Ingram DG, et al. – In this assessment, the clinicians analyzed polysomnographic outcomes of children with Down syndrome (DS) who underwent tonsillectomy. Investigations revealed that children with DS and obstructive sleep apnea (OSA) who undergo tonsillectomy experienced improvements in both respiratory event frequency and gas exchange. However, approximately half still had moderate to severe residual OSA.

Methods

• The clinicians reviewed children with DS who underwent a tonsillectomy between 2009–2015.
• All children had either a concurrent adenoidectomy or had previously underwent an adenoidectomy.
• This study enrolled children with preoperative and postoperative polysomnograms within 6 months of surgery.
• 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

• 75 children with DS met inclusion criteria.
• In total 41 males and 34 females with mean age of 5.1 years (± 3.6 years), range of 0.51–16.60 years were included.
• 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.
• 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.