Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.

Objective: To assess the prevalence of obstructive sleep apnea (OSA) in a cohort of children with craniofacial syndromes (CFS) within a single institution, and to describe their polysomnographic (PSG) characteristics and the overall management of OSA in this cohort. Design: A single-center retrospective study. Electronic healthcare records were used to access information regarding medical history, surgical history, and PSG details of patients with CFS. Setting: This study took place at a tertiary care center affiliated with a school of medicine. Patient, Participants: Patients with CFS under the age of 18 years with PSG data were assessed. Interventions: No intervention was performed as it was retrospective study. Main Outcome Measures: Obstructive sleep apnea prevalence among children with CFS. Results: A total of 46 patients were included in this study. In our study, 69.6% of the children with CFS had OSA, with 39.1% of them classified as severe. We performed mandibular distraction osteogenesis (MDO) to treat 26.5% of patients with OSA. The prevalence of OSA was 93.8% among a total of 16 Pierre Robin Sequence (PRS) patients. MDO substantially decreased apnea-hypopnea index (AHI), rapid eye movement AHI, and EtCO2 in PRS patients while simultaneously increasing SpO2 and total sleep time. Conclusions: Obstructive sleep apnea is more prevalent in children with CFS than was previously recognized, and MDO is the most frequently employed treatment. Pierre Robin Sequence is the most prevalent pediatric CFS associated with OSA. Mandibular distraction osteogenesis significantly improves OSA and sleep quality in PRS patients.