Cardiac workup before adenotonsillectomy in very severe OSA rarely changed anything

Design

Single-centre retrospective review

Population

144 children with very severe OSA (AHI ≥25) undergoing adenotonsillectomy

Primary outcome

Yield of preoperative cardiac workup and perioperative course

Effect

3 of 38 tested (7.9%) abnormal, all obese adolescents with AHI >50

A single-centre review of 144 children aged 2 to 18 with very severe obstructive sleep apnoea (AHI 25 or more) who had adenotonsillectomy between 2018 and 2024 examined preoperative cardiac assessment. Published in The Laryngoscope on 15 June 2026.

Thirty-eight children (26%) had a cardiac workup. Three (7.9%) had abnormal findings, and all three were obese adolescents aged 13 to 16 with AHI above 50. None had further testing or preoperative CPAP. Having a workup was not associated with the perioperative course. Higher AHI and younger age were linked to a longer stay.

The sample is small and the decision to test was not random, so the study cannot show testing is unnecessary. It supports a selective approach that targets obese adolescents with the most severe disease, rather than routine echocardiography for every child with a high AHI.

• Consider cardiac assessment before adenotonsillectomy mainly in obese adolescents with AHI above 50
• Avoid routine echocardiography in every child with very severe OSA when it would delay surgery
• Plan overnight monitoring for younger children and those with the highest AHI
• Look for clinical signs of right heart strain regardless of testing policy

Why it matters

Routine testing can delay surgery that treats the underlying problem.

Don't overread it

A small single-centre series with selective testing; it does not prove cardiac assessment is unnecessary.

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