Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children: A single-center retrospective cohort study.

OBJECTIVE

Adenotonsillectomy (T&A) is the first-line treatment for pediatric obstructive sleep apnea (OSA). However, a significant proportion of children, particularly those with specific phenotypes, exhibit residual OSA postoperatively. Identifying preoperative risk factors for residual disease is crucial for managing parental expectations and planning postoperative care.

METHODS

This single-center retrospective study included children (aged 3-14 years) who underwent T&A for OSA between January 2018 and December 2024. All patients had complete preoperative and postoperative (6-12 months) polysomnography (PSG) data. Residual OSA was defined as a postoperative obstructive apnea-hypopnea index (AHI) ≥ 2 events/h. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

RESULTS

A total of 642 children were included. The overall prevalence of residual OSA was 26.8% (172/642). The multivariate analysis identified three independent risk factors: obesity (BMI ≥ 95th percentile) [Odds Ratio (OR) 3.12, 95% CI 1.85-5.26], severe baseline AHI (OR 1.08 per unit increase, 95% CI 1.05-1.11), and concurrent asthma (OR 1.95, 95% CI 1.12-3.40). The multivariate risk assessment demonstrated good discrimination with an area under the curve (AUC) of 0.82 (95% CI 0.78-0.86).

CONCLUSION

Residual OSA is common after T&A, affecting approximately one-quarter of the pediatric population. Obesity, disease severity, and comorbid asthma are robust risk factors of incomplete resolution. Preoperative counseling and planned postoperative PSG surveillance are essential for these high-risk groups.