Abstract
Objectives Adenotonsillectomy (AT) markedly improves, but does not necessarily normalize polysomnographic (PSG) findings in children with adenotonsillar hypertrophy and related disordered breathing (SDB), potentially requiring follow-up PSG. Mandibular movement monitoring readily identifies respiratory effort (RE) during upper airway obstruction. We hypothesized that mandibular movements (MMas) indices for RE would decrease in a similar fashion as classical PSG indices, and that children with persistent RE could be reliably identified with MMas as with PSG.
Methods 25 children (3-12 years of age) were diagnosed with SDB over a period of 3 months. PSG was supplemented with a midsagittal movement magnetic sensor that measured MMas during each respiratory cycle before and >3 months after AT. The effect of AT was evaluated by linear mixed-model with best-fit distribution.
Results AT did significantly improve PSG indices, except RERA. MMas index changes under AT were significantly correlated with corresponding decreases in AHI, RDI and ODI (r=0.98, 0.98 and 0.92, respectively), while changes in MMas duration were significantly associated with both RERA duration (r=0.475, p=0.017) and RERA index (r=0.56, p=0.003). Conditional multivariate analysis showed that both AHI and RERA indices contributed significantly to the variance of MMas index after AT (p<0.001), while MMas duration was consistently related to the duration of RERA regardless of AT.
Conclusion AT significantly reduced AHI. However, residual AHI and persistent RE were apparent in a significant proportion of children. Follow-up of children with persistent RE after AT can be readily achieved by monitoring MMas.
- Copyright ©the authors 2017