Utility of concurrent pharyngoplasty with adenotonsillectomy to treat pediatric obstructive sleep apnea

Objective

This study assesses whether surgical procedures to address pharyngeal anatomy performed concurrently with adenotonsillectomy (AT) lead to improved postoperative polysomnogram (PSG) outcomes in children with obstructive sleep apnea (OSA) compared to AT alone.

Study design/setting

This is a retrospective cohort study conducted at a tertiary care children's hospital in the southeastern United States.

Methods

Patients were identified using Current Procedural Terminology (CPT) codes for pharyngoplasty and AT. Retrospective chart review was conducted to obtain clinical data. Patients were matched by age, body mass index (BMI), and preoperative apnea hypopnea index (AHI) to children who underwent AT alone.

Results

Forty-six children who underwent AT with concomitant pharyngoplasty were identified along with 187 patients who underwent AT alone. Age, BMI, and preoperative AHI were significantly higher in the pharyngoplasty + AT group. The pharyngoplasty + AT group demonstrated significantly greater improvement in AHI, REM AHI, and obstructive AHI (oAHI) postoperatively; however, multivariable regression showed that BMI predicted postoperative change in AHI. Twenty children in each group were therefore matched by age, BMI, and preoperative AHI. Subsequent analysis of matched cases revealed no significant difference in surgical outcomes between groups.

Conclusion

After controlling for age, BMI, and preoperative AHI, there was no difference between AT with concurrent pharyngoplasty and AT alone with respect to change in AHI or oxygen saturation nadir postoperatively. Ultimately, children who undergo pharyngoplasty in combination with AT are a clinically distinct group, and further randomized controlled trials within this population are necessary to define the role of pharyngoplasty concurrent with AT.