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

Ingram, David G.; Ruiz, Amanda G.; Gao, Dexiang; Friedman, Norman R.

doi:10.5664/jcsm.6698

Cited by 48 publications

(66 citation statements)

References 32 publications

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“…11 Adenotonsillectomy (T&A) remains the first-line treatment for young children with Down syndrome who have OSA. 12 Other treatments for SDB may include positive airway pressure (PAP) treatment or lingual tonsillectomy. While there is available data describing the use of these treatments, 13 there is little data available that assesses the long-term outcome of these treatment options.…”

Section: Sdb Can Occur In Children Withmentioning

confidence: 99%

“…A recent study in children with Down syndrome has demonstrated that T&A improves OSA, but that approximately 50% have residual moderate-severe SDB that persists within 6 months after this procedure. 12 It may also ultimately assist in guiding the choice of treatments for OSA in this population. The primary objectives of this study were to characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB in a retrospective longitudinal cohort of children with Down syndrome across the pediatric age range.…”

Section: Sdb Can Occur In Children Withmentioning

confidence: 99%

“…Previous studies have also shown that moderate to severe OSA in children with Down syndrome is likely to persist after a tonsillectomy. 12 Another study demonstrated that the success rate for T&A in children with Down syndrome and OSA varies based on numerous patient factors and may only be a successful treatment in 50% of cases. 21 Patient factors in that study that were associated with a risk for persistent SDB included anatomically narrowed airways and lingual tonsillar hypertrophy.…”

Section: Interventions For Sdb On Initial and Subsequent Psgmentioning

confidence: 99%

“…Adenotonsillectomy (T&A) remains the first‐line treatment for young children with Down syndrome who have OSA . Other treatments for SDB may include positive airway pressure (PAP) treatment or lingual tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

“…While there is available data describing the use of these treatments, there is little data available that assesses the long‐term outcome of these treatment options. A recent study in children with Down syndrome has demonstrated that T&A improves OSA, but that approximately 50% have residual moderate‐severe SDB that persists within 6 months after this procedure . Persistent SDB after a T&A was completely resolved in 19% of a sample of 40 children with Down syndrome by undergoing a lingual tonsillectomy …”

Section: Introductionmentioning

confidence: 99%

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Treatment and persistence/recurrence of sleep‐disordered breathing in children with Down syndrome

Nehme

LaBerge

Pothos

et al. 2019

Pediatric Pulmonology

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Objective Sleep‐disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long‐term outcomes are not well‐described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence. Methods A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)‐mixed (apnea‐hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z‐score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB. Results Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive‐mixed AHI (P = .01). Thirty‐five of fifty‐four (65%) were initially diagnosed with OSA‐mixed SDB. After first PSG, 67 of 120 had OSA‐mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA‐mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z‐score at first SDB. Conclusion Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z‐score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.

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Section: Sdb Can Occur In Children Withmentioning

confidence: 99%

Section: Sdb Can Occur In Children Withmentioning

confidence: 99%

Section: Interventions For Sdb On Initial and Subsequent Psgmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment and persistence/recurrence of sleep‐disordered breathing in children with Down syndrome

Nehme

LaBerge

Pothos

et al. 2019

Pediatric Pulmonology

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Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Pierce

Brietzke

2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Tonsil size assessment on physical examination is often used as a key component of clinical decision-making, specifically in estimating the success or failure of adenotonsillectomy surgery. The accuracy of this approach is not specifically known.OBJECTIVE To systematically review the biomedical literature for data comparing subjective preoperative tonsil (and adenoid) size (0-to >4-point scale) with adenotonsillectomy outcomes using polysomnography and/or quality of life outcomes. EVIDENCE REVIEW A PubMed and Embase search was conducted from June 1, 2018, through November 1, 2018, to identify articles comparing preoperative subjective tonsil and adenoid size with surgical outcomes. Key search terms included adenotonsillectomy, tonsil size, Brodsky scale, apnea-hypopnea index, OSA-18, polysomnography, and quality of life, with limits of 0 to 18 years of age. Inclusion criteria included articles on pediatric patients only, articles on patients who underwent tonsillectomy or adenotonsillectomy, and articles that included presurgical and postsurgical data. Exclusion criteria included patients who received surgery beyond adenotonsillectomy and studies that did not compare tonsil and adenoid size grades with surgical outcomes. FINDINGS A total of 27 studies were included in the final data set. The mean sample size was 79.7 (range, 17-250), and the mean age was 6.3 years (range, 4.2-12.8 years). Case series was the predominant study design (20 studies). Fourteen studies specifically excluded obesity and craniofacial syndromes, whereas 2 studies addressed patients with trisomy 21 only, and 5 studies focused on patients with obesity. Outcome measures included polysomnography (19 studies), Obstructive Sleep Apnea 18 survey (4 studies), Obstructive Sleep Apnea 6 (1 study), oxygen desaturation index (1 study), and overnight pulse oximetry (1 study). Ten studies conducted postoperative evaluations within 90 days of the intervention, and 17 studies had greater than 90-day follow-up. A total of 22 of the 27 studies (81.5%) concluded that there was no association between tonsil and adenoid size and surgical outcome, whereas 5 studies (18.5%) concluded that there was an association. Studies that found no association had a higher mean quality score than those that found an association (15.6 vs 14.5; difference in means, 1.13; 95% CI, 0.07-2.19). CONCLUSIONS AND RELEVANCEMost published clinical evidence suggests that subjective tonsil and adenoid size is not reliably associated with adenotonsillectomy success or failure because success rates are typically high regardless of tonsil size. Physicians should understand the potential limitations of using tonsil size alone as the key component of clinical decision-making for adenotonsillectomy.

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Evaluation of Upper Airway Stimulation for Adolescents With Down Syndrome and Obstructive Sleep Apnea

Stenerson

Ishman

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPatients with Down syndrome have a high incidence of persistent obstructive sleep apnea (OSA) and limited treatment options. Upper airway hypoglossal stimulation has been shown to be effective for adults with OSA but has not yet been evaluated for pediatric populations.OBJECTIVE To evaluate the safety and effectiveness of upper airway stimulation for adolescent patients with Down syndrome and severe OSA.DESIGN, SETTING, AND PARTICIPANTS This prospective single-group multicenter cohort study with 1-year follow-up was conducted between April 1, 2015, and July 31, 2021, among a referred sample of 42 consecutive adolescent patients with Down syndrome and persistent severe OSA after adenotonsillectomy.INTERVENTION Upper airway stimulation. MAIN OUTCOMES AND MEASURESThe prespecified primary outcomes were safety and the change in apnea-hypopnea index (AHI) from baseline to 12 months postoperatively. Polysomnographic and quality of life outcomes were assessed at 1, 2, 6, and 12 months postoperatively. RESULTS Among the 42 patients (28 male patients [66.7%]; mean [SD] age, 15.1 [3.0] years), there was a mean (SD) decrease in AHI of 12.9 (13.2) events/h (95% CI, -17.0 to -8.7 events/h). With the use of a therapy response definition of a 50% decrease in AHI, the 12-month response rate was 65.9% (27 of 41), and 73.2% of patients (30 of 41) had a 12-month AHI of less than 10 events/h. The most common complication was temporary tongue or oral discomfort, which occurred in 5 patients (11.9%). The reoperation rate was 4.8% (n = 2). The mean (SD) improvement in the OSA-18 total score was 34.8 (20.3) (95% CI, -42.1 to -27.5), and the mean (SD) improvement in the Epworth Sleepiness Scale score was 5.1 (6.9) (95% CI, -7.4 to -2.8). The mean (SD) duration of nightly therapy was 9.0 (1.8) hours, with 40 patients (95.2%) using the device at least 4 hours a night.CONCLUSIONS AND RELEVANCE Upper airway stimulation was able to be safely performed for 42 adolescents who had Down syndrome and persistent severe OSA after adenotonsillectomy with positive airway pressure intolerance. There was an acceptable adverse event profile with high rates of therapy response and quality of life improvement.

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

Cited by 48 publications

References 32 publications

Treatment and persistence/recurrence of sleep‐disordered breathing in children with Down syndrome

Treatment and persistence/recurrence of sleep‐disordered breathing in children with Down syndrome

Association of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes

Evaluation of Upper Airway Stimulation for Adolescents With Down Syndrome and Obstructive Sleep Apnea

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