were analyzed in groups defined by previous adenotonsillectomy. Two-sided t-tests with equal variances were used to assess statistical significance.

Results: Of 24 patients reviewed, 14 were surgically naïve and 10 had undergone prior adenotonsillectomy. The primary outcome was change in PSG parameters including apnea hypopnea index, obstructive apnea hypopnea index, oxygen nadir, oxygen desaturation index, and mean carbon dioxide level. While improvement was seen in all PSG parameters, only improvement in oxygen nadir in children who had undergone prior adenotonsillectomy was statistically significant (88.5% to 90.9%, p?=?.04).

Conclusions and Significance: DISE-directed surgery may be beneficial for children with DS and OSA, with improvement in the means of main PSG measures observed. A larger, prospective study is warranted to further explore DISE utility.     

Assessing outcomes after partial and total tonsillectomy for sleep-disordered breathing in children using Clinical Assessment Score-15

IntroductionThe Clinical Assessment Score-15 (CAS-15) is an office-based tool for assessing the risk of sleep disordered breathing (SDB), a relatively common condition in the pediatric population. Change in CAS-15 following total tonsillectomy (TT) has been shown to have a large effect size, but it is unclear how it varies following partial intracapsular tonsillectomy (PIT). Thus, the objective of the present study is to evaluate the utility of the CAS-15 score in assessing the effectiveness of PIT and how this compares to change after TT.Material methodsChildren ages 2–18 undergoing PIT (N = 16) or TT (N = 8) with or without adenoidectomy for SDB completed the CAS-15 before surgery and at their post-operative follow-up visit. Changes in CAS-15 score were assessed by paired t-test. The mean difference in CAS-15 change between PIT and TT was evaluated by unpaired t-test for unequal variances. Differences in participant characteristics were determined via unpaired t-test for unequal variances.ResultsParticipants undergoing PIT did not differ significantly than those undergoing TT with regard to age, sex, BMI percentile, pre-op CAS-15 score or tonsil size, or admission rates following surgery (p > 0.05). The median follow-up after surgery was 5.2 (PIT) and 4.4 (TT) weeks. CAS-15 score improved significantly following PIT (42.8 ± 12.3 vs. 9.4 ± 5.6, p < 0.0001) and TT (45.5 ± 13.3 vs. 7.9 ± 5.8, p < 0.0002). The decrease in CAS-15 for PIT did not differ from TT (33.3 ± 11.8 vs. 37.6 ± 15.0, p > 0.49).DiscussionCAS-15 decreases drastically following PIT and TT, indicating significant improvement of SDB symptoms. Because the change in CAS-15 after PIT was similar to TT, PIT may be preferred due to the decreased morbidity of the procedure. Given the cost, time required, inconvenience, and other limitations of overnight polysomnography (PSG), which is the gold standard method of diagnosing SDB, CAS-15 may be a suitable replacement or adjunct for the assessment of SDB following PIT in addition to TT.