1243 Revision Adenoidectomy in the Management of Residual OSA Post-Adenotonsillectomy in a Child

• Published in: Sleep (New York, N.Y.) N.Y.), 2017-04, Vol.40 (suppl_1), p.A463-A463
• Main Authors: Jesudoss, R, Otteson, TD, Strohl, KP, Rosen, CL
• Format: Article
• Language: English
• Subjects: Age; Asthma; Hypoxemia
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleepj/zsx052.033

Abstract Introduction: In children post adenotonsillectomy (AT), reassessment for residual OSA depends on the initial severity. When OSA remains severe, clinicians often choose positive airway pressure (PAP) therapy, but adherence is challenging. We present a case that highlights the importance of on-going monitoring of therapy, PAP adherence with advanced diagnostics, and upper airway re-evaluation for adjunctive surgical procedures, as OSA persisted. Report of a Case: Seen post-AT, this 7 yr-old boy had worsening OSA symptoms and was started on PAP therapy (autotitrating device at 6–16 cwp) after an urgent split-night polysomnogram (PSG) showed an obstructive apnea-hypopnea index (oAHI) of 42 with significant hypoxemia and poor nasal airflow requiring a full face mask. Comorbidities included nasal allergies, asthma and obesity (BMI z-score=2.7). He was originally diagnosed at age 2 (oAHI=12), underwent AT at age 3, then had a repeat PSG at age 5 with mild residual OSA (oAHI=3.1). Over the next 9 months, his 90th percentile PAP pressure increased from 8 to 14 cwp. He used his PAP therapy 90% of nights, but only 60% of nights for >4 hr; when used residual AHI was ~1.7/hr. An ENT reassessment showed 90% adenoidal regrowth with no other anatomical abnormalities. He underwent revision adenoidectomy with dramatic relief of symptoms. Follow-up PSG off CPAP showed mild residual OSA (oAHI=3.2) with no impact on gas exchange or sleep continuity. He continues on medical management of nasal allergies and asthma, with continued efforts on weight reduction. Conclusion: Regrowth of adenoids with recurrence may occur on CPAP, particularly in children undergoing adenoidectomy before 6 years of age. Benefit in terms of symptoms and freedom from CPAP can be derived from revision adenoidectomy. Re-assessment of OSA symptoms and response to treatments is also a key quality measure in children.