Effect of Adenotonsillectomy on Central and Obstructive Sleep Apnea in Children with Down Syndrome

Abstract

Objectives

To determine and quantify changes in both central and obstructive sleep apnea in patients with Down syndrome (DS) after adenotonsillectomy (AT).

Study Design

Case series with chart review.

Setting

Tertiary care children’s hospital.

Subjects and Methods

The records of all patients with DS who underwent AT for sleep-disordered breathing between November 2008 and December 2014 were examined. In total, 113 patients were identified, and 36 of these patients had pre- and postoperative polysomnograms (PSGs) that were analyzed for obstructive and central components. Wilcoxon signed-rank test, paired t test, and McNemar test were used to examine pre- and postoperative PSG differences. Logistic regression and multivariate analysis of variance of patient characteristics (between subjects) and PSG results (within subjects) were conducted.

Results

The mean (SD) patient age was 5.5 (4.0) years (range, 0.9-15 years); 50.0% were male. After AT, significant reductions were identified in both obstructive apnea-hypopnea index (AHI) (P < .001) and overall AHI (P < .001). Among the 15 patients with severe obstructive sleep apnea, 86.7% experienced a significant AHI reduction to moderate or mild disease (P < .001). In addition, of the 15 patients with central sleep apnea (central apnea index [CAI] >1), 66.7% had resolution of central sleep apnea postoperatively (P = .004). There was also a significant interaction identified between CAI reduction, preoperative CO₂ retention, and adenoid size, F(2, 20) = 6.87, P = .05.

Conclusion

Children with DS who underwent AT demonstrated significant reductions in both obstructive and central apneic indices on PSG. A significant number of patients with central sleep apnea demonstrated resolution postoperatively. Additional analysis demonstrated a significant interaction between CO₂ retention, adenoid size, and postoperative CAI reduction.