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ORIGINAL ARTICLE A study of Cardiorespiratory Parameters and Sleep Architecture in Patients with Pediatric Obstructive Sleep Apnea undergoing Adenotonsillectomy Elias Mir 1 , Rohit Kumar 2 , Tejas Suri 3 , JC Suri 4 Received on: 27 April 2020; Accepted on: 30 November 2021; Published on: 05 January 2023 A BSTRACT Background: Obstructive sleep apnea (OSA) in pediatric population is associated with cardiac, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. Adenotonsillectomy (AT) is the treatment of choice in children who have hypertrophied adenoid and/or palatine tonsils. However, there is paucity of literature on the impact of AT on cardiorespiratory and sleep parameters in these cases. Methods: We did a retrospective study on children who had undergone AT from July 2016 to December 2018 at a tertiary hospital in north India. Only those children, whose polysomnography (PSG) was available both before and after AT were enrolled in this study. • Cardiac parameters: Mean heart rate (MHR) and highest heart rate (HHR), number and duration of arrhythmias, and pulse transit time (PTT) drops. • Respiratory parameters: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (MOS). • Sleep parameters: Time spent in diferent stages, sleep efciency (SE), and arousal index (AI) on PSG were compared before and after AT. Results: A total of 56 children had undergone AT for OSA. Also, PSG, both before and after AT, was available in 37 children. After excluding children having undergone other surgeries for OSA and those with comorbidities, 32 children were enrolled. AT led to signifcant positive change in AHI (from 7.86 ± 7.91 to 2.03 ± 3.10, p = 0.01), RDI (from 16.319 ± 15.64 to 7.38 ± 3.72, p < 0.01), AI (from 22.10 ± 14.93 to 15.90 ± 8.48, p = 0.012), SE (from 91.47 ± 6.31 to 95.866 ± 3.03, p < 0.01), ODI (from 6.7959 ± 5.03 to 1.865 ± 2.09, p < 0.01), MOS (from 95.59 ± 2.19 to 97.28 ± 1.27), HHR (from 141.68 ± 17.93 to 120.93 ± 16.98, p < 0.01), MHR (86.68 ± 12.95 to 80.29 ± 8.81, p = 0.01), and PTT AI (from 36.67 ± 27.72 to 26.93 ± 24.86, p < 0.01). There was no non-sinus wide or narrow complex tachyarrhythmia in any child before or after AT. There was no statistically signifcant change in rapid eye movement (REM) sleep duration or number and duration of bradycardia episodes in these children (p > 0.05). Conclusion: Adenotonsillectomy improved SE and oxygenation, and decreased the number of obstructive events, arousals, heart rate, and PTT AI during sleep in children with OSA. Some children had residual disease after surgery. Heart rate and PTT can be excellent non-invasive parameters for detecting obstructive events during sleep in children and monitoring the impact of various therapeutic modalities. Keywords: Adenotonsillectomy, Cardiorespiratory parameters, Pediatric obstructive sleep apnea, Sleep architecture. The Indian Journal of Chest Diseases and Allied Sciences (2022): 10.5005/jp-journals-11007-0035 A BBREVIATIONS USED IN THIS A RTICLE OSA = Obstructive sleep apnea; AT = Adenotonsillectomy; PSG = Polysomnography; MHR = Mean heart rate; HHR = Highest heart rate; PTT = Pulse transit time; AHI = Apnea-hypopnea index; RDI = Respiratory disturbance index; ODI = Oxygen desaturation index; MOS = Mean oxygen saturation; SE = Sleep efciency; AI = Arousal index; REM = Rapid eye movement. I NTRODUCTION The prevalence rate of OSA in children using various diagnostic criteria in diferent studies across the world has been observed to be between 1 and 4% of the total pediatric population, 1 which makes it one of the commonest chronic disorders in this age group. Obstructive sleep apnea in children is associated with cardiovascular, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. 2–4 American Association of Pediatrics recommends AT as the treatment of choice in children with sleep- disordered breathing who have hypertrophied adenoid and/or palatine tonsils. 5 The impact of AT in these children is generally 1 Department of Chest Medicine, SKIMS Medical College & Hospital, Srinagar, Jammu and Kashmir, India 2 Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India 3 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India 4 Medeor JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India Corresponding Author: JC Suri, Medeor JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India, e-mail: docjcsuri@ gmail.com How to cite this article: Mir E, Kumar R, Suri T, et al. A study of Cardiorespiratory Parameters and Sleep Architecture in Patients with Pediatric Obstructive Sleep Apnea undergoing Adenotonsillectomy. Indian J Chest Dis Allied Sci 2022;64(4):238–242. Source of support: Nil Confict of interest: Dr. J C Suri is associated as Associate Editor of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of the Editor-in-Chief and his research group.