Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy

Objective: To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. Study Design: Case series with chart review. Setting: UT Southwestern/Children’s Medical Center Dallas. Methods: Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre- and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P≤.05 was considered significant. Results: Eighty-one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea-hypopnea index (27.9 to 14.0, P <.001), arousal index (25.2 to 18.8, P =.004), percent time with oxygen saturations <90% (8.8% to 3.4%, P =.003), and oxygen nadir (81.4% to 85%, P <.001). Forty-seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea-hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61-14.09; P =.005) and increasing age (odds ratio, 1.25; 95% CI, 1.09-1.43; P =.001). Conclusion: Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.