Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy

Publication date: Available online 1 November 2017
Source:Sleep Medicine
Author(s): Amal Isaiah, Edgar Kiss, Patrick Olomu, Korgun Koral, RonB. Mitchell
Objectives/Background: Tonsillectomy and adenoidectomy (T&A) leads to resolution of obstructive sleep apnea (OSA) in most children. However, it persists in about 25-40%. Cinematic magnetic resonance imaging (cine MRI) can aid management of persistent OSA by localizing airway obstruction. We describe our experience in implementing and optimizing a cine MRI protocol using a 3 Tesla MRI scanner and the use of dexmedetomidine for sedation to improve reproducibility, safety and diagnostic accuracy.Patients/Methods: Patients aged 3-18 years who underwent cine MRI for evaluation of persistent OSA after T&A and failed positive airway pressure (PAP) therapy were included. Clinical data and the apnea-hyponea index (AHI) were compared with quantitative and qualitative estimates of airway obstruction from imaging sequences.ResultsA total of 36 children were included with a mean age of 9.6 ± 4.6 (s.d.) years with 40% over 12 years of age. Two-thirds were boys. Seventeen of 36 children (47%) had Down syndrome. In 21 of 36 patients (58%), a single site and in 12 of 36 patients (33%) multilevel obstruction was identified. All cine MRIs were performed without complications. Multiple regression analysis demonstrated that a combination of the minimum airway diameter and body mass index z-score best predicted OSA severity (P = .002).ConclusionsCine MRI is a sensitive, safe and non-invasive modality for visualizing upper airway obstruction in children with persistent OSA after T&A. Accurate identification of obstruction can assist in surgical planning in children who fail PAP therapy.



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