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Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

David G Ingram1, Amanda G Ruiz2, Dexiang Gao3

  • 1Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|July 22, 2017
PubMed

Insights

Tonsillectomy improves respiratory function in children with Down syndrome and obstructive sleep apnea (OSA). However, about half of patients still experience moderate to severe residual OSA after surgery.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Genetics

Background:

  • Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS).
  • OSA in this population is linked to significant health issues and morbidity.
  • Tonsillectomy is a common surgical intervention for pediatric OSA.

Purpose of the Study:

  • To evaluate the polysomnographic outcomes in children with Down syndrome following tonsillectomy.
  • To assess the effectiveness of tonsillectomy in improving respiratory parameters in DS patients with OSA.

Main Methods:

  • Retrospective chart review of DS children who underwent tonsillectomy (2009-2015).
  • Inclusion criteria: preoperative and postoperative polysomnograms within 6 months of surgery, with or without concurrent/prior adenoidectomy.
  • Preoperative OSA severity classified by obstructive apnea-hypopnea index (OAHI).

Main Results:

  • 75 children with DS met inclusion criteria; 51/75 had severe preoperative OSA.
  • Tonsillectomy significantly improved OAHI (21.3 to 8.0, P < .001) and gas exchange parameters.
  • Postoperative cure rates varied (12% for OAHI < 1, 21% for OAHI < 2); 48% with moderate/severe OSA converted to mild or cured.

Conclusions:

  • Tonsillectomy offers significant respiratory improvements for children with DS and OSA.
  • Despite improvements, a substantial proportion (approx. 50%) continue to have moderate to severe residual OSA.
  • Further management strategies may be necessary for persistent OSA in this cohort.
Abstract

Keywords:
Down syndromechildgas exchangeobstructive sleep apneapolysomnographytonsillectomy

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