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Published on: December 6, 2016
Down syndrome and pediatric obstructive sleep apnea surgery: A national cohort
Adrian A Ong1, Carlyn M Atwood2, Shaun A Nguyen2
1Department of Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Insights
Pediatric sleep surgery trends show a decrease in tonsillectomy with adenoidectomy for children with Down syndrome (DS) and obstructive sleep apnea (OSA). Other procedures, like lingual tonsillectomies, increased, particularly in the DS population.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Genetics and Rare Diseases
Background:
- Obstructive sleep apnea (OSA) is a common comorbidity in children with Down syndrome (DS).
- Sleep surgery is a primary treatment for pediatric OSA, but trends vary between syndromic and nonsyndromic populations.
- Understanding surgical trends is crucial for optimizing care in children with DS and OSA.
Purpose of the Study:
- To analyze trends in sleep surgeries for pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA).
- To compare these trends with those in nonsyndromic (NS) children diagnosed with OSA.
- To identify shifts in surgical procedures over time for both groups.
Main Methods:
- Retrospective cohort database analysis utilizing the Kid's Inpatient Database (1997-2012).
- International Classification of Diseases, Ninth Revision codes were used to identify patients with OSA.
- Subgroup analysis was performed for children with DS and NS children with OSA to compare surgical trends.
Main Results:
- A total of 48,301 sleep surgeries in NS children and 2,991 in children with DS were identified.
- Tonsillectomy with adenoidectomy was the most frequent procedure but decreased over time in both groups (P < .01).
- Proportions of palatal surgery and tracheostomy decreased, while lingual tonsillectomies, tongue-base reduction, and supraglottoplasties increased, with higher rates of change in the DS population.
Conclusions:
- While tonsillectomy with adenoidectomy remains common, there's a significant rise in other sleep surgeries, especially for children with DS.
- The observed increase in procedures like lingual tonsillectomy, tongue-base reduction, and supraglottoplasty highlights evolving surgical management strategies.
- These trends suggest a shift towards more targeted interventions for complex airway issues in pediatric OSA, particularly in the DS population.
Objectives/Hypothesis:
To analyze the trend of sleep surgeries in pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA), and to compare this to nonsyndromic (NS) children with OSA.
Study Design:
Retrospective cohort database analysis.
Methods:
Analysis of the 1997 to 2012 editions of the Kid's Inpatient Database was conducted. Using International Classification of Diseases, Ninth Revision codes, all patients with OSA were identified, and subsequently, subgroups of NS children and children with DS were identified. Trends of the number and types of sleep surgeries were analyzed.
Results:
A total of 48,301 and 2,991 sleep surgeries were identified in the NS and DS groups, respectively, during the study period. Tonsillectomy with adenoidectomy was the most common procedure in both groups, but the proportion of tonsillectomy with adenoidectomy decreased over time (P < .01). The proportion of palatal surgery and tracheostomy also decreased significantly, whereas there was an increase in the proportion of lingual tonsillectomies, tongue-base reduction procedures, and supraglottoplasties performed in both groups over time. The relative rates of change in these procedures were higher in the DS population.
Conclusions:
Tonsillectomy with adenoidectomy remains the most commonly performed procedure, although there was a significant increase in other sleep surgeries performed (lingual tonsillectomy, tongue-base reduction, and supraglottoplasty) between the two study periods, especially in children with DS.
Level Of Evidence:
2c. Laryngoscope, 1963-1969, 2018.
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