Polysomnographic findings after adenotonsillectomy for obstructive sleep apnoea in obese and non-obese children: a systematic review and meta-analysis

• Published in: Clinical otolaryngology 2016-10, Vol.41 (5), p.498-510
• Main Authors: Lee, C.-H., Hsu, W.-C., Chang, W.-H., Lin, M.-T., Kang, K.-T.
• Format: Article
• Language: English
• Subjects: Adenoidectomy; Child; Humans; Meta-analysis; Pediatric Obesity - complications; Polysomnography; Sleep; Sleep apnea; Sleep Apnea, Obstructive - etiology; Sleep Apnea, Obstructive - surgery; Surgery; Tonsillectomy; Treatment Outcome
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.12549

Background Use of polysomnography (PSG) is the gold standard of diagnosis and measurement of treatment effectiveness for paediatric obstructive sleep apnoea (OSA). Although adenotonsillectomy (T&A) is effective in diminishing the apnoea–hypopnoea index (AHI), a meta‐analysis of postoperative changes for all other PSG parameters and outcome comparisons between obese and non‐obese children following T&A have never been conducted. Objective of review To comprehensively review polysomnographic findings after surgery for obese and non‐obese children with OSA. Search strategy Study protocol was registered on PROSPERO (CRD42013004737). Two authors independently searched databases including PubMed, MEDLINE, EMBASE and Cochrane Review from January 1997 to July 2014. The keywords used included the following: sleep apnea, OSA, sleep apnea syndromes, tonsillectomy, adenoidectomy, infant, child, adolescent, and Humans. Evaluation method A comprehensive systematic review and meta‐analysis for literature for OSA children treated by T&A with polysomnography data. Random‐effects model was applied to determine postoperative sleep parameter changes and the surgical success rate between obese and non‐obese groups. The quality of studies was assessed using the Newcastle–Ottawa Scale. Results In total, 51 studies with 3413 subjects were enrolled. After surgery, sleep architecture was altered by a significant decrease in sleep stage 1, and an increase in slow‐wave sleep and the rapid eye movement stage, and enhanced sleep efficiency. The mean difference between pre‐ and postoperative was a significant reduction of 12.4 event/h in AHI, along with a reduction of obstructive index, hypopnoea index, central index and arousal index. Mean and minimum oxygen saturation increased significantly after surgery. The overall success rate was 51% for postoperative AHI