What is the postsurgical prognosis of childhood obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Answer

Surgical treatment of severe obstructive sleep apnea warrants an overnight observation, especially if the child is younger than 3 years or has concomitant cardiopulmonary disease, morbid obesity, hypotonia, or craniofacial anomalies.

The major determinants of surgical outcome include the apnea hypopnea index (AHI) and obesity at the time of diagnosis. The AHI is the total number of apneas and hypopneas that occur divided by the total duration of sleep in hours. An AHI of 1 or less is considered to be normal by pediatric standards. An AHI of 1-5 is very mildly increased, 5-10 is mildly increased, 10-20 is moderately increased, and greater than 20 is severely abnormal.

In children with enlarged tonsils and adenoids that lead to obstructive sleep apnea, an adenotonsillectomy usually results in complete cure, although no definitive studies have clearly demonstrated this issue.

The outcome of patients who require extensive surgical management obviously depends on the severity of the condition that leads to upper airway compromise. With the emergence of noninvasive ventilation as an alternative option for these children, upper airway obstruction during sleep can be conservatively and successfully managed in most children.

In children with failure to thrive (FTT), treatment of obstructive sleep apnea leads to resolution of the somatic growth disturbance. Similarly, pulmonary hypertension resolves. Although major improvements in neurobehavioral outcomes are expected, data are currently insufficient to support a complete recovery in some of the cognitive abilities affected by obstructive sleep apnea.

Tauman et al reported that only 25% of children treated for obstructive sleep apnea with adenotonsillectomy had complete postoperative normalization of symptoms. [6]


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