Routine cardiac work-up before adenotonsillectomy for severe OSA rarely helps

Design

Retrospective single-centre review

Population

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

Primary outcome

Yield of preoperative cardiac work-up

Effect

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

This retrospective review included 144 children aged 2 to 18 with very severe obstructive sleep apnoea (AHI 25 or more) who had adenotonsillectomy between 2018 and 2024. Thirty-eight (26%) had a preoperative cardiac work-up.

Only three of the 38 (7.9%) had abnormal findings, and all three were obese adolescents aged 13 to 16 with AHI above 50. None had further testing or started CPAP before surgery as a result. Cardiac work-up was not associated with the perioperative course.

The numbers are small and the work-up was not applied to everyone, so selection may have shaped the yield. Still, it supports targeting echocardiography and cardiology review at obese adolescents with the most severe disease rather than requiring it for every child with severe OSA.

• Consider cardiac work-up mainly for obese adolescents with AHI above 50.
• Routine echocardiography for all children with severe OSA had low yield here.
• Avoid delaying adenotonsillectomy for low-yield testing in younger, non-obese children.
• Plan monitored overnight admission for the most severe and youngest patients.

Why it matters

Blanket cardiac testing delays a curative operation for children who are unlikely to benefit from it.

Don't overread it

Small, retrospective, and only a quarter of children were tested.

The statistics, in plain English

Three abnormal results out of 38 tests is a yield of about 8%, all within one identifiable subgroup.

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