The effect of adenotonsillectomy on obstructive sleep apnea in children with Down syndrome^*

Abstract

Objective: Children with Down syndrome (DS) are liable to develop obstructive sleep apnea (OSA) due to many anatomical airway abnormalities. The tonsils and adenoid occupy part of the airway space, and their removal may be helpful in relieving airway obstruction. The aim of this study was to assess the effectiveness of adenotonsillectomy in the treatment of OSA in those children.

Methods: Fifty DS children with difficult breathing were recruited, and they were subjected to polysomnographic examination (PSG). Patients with apnea-hypopnea index (AHI) > 1 were considered to have OSA. Adenotonsillectomy was performed for patients who had OSA and adenotonsillar hypertrophy, and after 3 months PSG was done for them with recording of the same preoperative parameters.

Results: Forty-three children demonstrated OSA on PSG, and they were included in the study. The preoperative mean AHI was 9.18 (± 6.17) that improved postoperatively to 2.72 (± 3.80) with its normalization in 72% of patients. Also, significant improvement of arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO₂ was achieved postoperatively.

Conclusion: Adenotonsillectomy is an effective method for the treatment of OSA in children with DS. However, the condition may persist in some children who usually have airway narrowing at multiple levels.

Chinese abstract

目的: 由于呼吸道解剖特征异常, 患有唐氏综合症的儿童 (DS) 易发生阻塞性睡眠呼吸暂停 (OSA) 。扁桃体和腺样体占据呼吸道空间的一部分, 将它去除可能有助于缓解呼吸道阻塞。本研究的目的是评估腺瘤切除术治疗儿童OSA的疗效。

方法: 招募了五十名呼吸困难的DS儿童, 并对其进行多导睡眠图检查 (PSG) 。呼吸暂停低通气指数 (AHI) > 1的患者被认为具有OSA。对于具有OSA和腺瘤肥大的患者进行腺瘤切除术, 并且在3个月后, 对于具有相同术前参数记录的患者进行PSG检查。

结果: 43名儿童的PSG证明患有OSA, 并将他们纳入研究。术前平均AHI为9.18 (±6.17) , 术后改善为2.72 (±3.80) , 其中72%的患者获得正常化。此外, 术后取得了苏醒指数、最小氧饱和度、去饱和指数和呼气CO₂峰值的显著改善。

结论: 腺瘤切除术是用DS治疗儿童OSA的有效方法。然而, 一些通常多种程度气道狭窄的儿童, OSA可能会持续下去。

Keywords:

• Down syndrome
• obstructive sleep apnea
• adenotonsillar hypertrophy
• adenotonsillectomy

Disclosure statement

The authors declare that they have no conflict of interest.