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Volume 15 No. 09
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Accepted Papers

Scientific Investigations

Polysomnography Parameters Assessing Gas Exchange Best Predict Postoperative Respiratory Complications Following Adenotonsillectomy in Children With Severe OSA

Helena Molero-Ramirez, MD1; Maximiliano Tamae Kakazu, MD2; Fuad Baroody, MD3; Rakesh Bhattacharjee, MD4
1Deparment of Pediatrics, Division of Pediatric Pulmonology, University of Minnesota, Minneapolis, Minnesota; 2Spectrum Health-Michigan State University, Grand Rapids, Michigan; 3Departments of Surgery, Section of Otolaryngology-Head and Neck Surgery, and Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois; 4Department of Pediatrics, Division of Respiratory Medicine, University of California-San Diego and Rady Children's Hospital of San Diego, San Diego, California; *Contributed equally

Study Objectives:

Adenotonsillectomy (AT) is the treatment of choice for obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. Severe OSA, identified by the apnea-hypopnea index (AHI), is a risk factor for surgical complications and AHI thresholds are used by surgeons to decide elective postoperative hospital admissions. The objective of this study was to identify the prevalence of surgical complications of AT in children with severe OSA and determine their association with specific parameters of polysomnography (PSG).


Retrospective evaluation of respiratory and nonrespiratory complications in children undergoing AT for severe OSA was performed. Events were then compared to several individual PSG indices. PSG indices included classic parameters such as AHI, and obstructive apnea indexes (OAI) as well as gas exchange parameters including the oxygen desaturation index (ODI), lowest oxyhemoglobin saturation (lowest SpO2), peak end-tidal CO2 (peak ETCO2), the percentage of the total sleep time (%TST) with ETCO2 > 50 mmHg (%TST ETCO2 > 50 mmHg) and oxygen saturation < 90% (%TST O2 < 90%).


A total of 158 children were identified with severe OSA. Major respiratory complications occurred in 21.5% and were only associated with the ODI (P = .014), lowest SpO2 (P = .001) and %TST O2 < 90% (P < .001). Minor respiratory complications occurred in 19.6% and these were not associated with any PSG parameters. Major nonrespiratory complications occurred in 4.4% and also were not associated with any PSG parameters; however, minor nonrespiratory complications occurring in 37.3%, and were associated with %TST O2 < 90% (P < 0.001).


PSG measures of gas exchange are strongly associated with postoperative complications of AT and are better suited for postoperative planning than classic indices such as AHI.


Molero-Ramirez H, Tamae Kakazu M, Baroody F, Bhattacharjee R. Polysomnography parameters assessing gas exchange best predict postoperative respiratory complications following adenotonsillectomy in children with severe OSA. J Clin Sleep Med. 2019;15(9):1251–1259.

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