A 5-year-old child presents with snoring, witnessed apneas, and behavioral issues including hyperactivity and poor school performance. Polysomnography shows an Apnea-Hypopnea Index (AHI) of 8/hour. What is the current recommended AHI threshold for diagnosing OSA in children, and what is the first-line surgical treatment?
- A AHI >1/hour; adenotonsillectomy ✓
- B AHI >5/hour; tonsillectomy alone
- C AHI >5/hour; adenotonsillectomy
- D AHI >2/hour; adenoidectomy alone
Correct answer: A. AHI >1/hour; adenotonsillectomy
Explanation
In children, an AHI >1/hour (unlike adults where >5/hour) is diagnostic of obstructive sleep apnea because children have a narrower airway and lower respiratory arousal threshold. The first-line treatment for pediatric OSA due to adenotonsillar hypertrophy is adenotonsillectomy (removal of both adenoids and tonsils), which achieves cure in the majority of otherwise-healthy children. Tonsillectomy alone is insufficient because the adenoids contribute significantly to nasopharyngeal obstruction in children.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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