• Shalini Paruthi, Carol L Rosen, Rui Wang, Jia Weng, Carole L Marcus, Ronald D Chervin, Jeffrey J Stanley, Eliot S Katz, Raouf Amin, and Susan Redline.
• Department of Pediatrics, Saint Louis University, St. Louis, MO.
• Sleep. 2015 Nov 1; 38 (11): 1719-26.

Study ObjectivesTo identify the role of end-tidal carbon dioxide (EtCO2) monitoring during polysomnography in evaluation of children with obstructive sleep apnea syndrome (OSAS), including the correlation of EtCO2 with other measures of OSAS and prediction of changes in cognition and behavior after adenotonsillectomy.DesignAnalysis of screening and endpoint data from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study comparing early adenotonsillectomy (eAT) to watchful waiting/supportive care (WWSC) in children with OSAS.SettingMultisite clinical referral settings.ParticipantsChildren, ages 5.0 to 9.9 y with suspected sleep apnea.InterventionseAT or WWSC.Measurements And ResultsQuality EtCO2 waveforms were present for ≥ 75% of total sleep time (TST) in 876 of 960 (91.3%) screening polysomnograms. Among the 322 children who were randomized, 55 (17%) met pediatric criteria for hypoventilation. The mean TST with EtCO2 > 50 mmHg was modestly correlated with apnea-hypopnea index (AHI) (r = 0.33; P < 0.0001) and with oxygen saturation ≤ 92% (r = 0.26; P < 0.0001). After adjusting for AHI, obesity, and other factors, EtCO2 > 50 mmHg was higher in African American children than others. The TST with EtCO2 > 50 mmHg decreased significantly more after eAT than WWSC. In adjusted analyses, baseline TST with EtCO2 > 50 mmHg did not predict postoperative changes in cognitive and behavioral measurements.ConclusionsAmong children with suspected obstructive sleep apnea syndrome, overnight end-tidal carbon dioxide (EtCO2) levels are weakly to modestly correlated with other polysomnographic indices and therefore provide independent information on hypoventilation. EtCO2 levels improve with adenotonsillectomy but are not as responsive as AHI and do not provide independent prediction of cognitive or behavioral response to surgery.Clinical Trial RegistrationChildhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.© 2015 Associated Professional Sleep Societies, LLC.

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