Here’s a recent study in one of our major journals showing that a significant number of children (22%) younger than 3 years old had residual obstructive sleep apnea after adenotonsillectomy. They defined surgical failure as an apnea hypopnea index, or AHI of greater than 5. AHI is the number of times you stop breathing every hour. What’s striking about this study is that this information is not new. Another study on adenotonsillectomy in children showed that 29% of children had an AHI of greater than 5.
Unfortunately, different studies use different criteria for “surgical success.” Many studies use an AHI threshold of less than 1 for surgical success. If you applied this standard to the first study, the number of patients that don’t respond will be significantly higher.
Even if you don’t reach levels of surgical cure, most children do have significant drops in their AHI levels. The argument for continuing to perform surgery is that a 50% drop is better than nothing, especially if a child is not going to use CPAP. Getting that child to normal levels with more surgery can be challenging.