Polysomnographic Variables Predictive of Adverse Respiratory Events After Pediatric Adenotonsillectomy

Objective: To determine polysomnographic (PSG) variables that may potentially predict adverse respiratory events after pediatric adenotonsillectomy. Design: Retrospective, case-control study. Setting: Free-standing academic tertiary-care pediatric hospital. Patients: The study included 1131 patients undergoing adenotonsillectomy by 2 attending surgeons. There were no exclusion criteria. Main Outcome Measures: Variables from preoperative PSGs were analyzed to determine predictors of postoperative respiratory complications. Logistic regression analysis was performed. Results: A total of 151 patients (13.4%) underwent preoperative PSG. Twenty-three of these patients (15.2%) had adverse respiratory events. The primary adverse event was desaturation requiring supplemental oxygen therapy, with 1 case of postobstructive pulmonary edema. Patients with adverse events had a significantly higher apneahypopnea index) (31.8 vs 14.1; P=.001), higher hypopnea index (22.6 vs 8.9; P=.004), higher body mass index (z score, 1.43 vs 0.70; P=.02), and lower nadir oxygen saturation (72% vs 84%; P<.001). Patients with adverse events had a prolonged hospital course (odds ratio, 32.1; 95% confidence interval, 7.8-131.4). There were no differences in age or other PSG variables. There were no intubations or mortalities. Conclusions: Polysomnography may be used to predict which patients are at higher risk for adverse respiratory events after adenotonsillectomy. Such knowledge is valuable for planning optimal postoperative management and intraoperative anesthesia. Predictors of increased respiratory complications include apneahypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.