Effects of adeno-tonsillectomy on polysomnography patterns in Down syndrome children with obstructive sleep apnea: A comparative study with children without Down syndrome

Abstract

Objective To determine if adeno-tonsillectomy (T&A) in children with Down syndrome (DS) improves breathing, measured by apnea hypopnea index (AHI), rapid eye movement AHI (REM-AHI) and the lowest oxygen desaturation (SaO 2), and sleep disruption, measured by arousal index (ArI) and time spent in stages 1–4 and rapid eye movement (REM) sleep and compare these results with a group of non-DS children with obstructive sleep apnea (OSA). Study design Retrospective chart review at pediatric sleep center. Patients Eleven DS and nine non-DS children underwent pre- and post-T&A polysomnography between 1997 and 2005. Outcome measures Pre- and post-T&A polysomnography parameters were compared using paired t-test and independent samples test. Results Mean age in DS group was 101 months and non-DS group was 80 months (64% males in DS and 88% in non-DS group). The average BMI was 29.8 and 27.6 for DS and non-DS group. The total AHI showed significant improvement after T&A but this was not as marked as the non-DS group. REM-AHI and lowest SaO 2 did not show significant change in the DS children. The non-DS group showed significant improvement in all respiratory parameters. Both groups showed mild improvement in sleep parameters. With the modest overall improvement, 27% of the DS children required no further treatment. However, 73% required CPAP, BiPAP or oxygen for persistent OSA. Conclusion This study supports the fact that T&A in DS children improves some parameters of OSA, however not as markedly as in non-DS children.