(A917) Do Obese Children with Non-Severe Sleep Apnea Benefit from Overnight Observation

Introduction: Current clinical guidelines recommend that obese children be admitted overnight after adenotonsillectomy (T&A) regardless of polysomnogram (PSG) findings. An institutional obstructive sleep apnea (OSA) database was reviewed to assess whether obese children with non-severe OSA would benefit from being monitored overnight.

Methods: A retrospective dataset of T&As on obese patients (>95th percentile weight-for-age) from 2017 to 2023 was analyzed. Non-severe OSA patients (1≤AHI < 10) were divided into two groups: overnight stay and no overnight stay. These groups, along with patients who had severe OSA (all stayed overnight) were used to create the primary predictor. Outcomes included total time in the PACU and post-operative emergency department (ED) visits, among others. Demographics, risk factors, and surgical characteristics were analyzed across OSA categories using chi-square and ANOVA. Multivariate linear and logistic regressions were employed to evaluate the effects of these variables on the stated outcomes.

Results: Of the 276 obese patients undergoing T&A in the database, 141 had non-severe OSA and did not stay overnight, 55 had non-severe OSA and stayed overnight, and 80 had severe OSA (thus staying overnight). Twenty-nine patients visited the ED post-operatively, and of these, 17 were readmitted. Compared to those that did not stay overnight, patients with non-severe OSA who stayed overnight were associated with longer PACU stays (B = 49.005, P-Value = < 0.0001). Patients with higher O2 nadirs were associated with shorter PACU stays (B = -1.344, P-Value = 0.023). There were no significant differences between the groups in terms of ED visits.

Conclusions: This single-institution retrospective review demonstrated no significant difference in ED visitation irrespective of sleep apnea severity or overnight stay. Patients with non-severe OSA with overnight stay were associated with a longer PACU stay compared to non-severe OSA patients with no stay. Higher O2 nadirs were associated with shorter PACU times. This study suggests using O2 nadir as another metric for determining post-operative admission.