TOPLINE:

1 in 5 children with obstructive sleep apnoea (OSA) who had preoperatively planned ICU admission after tonsillectomy experienced early respiratory complications mainly requiring oxygen therapy or non-invasive ventilation (NIV). Age below 3 years and oximetry parameters were the significant predictors, whereas the apnoea-hypopnoea index (AHI) and comorbidities were not significantly associated with complications.

METHODOLOGY:

• Researchers conducted a single-centre observational study to determine how often postoperative respiratory complications occur after tonsillectomy for paediatric OSA and to identify risk factors in children planned for postoperative ICU admission.
• They included 166 consecutive children (median age, 3 years; median preoperative AHI, 25 events/hour) who underwent tonsillectomy for OSA at a tertiary academic paediatric care centre in France from January 2020 to December 2022.
• Postoperative ICU admission was planned preoperatively according to the French Society of Anaesthesia and Intensive Care Medicine recommendations: either an AHI of at least 10 events/hour on polysomnography or respiratory polygraphy or the presence of comorbidities that increased the risk for postoperative respiratory complications.
• The primary outcome was the frequency of early postoperative respiratory complications within 24 hours, defined as the need for oxygen therapy, NIV, and/or tracheal intubation.

TAKEAWAY:

• Overall, 21% of children experienced postoperative respiratory complications after tonsillectomy, of whom 19% required oxygen therapy and 3% needed NIV; none required tracheal intubation.
• Age was significantly associated with postoperative respiratory complications (P < .001); children younger than 3 years had 2.65-fold higher odds of developing postoperative respiratory complications. However, the AHI, including an AHI of at least 20 events/hour, was not significantly associated with postoperative respiratory complications.
• Any sleep time spent with oxygen saturation below 85% (T85 > 0%) and more than 5% of sleep time spent with oxygen saturation below 90% (T90 > 5%) were significantly associated with postoperative respiratory complications, as was a McGill oximetry score of 3 or 4 (P < .05 for all).
• Preoperative AHI and the presence of at least one comorbidity, such as Down syndrome, a craniofacial malformation, or obesity status, were not significantly associated with early postoperative respiratory complications.

IN PRACTICE:

"Our findings suggest that using a composite score including the age and AHI or T90, perform better than the criterion currently recommended in France guidelines, i.e. an AHI ≥ 10 events/hour to predict postoperative respiratory complications. Implementing these revised criteria could reduce unnecessary planned ICU admissions without compromising patient safety," the authors wrote.

SOURCE:

This study was led by Romane Gozlan, APHP, Hôpital Necker-Enfants Malades, Paris, France. It was published online on February 16, 2026, in the European Journal of Pediatrics.

LIMITATIONS:

The study's single‑centre design may have limited generalisability. Few children had a McGill oximetry score of 3 or 4, reducing power to assess severe desaturation. The variable duration of gas exchange recordings among patients may have biased estimates of oxygen desaturation.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.