Respiratory events after adenotonsillectomy in children with severe obstructive sleep apnea (OSA): A prospective exploratory study.

BACKGROUND

Children with severe obstructive sleep apnea (OSA) are at high risk for respiratory complications following adenotonsillectomy, necessitating overnight observation. We assessed the feasibility of noninvasive respiratory volume monitoring in the postoperative period to predict low minute ventilation (MV) and respiratory events on the first postoperative night.

METHODS

We conducted a prospective observational exploratory study of children under 18 years of age with severe OSA undergoing adenotonsillectomy with planned postoperative admission. The primary outcome was the occurrence of low MV events on the ward, defined as predicted MV < 40% for at least 2 min, measured using a noninvasive respiratory volume monitor (RVM).

RESULTS

We enrolled 60 children (77% male, median age 6 [4.5] years, 55% non-white, 55% Hispanic, median apnea-hypopnea index 31 [33] events per hour). The RVM sensor was not tolerated overnight in only 5 patients (8%). Low MV events occurred in 33% (19/58) in the postanesthesia care unit (PACU) and 62% (34/55) on the ward. Patients who had PACU events were more likely to have ward events (odds ratio [OR] 4.26; 95% CI 0.98-18.55). Increasing age increased ward events (OR 1.25 per year; 95% CI 1.02-1.52) while history of asthma was protective (OR 0.15; 95% CI 0.02-0.87).

CONCLUSIONS

This exploratory study suggests that PACU low MV events may predict subsequent events on the ward in children with severe OSA undergoing adenotonsillectomy. The RVM demonstrated good feasibility and should be tested in future studies to predict ventilatory derangements on the first postoperative night.