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Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome

  • Laryngology
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Abstract

Adenotonsillectomy is recommended for children who need surgery for obstructive sleep apnea syndrome (OSAS). Overnight, polysomnography (PSG) is suggested for post-surgery follow-up, but this diagnostic technique is time consuming and inconvenient. Desaturation index (DI) has been reported as a good tool for predicting both the presence and severity of OSAS in children. The purpose of this study was to determine the usefulness of the DI for post-surgery follow-up of children with OSAS. This retrospective study enrolled 42 children, aged 3–12 years, who were snorers diagnosed with OSAS by overnight PSG and who underwent an adenotonsillectomy. Pre- and postoperative PSG parameters, nocturnal pulse oximetry data, and modified Epworth sleepiness scale scores were assessed. Previously determined cut-off DI values (2.05, 3.50, and 4.15 for mild, moderate, and severe OSAS, respectively) were used to predict residual OSAS. Of the 42 children, obvious improvements were observed in apnea-hypopnea index (AHI, decreased 45.5 %), arousal index (decreased 30.5 %), DI (decreased 40.4 %), and snore index (decreased 100.3 %) compared with the preoperative measurements. Among these objective PSG measures, DI had the strongest correlation with AHI both pre- and post-surgeries (r = 0.947 and r = 0.954, respectively; p all <0.001). The DI change, before and after surgery, also had the strongest positive correlation to the AHI change (r = 0.482 and p = 0.001). Using the previously determined DI cut-off values to predict postoperative residual OSAS, there was a good positive predictive value (92.6 %) for mild residual OSAS and a good negative predictive value for moderate and severe residual OSAS (85.2 and 89.7 %, respectively). These findings suggest that DI, as determined using a nocturnal pulse oximeter, may be an alternative tool for postoperative evaluation and follow-up of children with OSAS.

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    Authors and Affiliations

    1. Department of Respiratory Care, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan

      Jui-Fang Liu

    2. Department of Pediatrics, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan

      Chih-Min Tsai, Wei-Ju Lee, Kai-Sheng Hsieh, Chen-Kuang Niu & Hong-Ren Yu

    3. Department of Internal Medicine, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan

      Mao-Chang Su & Meng-Chih Lin

    4. Department of Otorhinolaryngology, Chang Gung Memorial Hospital -Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan

      Hsin-Ching Lin

    5. Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan

      Jui-Fang Liu

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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     This is a retrospective review of medical records, and no informed consent is needed. The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved the study.

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    J.-F. Liu and C.-M. Tsai contributed equally to this article.

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    Liu, JF., Tsai, CM., Su, MC. et al. Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 274, 375–382 (2017). https://doi.org/10.1007/s00405-016-4262-4

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