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Comparison of treatment modalities in syndromic children with obstructive sleep apnea--a randomized cohort study

Shyam Sudhakar Sudarsan1, Vijaya Krishnan Paramasivan1, Senthil Vadivu Arumugam1

  • 1Madras ENT Research Foundation (P) Ltd, Chennai, India.

International Journal of Pediatric Otorhinolaryngology
|July 28, 2014
PubMed

Insights

Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) offer comparable outcomes for treating Obstructive Sleep Apnea (OSA) in syndromic children. T&A is a viable first-line option, providing gradual improvement over one year.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics and Rare Diseases

Background:

  • Obstructive Sleep Apnea (OSA) is increasingly recognized in children, with significantly higher prevalence (50-100%) in syndromic populations like Down syndrome (DS) and Mucopolysaccharidoses (MPS).
  • Pediatric OSA negatively impacts Quality-of-Life (QOL) and presents management challenges.
  • Thorough evaluation is crucial for effective intervention planning in syndromic children with OSA.

Purpose of the Study:

  • To compare the efficacy of Adenotonsillectomy (T&A) versus Continuous Positive Airway Pressure (CPAP) for treating Obstructive Sleep Apnea (OSA).
  • To evaluate treatment outcomes in syndromic children, specifically those with Down syndrome (DS) and Mucopolysaccharidoses (MPS).

Main Methods:

  • A prospective, randomized comparative study involving 124 syndromic children (DS and MPS) aged 6-12 years.
  • Initial assessments included Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C), and the OSA-18 QOL tool.
  • Eighty children with positive PSG were randomized into T&A or CPAP groups, followed for one year with repeat assessments.

Main Results:

  • Both T&A and CPAP groups demonstrated statistically significant improvements (p < 0.05) in Apnea-Hypoapnea Index (AHI), ESS-C scores, and QOL.
  • Adenotonsillectomy (T&A) yielded comparable outcomes to CPAP in the long term.
  • CPAP provided immediate, sustained symptom improvement, while T&A showed gradual, progressive improvement over the year.

Conclusions:

  • Adenotonsillectomy (T&A) offers similar efficacy to CPAP for managing OSA in syndromic children.
  • T&A can be considered a recommended first-line treatment option for this specific pediatric population.
  • Both interventions significantly improve AHI, sleepiness, and QOL in syndromic children with OSA.
Abstract

Keywords:
Continuous Positive Airway PressureDown syndromeESS-CMucopolysaccharidosesOSA-18Pediatric Obstructive Sleep Apnea

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