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Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea
  1. Mieke Maris1,
  2. Stijn Verhulst2,
  3. Marek Wojciechowski2,
  4. Paul Van de Heyning1,
  5. An Boudewyns1
  1. 1Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
  2. 2Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
  1. Correspondence to Professor An Boudewyns, Antwerp University Hospital, Wilrijkstraat 10, Edegem (Antwerp) B-2650, Belgium; an.boudewyns{at}uza.be

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.

  • Down syndrome
  • obstructive sleep apnea
  • adenotonsillectomy

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