Mieke Maris1, Stijn Verhulst2, Marek Wojciechowski2, Paul Van de Heyning1, An Boudewyns1. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium. 2. Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Abstract
OBJECTIVE: To evaluate the outcome of adenotonsillectomy (AT) in a cohort of children with Down syndrome (DS) and obstructive sleep apnoea (OSA). DESIGN: Retrospective, cross-sectional study. SETTING: Tertiary care centre. PATIENTS: Children with DS and OSA, without previous upper airway (UA) surgery. INTERVENTIONS: AT and full overnight polysomnography. MAIN OUTCOME RESULTS: A significant improvement of the obstructive apnoea-hypopnoea index (oAHI) after AT was obtained. No differences in sleep efficiency or sleep fragmentation were found postoperatively. Almost half of the children had persistent OSA (oAHI ≥5/hour). RESULTS: Data are presented as median (lower-upper quartile). Thirty-four children were included, median age 4.0 years (2.7-5.8), body mass index (BMI) z-score 0.81 (-0.46-1.76), and oAHI 11.4/hour (6.5-22.7). The majority presented with severe OSA (58.9%). AT was performed in 22 children, tonsillectomy in 10 and adenoidectomy in two. Postoperatively, a significant improvement of the oAHI was measured from 11.4/hour (6.5-22.7) to 3.6/hour (2.1-9.5) (p=0.001), with a parallel increase of the minimum oxygen saturation (p=0.008). Children with initially more severe OSA had significantly more improvement after UA surgery (p=0.001). Persistent OSA was found in 47.1% of the children. CONCLUSIONS: AT results in a significant improvement of OSA in children with DS without a change in sleep efficiency or sleep stage distribution. Severe OSA was associated with a larger reduction of OSA severity. Almost half of the children had persistent OSA, which was not correlated to age, gender or BMI z-score. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To evaluate the outcome of adenotonsillectomy (AT) in a cohort of children with Down syndrome (DS) and obstructive sleep apnoea (OSA). DESIGN: Retrospective, cross-sectional study. SETTING: Tertiary care centre. PATIENTS: Children with DS and OSA, without previous upper airway (UA) surgery. INTERVENTIONS: AT and full overnight polysomnography. MAIN OUTCOME RESULTS: A significant improvement of the obstructive apnoea-hypopnoea index (oAHI) after AT was obtained. No differences in sleep efficiency or sleep fragmentation were found postoperatively. Almost half of the children had persistent OSA (oAHI ≥5/hour). RESULTS: Data are presented as median (lower-upper quartile). Thirty-four children were included, median age 4.0 years (2.7-5.8), body mass index (BMI) z-score 0.81 (-0.46-1.76), and oAHI 11.4/hour (6.5-22.7). The majority presented with severe OSA (58.9%). AT was performed in 22 children, tonsillectomy in 10 and adenoidectomy in two. Postoperatively, a significant improvement of the oAHI was measured from 11.4/hour (6.5-22.7) to 3.6/hour (2.1-9.5) (p=0.001), with a parallel increase of the minimum oxygen saturation (p=0.008). Children with initially more severe OSA had significantly more improvement after UA surgery (p=0.001). Persistent OSA was found in 47.1% of the children. CONCLUSIONS: AT results in a significant improvement of OSA in children with DS without a change in sleep efficiency or sleep stage distribution. Severe OSA was associated with a larger reduction of OSA severity. Almost half of the children had persistent OSA, which was not correlated to age, gender or BMI z-score. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
Down syndrome; adenotonsillectomy; obstructive sleep apnea
Authors: Monique A L J Slaats; Dieter Loterman; Cedric van Holsbeke; Wim Vos; Kim Van Hoorenbeeck; Jan de Backer; Wilfried de Backer; Marek Wojciechowski; An Boudewyns; Stijn Verhulst Journal: J Clin Sleep Med Date: 2018-04-15 Impact factor: 4.062