Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy. (13th July 2021)

• Record Type: Journal Article
• Authors: Abijay, Claire A.; Tomkies, Anna; Rayasam, Swathi; Johnson, Romaine F.; Mitchell, Ron B.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 166:Number 3(2022)
• Page Start: 557
• Page End: 564
• Publication Date: 2021-07-13
• Subjects: obstructive sleep apnea -- Down syndrome -- tonsillectomy and adenoidectomy -- pediatrics -- asthma; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211023102
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. Study Design: Case series with chart review. Setting: UT Southwestern/Children's Medical Center Dallas. Methods: Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre‐ and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P ≤. 05 was considered significant. Results: Eighty‐one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea‐hypopnea index (27.9 to 14.0, P <. 001), arousal index (25.2 to 18.8, P =. 004), percent time with oxygen saturations <90% (8.8% to 3.4%, P =. 003), and oxygen nadir (81.4% to 85%, P <. 001). Forty‐seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea‐hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61‐14.09; P =. 005) and increasing age (odds ratio, 1.25; 95% CI, 1.09‐1.43; P =. 001). Conclusion: Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.