PP24 CHARACTERISTICS AND MANAGEMENT OUTCOMES OF SEVERE PEDIATRIC OBSTRUCTIVE SLEEP APNEA SYNDROME

Yeong Yoong Hui, Amanil ‘Ula Hassan

Pediatric Department, Hospital Sultanah Bahiyah, Kedah, Malaysia

Introduction
Obstructive sleep apnea (OSA) is a partial or complete airway obstruction that may disrupt normal sleep resulting respiratory events. Polysomnography (PSG) and overnight oximetry trending are the reliable diagnostic tools. Severe OSAS in children is defined as Apnea Hypopnea Index (AHI) more than 10/hour or based on McGill’s criteria from oximetry trending.

Objectives
To determine the clinical characteristics and outcomes of the pediatric patients with severe obstructive sleep apnea syndrome (OSAS)

Methodology 
Retrospective study review on patients aged from 1 month old to 18 years old who were diagnosed with severe OSA based on polysomnography or overnight oximetry trending from July 2022 till December 2024

Result
Among 163 patients with OSA, 52 cases were recruited in the study. The median age is 8.6years (1.7-14years), and the majority is male (40/52, 77%). 65% are obese (BMI>95th percentile), and 36 patients (39.3%) had adenotonsillar hypertrophy. The median AHI is 16/hour (11.1-80.6), and the pre-intervention median baseline saturation is 89% (81-99.2%), and oxygen nadir of 77% (20-90%). 32/52 underwent adenotonsillar resection. Post-surgery, the median baseline saturation was improved to 98.9% (90-99.7%), and oxygen nadir is 90% (65-95%). However 40% had residual OSA based on repeated PSG and oximetry trending and 37 patients required home nocturnal Positive Airway Pressure (PAP) therapy due to severe obesity and underlying syndromes and neurological disorders.

Conclusion
OSA is common among children with obesity and adenotonsillar enlargement. Adenotonsillectomy is the treatment of choice in moderate to severe cases. Home nocturnal PAP therapy may be considered in patients with residual OSA. Both interventions have shown to  significantly improve the AHI, baseline saturation, and oxygen nadir. Children with obesity and hypotonia may suffer from residual symptoms.