ADVERTISEMENT

Issue Navigator

Volume 13 No. 08
Earn CME
Accepted Papers
Classifieds





Scientific Investigations

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

David G. Ingram, MD1; Amanda G. Ruiz, BA2; Dexiang Gao, PhD3; Norman R. Friedman, MD2
1Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; 2Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; 3Department of Pediatrics, Child Health Research Biostatistics Core, University of Colorado School of Medicine, Aurora, Colorado

Study Objectives:

Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and associated with significant morbidity. In the current study we examined polysomnographic outcomes of children with DS who underwent tonsillectomy.

Methods:

A retrospective chart review of children with DS who underwent a tonsillectomy between 2009–2015 was performed. All children had either a concurrent adenoidectomy or had previously underwent an adenoidectomy. Children with preoperative and postoperative polysomnograms within 6 months of surgery were included in the analysis. Preoperative OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as follows: mild = 1.5–4.9 events/h; moderate = 5–9.9 events/h; severe ≥ 10 events/h.

Results:

Seventy-five children with DS met inclusion criteria. The cohort included 41 males and 34 females with mean age of 5.1 years (± 3.6 years), range of 0.51–16.60 years. Preoperative OSA severity was as follows, mild = 8/75; moderate = 16/75; severe = 51/75. Cure rates varied depending on definition: 12% for OAHI < 1 event/h and 21% for OAHI < 2 events/h. 48% had residual OAHI < 5 events/h. On postoperative PSG 16/75 saw resolution (OAHI < 2) in OSA; mild = 21/75; moderate = 20/75; severe = 18/75. 48% moderate/severe patients saw conversion to mild or cure. Overall, tonsillectomy resulted in significant improvements in multiple respiratory parameters, including OAHI (OAHI; 21.3 ± 19.7 to 8.0 ± 8.1, P < .001), percent sleep time with oxygen saturations < 90% (19.0 ± 25.0 to 6.1 ± 10.1, P < .001), and percent sleep time with end-tidal carbon dioxide above 50 mmHg (7.7 ± 18.0 to 1.8 ± 6.6, P = .001). Average asleep oxygen saturation was associated with postoperative OSA severity.

Conclusions:

Children with DS and OSA who undergo tonsillectomy experience improvements in both respiratory event frequency and gas exchange but approximately half still have moderate to severe residual OSA.

Citation:

Ingram DG, Ruiz AG, Gao D, Friedman NR. Success of tonsillectomy for obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2017;13(8):975–980.




Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.