Claire A Abijay1, Anna Tomkies2, Swathi Rayasam3, Romaine F Johnson3, Ron B Mitchell4. 1. UT Southwestern Medical School, Dallas, Texas, USA. 2. Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, USA. 3. Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA. 4. Department of Otolaryngology Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA.
Abstract
OBJECTIVE: To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. STUDY DESIGN: Case series with chart review. SETTING: UT Southwestern/Children's Medical Center Dallas. METHODS: Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre- and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P≤ .05 was considered significant. RESULTS: Eighty-one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea-hypopnea index (27.9 to 14.0, P < .001), arousal index (25.2 to 18.8, P = .004), percent time with oxygen saturations <90% (8.8% to 3.4%, P = .003), and oxygen nadir (81.4% to 85%, P < .001). Forty-seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea-hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61-14.09; P = .005) and increasing age (odds ratio, 1.25; 95% CI, 1.09-1.43; P = .001). CONCLUSION: Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.
OBJECTIVE: To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. STUDY DESIGN: Case series with chart review. SETTING: UT Southwestern/Children's Medical Center Dallas. METHODS: Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre- and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P≤ .05 was considered significant. RESULTS: Eighty-one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea-hypopnea index (27.9 to 14.0, P < .001), arousal index (25.2 to 18.8, P = .004), percent time with oxygen saturations <90% (8.8% to 3.4%, P = .003), and oxygen nadir (81.4% to 85%, P < .001). Forty-seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea-hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61-14.09; P = .005) and increasing age (odds ratio, 1.25; 95% CI, 1.09-1.43; P = .001). CONCLUSION: Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.
Entities:
Keywords:
Down syndrome; asthma; obstructive sleep apnea; pediatrics; tonsillectomy and adenoidectomy
Authors: M Bruce Edmonson; Qianqian Zhao; David O Francis; Michelle M Kelly; Daniel J Sklansky; Kristin A Shadman; Ryan J Coller Journal: JAMA Date: 2022-06-21 Impact factor: 157.335