Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Patients With Clefts Who Undergo Sleep Studies After Surgery Do Not Show Significantly Improved Sleep Parameters After Adenotonsillectomy
Justine M. McGauley, BA, Jeremy Goss, BA, Eric Adjei Boakye, MA, Margie S. Hunter, BS, Paula Buchanan, MPH, PhD, Shalini Paruthi, MD, Alexander Y. Lin, MD.
Saint Louis University, St. Louis, MO, USA.

PURPOSE:
The most common etiology for pediatric obstructive sleep apnea (OSA) is tonsillar or adenoidal hypertrophy. Children with cleft-craniofacial conditions have additional factors that lead to OSA, such as scarring and volume of the velopharyngeal complex. Our goal was to examine these patients who had postoperative polysomnograms (PSG), and compare adenotonsillectomy (AT) procedures versus non-AT procedures, in terms of their PSG measurements. Our hypothesis was that children with AT procedures would have better PSG outcomes than non-AT procedures.
METHODS:
After IRB approval, a retrospective review of records from 2009-2014 was conducted. Patients with PSGs were included for analysis including demographics, cleft type, syndromes, types of surgery, and PSG outcome measures. Data was analyzed per procedure, with postoperative PSGs (before the next surgery if there was an additional surgery), and preoperative PSG if one existed. Continuous outcomes were compared with Mann Whitney U-tests, and categorical by chi-square or Fisher exact tests.
RESULTS:
92 patients had a postoperative PSG after surgery, for a total of 115 postoperative PSGs. Of these postoperative PSGs, the procedure distribution was tonsillectomy (T) 5/115 (4.4%), adenoidectomy (A) 5/115 (4.4%), adenotonsillectomy (AT) 19/115 (16.5%). Postoperative OSA as defined by apnea-hypopnea index (AHI) > 1: T 4/5 (80%), A 4/5 (80%), AT 18/19 (95%), P=0.2668. Total AHI median (IQR) was T: 4.1 (1.5 - 5.0), A: 4.2 (3.1 - 7.3), AT: 6.3 (3.6 - 12.9), P=0.4130. Obstructive AHI median (IQR) was T: 3.5 (1.3 - 4.5), A: 2.3 (1.9 - 6.9), AT: 6.0 (2.0 - 9.1), P=0.3677. Arousal index median (IQR) was T: 22.0 (13.4 - 22.2), A: 16.5 (11.0 - 23.0), AT: 14.9 (9.6 - 24.9), P=0.7449.
We then compared change between preoperative and postoperative PSGs. 30 patient procedures were associated with pre- and post- operative PSGs. 16 procedures were T, A or AT (TAAT), versus 14 non-TAAT procedures. Changes were measured as post-PSG minus pre-PSG. Median (IQR) AHI change was: TAAT 0.45 (-5.8 - 5.05), non-TAAT 0.6 (-13.0 - 1.9), P=0.5160. Median (IQR) obstructive AHI change was: TAAT 1.7 (-4.2 - 4.95), non-TAAT -0.5 (-11.3 - 2.5), P=0.2550. Median arousal index change was: TAAT -1.6 (-12.25 - 4.75), non-TAAT -1.85 (-12.9 - 1.2), P=0.6362.
CONCLUSION:
Tonsillectomy, adenoidectomy, and adenotonsillectomy procedures, hypothesized to improve airway patency in patients with cleft palates, were not associated with significant improvement in OSA when compared to other cleft procedures. This result may be the result of heterogeneity of the procedures, or being underpowered, or indication bias from patients who received sleep studies were more likely symptomatic. We tentatively caution that tonsillectomy, adenoidectomy, and adenotonsillectomy may not have a strong an effect as we would expect, and in that scenario, teams may want to avoid adenoidectomy to avoid its risks of velopharyngeal insufficiency.


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