The Improvement of Central Apnea Index after Adenotonsillectomy in Children: A Systematic Review and Meta-analysis

Abstract Background Central sleep apnea has been reported in pediatric patients with obstructive sleep apnea (OSA). However, the effect of adenotonsillectomy (TA) on the presentation of the central apnea index (CAI) remains unclear. We investigated the effect of TA on CAI in children with OSA through a systematic review and meta-analysis. Methods A systematic search was performed to identify original studies that compare the CAI obtained before and after TA from polysomnography in children under 18 years of age. Non-original studies and full papers that were not available were excluded. Only relevant data were pooled for meta-analysis. Results Eleven studies with 689 participants were included. The mean age was 5.6 ± 3.0 years and the mean BMI was 21.0 ± 10.6 kg/m2. Post-TA CAI decreased significantly from pre-TA CAI with a mean difference (MD) of 0.70 events/h (95%CI, 0.25–1.15), especially in the non-Down syndrome subgroup [MD of 0.75 events/h (95%CI, 0.24 to 1.26)]. Other parameters, including the apnea-hypopnea index and oxygen saturation, were also significantly improved after TA. However, there was no significant difference in CAI reduction between the subgroups of patients with and without TA, and those with and without obesity. Conclusion This meta-analysis revealed that pediatric patients with OSA who underwent TA had a significant reduction in CAI, particularly in patients without Down syndrome. The study suggests that CAI should be considered an important PSG parameter in post-TA patients. A further well-controlled and long-term study considering the impact of pediatric OSA surgery on CAI is needed.