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The effect of adenotonsillectomy on obstructive sleep apnea in children with Down syndrome
Mosaad Abdel-Aziz1, Khaled Azooz1, Nader Naguib2
1a Department of Otolaryngology, Faculty of Medicine , Cairo University , Cairo , Egypt.
Insights
Adenotonsillectomy effectively treats obstructive sleep apnea (OSA) in children with Down syndrome (DS). Surgery significantly reduced apnea-hypopnea index (AHI) in most patients, though some may still experience residual airway narrowing.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Genetics
Background:
- Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA) due to anatomical airway abnormalities.
- Enlarged tonsils and adenoids are common contributors to airway obstruction in DS patients.
Purpose of the Study:
- To evaluate the efficacy of adenotonsillectomy in treating OSA in children with Down syndrome.
- To assess the impact of adenotonsillectomy on polysomnographic parameters in DS children with OSA.
Main Methods:
- Fifty children with Down syndrome and breathing difficulties underwent polysomnography (PSG) to diagnose OSA (apnea-hypopnea index [AHI] > 1).
- Patients diagnosed with OSA and adenotonsillar hypertrophy underwent adenotonsillectomy.
- Postoperative PSG was performed after 3 months to compare with preoperative findings.
Main Results:
- Out of 50 recruited children, 43 were diagnosed with OSA and included in the study.
- The mean AHI significantly decreased from 9.18 preoperatively to 2.72 postoperatively, with 72% of patients achieving normalized AHI.
- Significant improvements were observed in arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO2 levels.
Conclusions:
- Adenotonsillectomy is a highly effective treatment for obstructive sleep apnea in children with Down syndrome.
- Persistent OSA may occur in some DS patients, potentially due to multilevel airway narrowing.
Objective:
Children with Down syndrome (DS) are liable to develop obstructive sleep apnea (OSA) due to many anatomical airway abnormalities. The tonsils and adenoid occupy part of the airway space, and their removal may be helpful in relieving airway obstruction. The aim of this study was to assess the effectiveness of adenotonsillectomy in the treatment of OSA in those children.
Methods:
Fifty DS children with difficult breathing were recruited, and they were subjected to polysomnographic examination (PSG). Patients with apnea-hypopnea index (AHI) > 1 were considered to have OSA. Adenotonsillectomy was performed for patients who had OSA and adenotonsillar hypertrophy, and after 3 months PSG was done for them with recording of the same preoperative parameters.
Results:
Forty-three children demonstrated OSA on PSG, and they were included in the study. The preoperative mean AHI was 9.18 (± 6.17) that improved postoperatively to 2.72 (± 3.80) with its normalization in 72% of patients. Also, significant improvement of arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO2 was achieved postoperatively.
Conclusion:
Adenotonsillectomy is an effective method for the treatment of OSA in children with DS. However, the condition may persist in some children who usually have airway narrowing at multiple levels.