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Sleep Characteristics Following Adenotonsillectomy in Children With Obstructive Sleep Apnea Syndrome^*

^* From the Department of Pediatrics B (Dr. Tal), Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva; Sleep-Wake Disorders Unit (Drs. Bar and Tarasiuk), Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva; and Department of Otolaryngology (Dr. Leiberman), Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Correspondence to: Asher Tal, MD, Professor of Pediatrics, Head, Department of Pediatrics B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel; e-mail: ashik{at}bgumail.bgu.ac.il

Objective: To compare the effect of adenotonsillectomy on rapid eye movement (REM)- and non-REM–related respiratory and sleep architecture characteristics in children with obstructive sleep apnea syndrome (OSAS).

Study design: This prospective study evaluated 36 children (median age, 6.9 years; range, 1.8 to 12.6 years) with OSAS using polysomnography before and a few months after adenotonsillectomy. Primary outcomes included the number of obstructive apnea and hypopnea and arousals per hour of sleep.

Results: At 4.6 months (range, 1 to 16 months) after adenotonsillectomy, there was a significant improvement of all respiratory parameters. The median respiratory disturbance index (RDI) decreased from 4.1/h (range, 0 to 85/h) to 0.9/h (range, 0 to 13/h) after adenotonsillectomy (p < 0.0001). The median non-REM RDI decreased from 3.0/h (range, 0 to 89/h) to 0.4/h (range, 0 to 13/h) [p < 0.001] as compared with REM RDI, which decreased from 7.8/h (range, 0 to 69/h) to 2.3/h (range, 0 to 54/h) after adenotonsillectomy (p < 0.01). Median arousal index decreased following adenotonsillectomy from 17.5/h (range, 7 to 57/h) to 14.0/h (range, 6 to 47/h) [p < 0.03].

Conclusions: Adenotonsillectomy resulted in a greater improvement in non-REM RDI as compared with REM-RDI, and a decrease in the number of arousals.

Key Words: adenotonsillectomy • arousal • rapid eye movement sleep • sleep apnea

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