OSAS in Down syndrome: T&A versus T&A plus lateral pharyngoplasty

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Genetics

Background:

• Obstructive Sleep Apnea Syndrome (OSAS) is prevalent in children with Down syndrome (DS).
• Adenotonsillectomy (T&A) is a common initial surgical approach, but its effectiveness in this population requires objective evaluation.
• Previous outcome assessments relied on subjective parental reports, necessitating studies using objective data.

Purpose of the Study:

• To objectively compare the efficacy of T&A versus T&A plus lateral pharyngoplasty as initial surgical treatments for OSAS in children with DS.
• To utilize polysomnography (PSG) for evaluating post-operative outcomes.

Main Methods:

• A retrospective study compared two groups of pediatric patients with OSAS and DS.
• Group 1 (n=21) underwent T&A; Group 2 (n=16) had T&A plus lateral pharyngoplasty.
• Post-operative PSG data, including apnea/hypopnea index (AHI), hypoxemia, hypercarbia, and arousal index, were analyzed.

Main Results:

• Following T&A alone, 48% of patients had elevated AHI, rising to 67% when hypoxemia and hypercarbia were considered.
• After T&A with lateral pharyngoplasty, 63% had elevated AHI, and 75% showed abnormalities including hypoxemia and hypercarbia.
• No statistically significant difference in treatment outcomes was observed between the two surgical approaches.

Conclusions:

• While T&A may offer some improvement, approximately one-third of pediatric patients with OSAS and DS achieve normal post-operative sleep study results.
• The addition of lateral pharyngoplasty to T&A does not appear to enhance surgical treatment outcomes for OSAS in this cohort.
• Further research employing objective outcome measures is crucial to identify optimal first-line surgical interventions for pediatric DS patients with OSAS.