A 5-year-old with obstructive sleep apnea syndrome (OSAS) confirmed on polysomnography (AHI 15/hour) undergoes adenotonsillectomy. One year post-operatively, overnight oximetry shows persistent nocturnal hypoxemia. Which condition is most likely responsible for surgical failure?
- A Obesity contributing to multi-level airway obstruction ✓
- B Regrowth of adenoid tissue
- C Development of nasal polyps
- D Laryngomalacia
Correct answer: A. Obesity contributing to multi-level airway obstruction
Explanation
Obesity is the most significant predictor of persistent OSAS after adenotonsillectomy in children, as obese children often have multi-level airway collapse that is not corrected by adenotonsillectomy alone. Adenoid regrowth is possible but less common and typically presents with nasal obstruction rather than oxygen desaturation alone. Nasal polyps and laryngomalacia are less likely causes of persistent post-surgical OSAS.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.