Abstract
Objectives: Given that 30-50% of children with Down syndrome have
persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we
evaluated whether demographic, clinical and polysomnographic factors
predicted persistent OSA and OSA severity after adenotonsillectomy.
Design: Retrospective study. Setting: Secondary care hospital.
Participants: Retrospective review of 32 children with the diagnosis of
DS and OSA by polysomnography type 1 who underwent adenotonsillectomy,
from January 2010 to December 2018. Main outcome and measure:
Non-parametric analysis was used to compare pre and postoperative
factors, regression was used to model persistent OSA and OSA severity.
Results: Thirty-two children were included (17 male, median age 10.00 ±
8.00 years, median body mass index z-score 0.89 ± 1.25). Overall,
adenotonsillectomy resulted in a significant improvement in median
obstructive apnea-hypopnea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38
events per hour (p<0.001) and in median OSA-18 score from
85.00 ± 12.00 to 61 ± 37.75 (p<0.001). Persistent OSA was
found in 56.25% of the children. Univariate regression suggests that
postoperative OSA-18 score predicted persistent OSA after
adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation
rate, pre and postoperative OSA-18 scores correlated with OSA severity
after adenotonsillectomy. However, in a multivariate model only the
postoperative OSA-18 score was able to predict OSA severity after
adenotonsillectomy. Conclusions: Although adenotonsillectomy results in
a significant improvement of OSA in children with Down syndrome, more
than half of the children had persistent OSA. The postoperative OSA-18
score predicted both persistent OSA and OSA severity after
adenotonsillectomy.