• Cristina M Baldassari, Jessica Kepchar, Lucas Bryant, Hind Beydoun, and Sukgi Choi.
• Department of Otolaryngology--Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia 23507, USA. cristina.baldassari@chkd.org
• Otolaryngol Head Neck Surg. 2012 Mar 1;146(3):487-90.

ObjectivesTo determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA).Study DesignCase series with chart review.SettingTwo tertiary children's hospitals.Subjects And MethodsChildren between 1 and 16 years of age who underwent adenotonsillectomy for OSA and had both preoperative and postoperative full-night polysomnography (PSG) with CAI greater than 1 on preoperative PSG were eligible for inclusion. Central apnea was defined as the absence of both inspiratory effort and chest wall movement lasting longer than 20 seconds. Criteria for diagnosis of central sleep apnea (CSA) was CAI greater than 1.ResultsA total of 101 children with OSA had preoperative and postoperative PSG. Fifteen of these patients had a preoperative CAI greater than 1. The mean age was 67.7 months (SD, 62.7 months). The CAI ranged from 1.1 to 11.1. The mean preoperative CAI was 3.9 (SD, 2.9), while the mean postoperative CAI was 1.9 (SD, 4.8). There was significant improvement (P = .008) of the CAI following adenotonsillectomy. Ninety percent of subjects with mild CSA (CAI between 1 and 5) had postoperative resolution of their disease. There was also significant improvement (P = .004) in the obstructive apnea hypopnea index (AHI), with the mean preoperative AHI of 22.8 (SD, 19.8) decreasing to an AHI of 5.5 (SD, 6.5) postoperatively.ConclusionsChildren with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.

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