Predictors of symptom score improvement in pediatric otolaryngology patients with obstructive sleep apnea
DOI:
https://doi.org/10.5281/zenodo.22813329Keywords:
pediatric obstructive sleep apnea, adenotonsillectomy, OSA-18, quality of life, predictorsAbstract
Background: A substantial minority of children with obstructive sleep apnea (OSA) have only modest symptomatic improvement after adenotonsillectomy, and improvement on caregiver-reported quality-of-life instruments correlates only loosely with polysomnographic normalization.
Objective: To identify preoperative predictors of clinically meaningful improvement in the OSA-18 symptom score six months after adenotonsillectomy in a pediatric otolaryngology cohort.
Methods: This retrospective cohort study included children aged 2 to 17 years with polysomnography-confirmed OSA who completed the OSA-18 survey before and six months after adenotonsillectomy. Candidate predictors were screened univariably and entered into a multivariable logistic regression model for a decrease of at least 1.0 standard deviation in total OSA-18 score.
Findings: Of 214 children, 71% met the improvement threshold. Higher baseline OSA-18 score (adjusted OR 1.62 per 10 points), higher baseline AHI severity (severe vs mild adjusted OR 2.71), and absence of obesity (adjusted OR 0.38) were independently associated with improvement; tonsil size, adenoid size, and snoring frequency were not retained after adjustment.
Conclusions: Baseline symptom burden, OSA severity, and weight status, rather than anatomic grading alone, predict symptomatic improvement after adenotonsillectomy and should inform preoperative counselling, particularly for obese children.
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