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Surgery for Obstructive Sleep Apnea in Children With Down Syndrome in an Australian Population
Rebecca Kim1, Arthur Teng1,2, Marlene Soma1,3
1School of Clinical Medicine, Women's Health Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia.
Insights
Obstructive sleep apnea (OSA) affects 65.8% of children with Down syndrome (DS). Surgical intervention significantly improves OSA severity, indicating potential benefits for this population.
Area of Science:
- Pediatric Pulmonology
- Genetics
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is more prevalent in children with Down syndrome (DS) compared to the general pediatric population.
- Surgical cure rates for OSA in children with DS are generally lower.
Purpose of the Study:
- To determine the prevalence and predictors of OSA in Australian children with DS.
- To evaluate the outcomes of surgical interventions for OSA in this cohort.
Main Methods:
- Retrospective chart review of 156 children (0-18 years) with DS who underwent polysomnography (PSG).
- Logistic regression analysis to identify OSA predictors (age, gender, BMI, tonsillar size).
- Comparison of pre-operative and post-operative PSG results to assess surgical outcomes.
Main Results:
- OSA prevalence was 65.8% at initial PSG.
- Elevated BMI (age >2 years) predicted OSA (OR=1.32).
- Male gender predicted higher apnea-hypopnea index (OAHI >5; OR=4.01).
- Adenotonsillectomy reduced median OAHI from 12.6 to 3.8 (P=.002).
- Secondary upper airway surgery reduced median OAHI from 8.5 to 2.6 (P=.075).
Conclusions:
- Children with DS and OSA who undergo surgery show improvements in PSG parameters.
- Surgical intervention may be an effective treatment for OSA in children with Down syndrome.
Objectives:
The prevalence of obstructive sleep apnea (OSA) is known to be higher in children with Down syndrome (DS) than the general pediatric population, with lower rates of surgical cure. This study aims to determine the prevalence and predictors of OSA and evaluate the outcomes of surgical intervention for OSA in a cohort of Australian children with DS.
Methodology:
A retrospective chart review was conducted on 156 patients with DS from 0 to 18 years who had undergone overnight, attended polysomnography (PSG) at Sydney Children's Hospital from January 2010 to July 2023. Logistic regression was used to assess associations between OSA and age, gender, body mass index (BMI), and tonsillar size. The outcomes of surgery were determined by comparing the pre-operative and post-operative PSG results.
Results:
The prevalence of OSA at first PSG was 65.8%, defined by an obstructive apnea-hypopnea index (OAHI) ≥1 event/hour. Elevated BMI in children above 2 years was associated with the presence of OSA (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.02-1.71). Male gender was a predictor for an OAHI >5 events/hour (OR = 4.01, 95% CI = 1.09-14.78). Among 35 patients who underwent adenotonsillectomy and had a valid pre-operative and post-operative PSG, median OAHI was reduced from 12.6 to 3.8 events/hour (P = .002). In 13 patients who had secondary upper airway surgery, median OAHI was reduced from 8.5 to 2.6 events/hour (P = .075).
Conclusion:
Children with DS and OSA who undergo surgical intervention may experience improvements to their PSG parameters.
