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Adenotonsillectomy outcomes in patients with D own syndrome and obstructive sleep apnea
Author(s) -
Farhood Zachary,
Isley Jonathan W.,
Ong Adrian A.,
Nguyen Shaun A.,
Camilon Terence J.,
LaRosa Angela C.,
White David R.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26398
Subject(s) - medicine , obstructive sleep apnea , interquartile range , polysomnography , tonsillectomy , apnea–hypopnea index , medline , sleep study , pediatrics , medical record , physical therapy , apnea , surgery , political science , law
Objective To review the literature for studies examining polysomnography (PSG) outcomes in patients with Down syndrome (DS) and obstructive sleep apnea (OSA) following adenotonsillectomy (T&A), and to review our experience with these patients. Data Sources PubMed‐NCBI, Scopus, Ovid, EBSCO, Cochrane, and EMBASE databases; tertiary academic center medical records. Review Methods A systematic review of the medical literature identified articles reporting objective outcomes following T&A for OSA treatment in patients with DS. Articles were critically appraised to assess level of evidence and bias, and the results of articles were summarized. A case series of confirmed patients with DS and OSA was conducted, evaluating T&A efficacy by comparing pre‐ and posttreatment PSG data. Results Six articles were identified, which demonstrated some improvement after T&A in the treatment of OSA; however, subjects frequently had persistent disease. At our institution, preoperative Apnea‐Hypopnea Index (AHI) improved from 13.75 (interquartile range [IQR] = 6.65–23.43) to 3.5 (IQR = 1.96–9.63) postoperatively; P = 0.004. Ten percent of patients had preoperative AHIs < 5; this proportion increased to 60% following surgery. Twenty percent of patients had postoperative AHIs < 1. Conclusion There is little objective data in the medical literature addressing T&A efficacy in treating OSA in patients with DS patients. Patients show objective improvement in sleep parameters following T&A for OSA. Adenotonsillectomy should be suggested as a first‐line treatment for children with DS and OSA, keeping in mind that monotherapy may be insufficient. Future studies utilizing objective measures are required to further quantify the effect in this patient population. Level of Evidence Laryngoscope , 127:1465–1470, 2017