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Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a
Lena Xiao1,2, Nicholas Barrowman2,3, Franco Momoli2,3,4
1Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.
Insights
Children with Down syndrome undergoing adenoidectomy and/or tonsillectomy face risks for perioperative respiratory adverse events (PRAEs). Lower average oxygen saturation during sleep is linked to increased PRAE risk in this population.
Area of Science:
- Pediatric Surgery
- Sleep Medicine
- Genetics
Background:
- Obstructive sleep apnea syndrome is a significant health concern in children with Down syndrome.
- Adenoidectomy and/or tonsillectomy (AT) are common treatments for sleep apnea in this population.
- Children with Down syndrome have a higher risk of perioperative respiratory adverse events (PRAEs) after AT.
Purpose of the Study:
- To identify risk factors for major PRAEs requiring intervention in children with Down syndrome undergoing AT.
- To describe the postoperative monitoring environment for these patients.
Main Methods:
- Retrospective study of children (0-18 years) with Down syndrome undergoing AT after polysomnography.
- Multivariable analysis to predict PRAEs, including oxygen saturation, apnea-hypopnea index, and comorbidities.
- Descriptive statistics to summarize patient characteristics and outcomes.
Main Results:
- Twelve out of fifty-eight children experienced a PRAE.
- Cardiac disease was a risk factor on univariable analysis (p=0.03).
- Lower average oxygen saturation during sleep was associated with PRAEs in multivariable analysis (OR 1.50, p=0.05).
Conclusions:
- Lower average oxygen saturation during sleep is associated with an increased risk of PRAEs requiring intervention in children with Down syndrome.
- Predicting complications in this population remains challenging.
Abstract:
Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy (AT). However, these children are at increased risk for perioperative respiratory adverse events (PRAEs). The objective of this study was to examine risk factors for major PRAEs requiring intervention in children with Down syndrome undergoing AT and to describe their postoperative monitoring environment. This retrospective study included all children with Down syndrome aged 0-18 years who underwent a preoperative polysomnogram followed by AT at a tertiary pediatric institution. Descriptive statistics were used to summarize baseline demographic and clinical characteristics. A multivariable model for prediction of PRAEs was constructed. A priori, it was decided that minimum oxygen saturation, apnea-hypopnea index, and average oxygen saturation asleep would be included, along with medical comorbidities associated with PRAEs at p < 0.2 in univariable analyses. Fifty-eight children were included in this study; twelve had a PRAE. Cardiac disease was associated with PRAEs on univariable analysis (p = 0.03). In multivariable analysis, average oxygen saturation asleep was associated with PRAEs (OR 1.50; 95% confidence interval 1.00, 2.41; p = 0.05). For all of the remaining variables, p > 0.15. Fifty-six children were admitted for monitoring overnight; four were admitted to the intensive care unit and fifty-two were admitted to the ward.
Conclusions:
A multivariable model found evidence that lower average oxygen saturation while asleep was associated with PRAEs requiring intervention in children with Down syndrome. This study highlights the difficulty in predicting complications in this population.
What Is Known:
• Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy. • However, children with Down syndrome are at increased risk for perioperative respiratory adverse events (PRAEs) following adenoidectomy and/or tonsillectomy.
What Is New:
• We found that a lower average oxygen saturation asleep is associated with increased odds of PRAEs, adjusting for age, total apnea-hypopnea index, cardiac comorbidity, and minimum oxygen saturation. • This study highlights the difficulty in predicting complications in this population.
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