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  • Title: Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea.
    Author: Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A.
    Journal: Arch Dis Child; 2017 Apr; 102(4):331-336. PubMed ID: 27484971.
    Abstract:
    OBJECTIVE: To evaluate the outcome of adenotonsillectomy (AT) in a cohort of children with Down syndrome (DS) and obstructive sleep apnoea (OSA). DESIGN: Retrospective, cross-sectional study. SETTING: Tertiary care centre. PATIENTS: Children with DS and OSA, without previous upper airway (UA) surgery. INTERVENTIONS: AT and full overnight polysomnography. MAIN OUTCOME RESULTS: A significant improvement of the obstructive apnoea-hypopnoea index (oAHI) after AT was obtained. No differences in sleep efficiency or sleep fragmentation were found postoperatively. Almost half of the children had persistent OSA (oAHI ≥5/hour). RESULTS: Data are presented as median (lower-upper quartile). Thirty-four children were included, median age 4.0 years (2.7-5.8), body mass index (BMI) z-score 0.81 (-0.46-1.76), and oAHI 11.4/hour (6.5-22.7). The majority presented with severe OSA (58.9%). AT was performed in 22 children, tonsillectomy in 10 and adenoidectomy in two. Postoperatively, a significant improvement of the oAHI was measured from 11.4/hour (6.5-22.7) to 3.6/hour (2.1-9.5) (p=0.001), with a parallel increase of the minimum oxygen saturation (p=0.008). Children with initially more severe OSA had significantly more improvement after UA surgery (p=0.001). Persistent OSA was found in 47.1% of the children. CONCLUSIONS: AT results in a significant improvement of OSA in children with DS without a change in sleep efficiency or sleep stage distribution. Severe OSA was associated with a larger reduction of OSA severity. Almost half of the children had persistent OSA, which was not correlated to age, gender or BMI z-score.
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