Adenotonsillectomy Is Likely to Resolve Central Sleep Apnea in Most Children with OSA

by Linda Kossoff •

Does central sleep apnea (CSA) improve following adenotonsillectomy (T&A) performed for obstructive sleep apnea (OSA) in children, and what factors are associated with improvement?

BOTTOM LINE

Adenotonsillectomy appears to lead to CSA resolution in most children with OSA.

BACKGROUND: Sleep-disordered breathing can be obstructive, central, or both. In children undergoing T&A for OSA, studies have shown improvement in CSA, too. Although OSA is known to lead to arousals and central apneas are known to occur following arousals, no study has identified factors associated with CSA improvement following T&A.

STUDY DESIGN: Retrospective study.

SETTING: University of Chicago Pritzker School of Medicine, Chicago.

SYNOPSIS: Researchers identified 123 children undergoing primary T&A between 1994 and 2020 for OSA (obstructive apnea–hypopnea index >1) with CSA (central apnea index [CAI] >1). All patients received pre- and postoperative polysomnograms (PSG) within 12 months of T&A. Of the 123 patients, 58.5% were overweight/obese and 15.4% had a syndromic condition. Following surgery, overall CAI significantly decreased (preoperative 2.1, postoperative 0.4); 26.0% of patients still had CSA postoperatively. Preoperative CAI was >5 in 17.1% of patients; postoperatively, 62% of these patients had no residual CSA and 29% had mild CSA, suggesting that severe CSA in the context of OSA is most often not indicative of a neurologic abnormality and is likely to resolve following T&A. Increased age was significantly associated with CSA improvement, indicating that younger children are more likely to have physiologic central apneas not due to the post-arousal effect of obstructive apneas. Authors conclude that, although relatively uncommon, CSA persistence following T&A should warrant further investigation into a central nervous system cause of apneas. Study limitations included lack of follow-up PSG for many patients and the homogenous nature of the population studied.

CITATION: Judd RT, Mokhlesi B, Shogan A, et al. Improvement in central sleep apnea following adenotonsillectomy in children. Laryngoscope. 2022;132;478-484.