Long-term outcome after adenotonsillectomy in Down Syndrome with OSAS.

OBJECTIVES

The study aimed to evaluate short- and long-term polysomnographic parameters in children with Down Syndrome (DS) and Obstructive Sleep Apnea Syndrome (OSAS) submitted to surgical therapy. Secondarily, this study also aimed to describe how other congenital comorbidities influence sleep patterns and to present trends in Body Mass Index (BMI) percentile/Z-score after adenotonsillectomy in DS population.

METHODS

Longitudinal retrospective-cohort study of children with Down syndrome and respiratory sleep disorders. Patients with habitual snoring that underwent polysomnographic exams and surgical therapy were included (n = 54). We excluded patients >18-years old by the time of the surgery and who presented diagnostic polysomnography with Total Sleep Time (TST) <180 min, ending in a group of 25 children. The post-therapy parameters were divided in short- (<18-months) and long-term (>18-months) results, as heterogeneity in follow-up intervals occurred.

RESULTS

Of the 25 subjects, the short- and long-term Obstructive Apnea-Hypopnea Index (OAHI) were both significantly different from the pre-surgery value. However, there is also a difference between the short- and long-term OAHI post-surgery (p < 0.001). Children with laryngomalacia present the highest OAHI mean pre-surgery (56.7 ± 13.8).

CONCLUSIONS

Adeno/tonsillectomy for children with DS and OSAS brings a significant lowering on OAHI in a short- and long-term post-surgical follow-up, although long-term OAHI is significantly higher than the short-term. An extended polysomnographic post-surgical follow-up should be recommended. Due to the study limitations, further studies are still needed to clarify the best practice for this specific population.

LEVEL OF EVIDENCE: Level 3.

CLINICAL TRIAL REGISTRATION: Not applicable.