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Persistent respiratory effort after adenotonsillectomy in children with sleep‐disordered breathing
Author(s) -
Martinot JeanBenoît,
LeDong N. Nam,
Denison Stéphane,
Guénard Hervé JeanPierre,
Borel JeanChristian,
Silkoff Philip E.,
Pepin JeanLouis,
Gozal David
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26830
Subject(s) - medicine , polysomnography , sleep disordered breathing , tonsillectomy , apnea–hypopnea index , apnea , airway obstruction , adenoidectomy , breathing , prospective cohort study , anesthesia , obstructive sleep apnea , pediatrics , airway
Objectives Adenotonsillectomy (AT) markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep‐disordered breathing (SDB). Adenotonsillectomy efficacy should be evaluated by follow‐up polysomnography (PSG), but this method may underestimate persistent respiratory effort (RE). Mandibular movement (MMas) monitoring is an innovative measurement that readily identifies RE during upper airway obstruction. We hypothesized that MMas indices would decrease in parallel of PSG indices and that children with persistent RE more reliably could be identified with MMas. Methods Twenty‐five children (3–12 years of age) with SDB were enrolled in this individual prospective‐cohort study. Polysomnography was supplemented with a midsagittal movement magnetic sensor that measured MMas during each respiratory cycle before and > 3 months after AT. Results Adenotonsillectomy significantly improved PSG indices, except for RE‐related arousals (RERA). Mandibular movement index changes after AT significantly were correlated with corresponding decreases in sleep apnea–hypopnea index (AHI) and O 2 desaturation index (ODI) (Spearman's rho = 0.978 and 0.922, respectively), whereas changes in MMas duration significantly were associated with both RERA duration (rho = 0.475, P = 0.017) and index (rho = 0.564, P = 0.003). Conditional multivariate analysis showed that both AHI and RERA significantly contributed to the variance of MMas index after AT ( P = 0.0003 and 0.0005, respectively), whereas MMas duration consistently was related to the duration of RERA regardless of AT. Conclusion Adenotonsillectomy significantly reduced AHI. However, persistent RERA were apparent in a significant proportion of children, and this was reflected by the remaining abnormal MMas pattern. Follow‐up of children after AT can be recommended and readily achieved by monitoring MMas to identify persistent RE. Level of Evidence 4. Laryngoscope , 128:1230–1237, 2018