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

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. Objective: To investigate the effect of TA on CAI in children with OSA through a systematic review and meta-analysis. Materials and Methods: A systematic search was performed to identify original studies that compare the CAI obtained before and after TA from polysomnography (PSG) 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 per m^2. Post-TA CAI decreased significantly from pre-TA CAI, with a mean difference (MD) of 0.70 events per hour (95% CI 0.25 to 1.15), especially in the non-Down syndrome subgroup with a MD of 0.75 events per hour (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 present study suggested 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.