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Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome

Obinna R Diala1, Pinar Polat2,3, Kaci Pickett-Nairne4,5

  • 1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|July 21, 2024
PubMed

Insights

Children with Down syndrome (DS) and mild obstructive sleep apnea (OSA) may experience worsening symptoms after tonsillectomy and adenoidectomy (T&A). Regular follow-up polysomnograms (PSGs) are crucial for monitoring disease progression.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Genetics

Background:

  • Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS).
  • Tonsillectomy and adenoidectomy (T&A) is a common treatment for pediatric OSA, but long-term outcomes in DS patients are not well-documented.

Purpose of the Study:

  • To evaluate the long-term polysomnographic and symptomatic outcomes of T&A in children with DS.
  • To determine if the effectiveness of T&A in treating OSA in children with DS diminishes over time.

Main Methods:

  • Retrospective chart review of children with DS who underwent T&A between 2009 and 2015.
  • Inclusion criteria: initial postoperative polysomnogram (PSG) with an obstructive apnea/hypopnea index (OAHI) < 5.
  • Outcomes assessed via subsequent clinic visits and PSGs, monitoring OAHI, snoring, and time to recurrence.

Main Results:

  • Of 57 children with mild OSA post-T&A, 33% had OAHI ≥ 5 on a second PSG.
  • 22% of patients undergoing a third PSG progressed to moderate/severe OSA.
  • 30% of the initial cohort progressed to moderate/severe OSA, with a median follow-up of 2.3 years.

Conclusions:

  • Children with DS and mild OSA post-T&A are at risk of progressing to moderate or severe OSA within two years.
  • Surveillance PSGs approximately two years after surgery are recommended to identify children requiring further intervention.
Abstract

Keywords:
Down syndromelongitudinalobstructive sleep apneaoutcomespediatricssleep disordered breathingtonsillectomy and adenoidectomy

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