Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, KY40241, USA.
Department of Pediatrics, Norton Children's Research Institute, Affiliated with University of Louisville School of Medicine, Louisville, Kentucky, USA.
Sleep Breath. 2024 Oct;28(5):2213-2221. doi: 10.1007/s11325-024-03085-2. Epub 2024 Jun 19.
This study aimed to evaluate polysomnographic (PSG) outcomes of tonsillectomy and adenoidectomy (T&A) in children with Down Syndrome (DS) and OSA, and the difference in PSG outcomes of T&A between children with DS and age- and gender-matched normally developing (non-DS) children.
This was a single center retrospective study that included children with DS and OSA who underwent T&A and had pre-operative and post-operative PSG. The baseline and the differences of pre- and post-operative PSG variables were compared with those of an age- and gender-matched group of non-DS children.
Forty-eight children with DS were included in the study; the median age was 5 years (IQR 5.5), 58% were males, and the median BMI was 18.2 (IQR 3.3). There was statistically significant improvement noted between pre-operative and post-operative OAHI 17.9 ± 26.7 vs. 9.1 ± 13.6 (p = 0.022) and non-REM AHI 13.9 ± 19.7 vs. 6.9 ± 14.2 (p = 0.027). However, there were no significant changes in sleep architecture, oxygen desaturation nadir, or CO2 levels. 54.2% of the DS children continued to have moderate to severe OSA after T&A. Univariate logistic regression showed that for every 1% increase in oxygen desaturation nadir, the odds of having residual moderate or severe OSA decreased by 28% (p = 0.002) compared to the cured and mild OSA groups. There was no significant pre- and post-operative differences in PSG variables noted in 16 children with DS compared to age- and gender-matched non-DS children.
Despite the overall significant reduction of OAHI in children with DS and OSA who underwent T&A, there was a residual moderate to severe OSA in about half of the included children. Oxygen desaturation nadir was a predicting factor for persistent moderate to severe OSA. There were no significant pre- and post-operative PSG differences in between DS children compared to non-DS children.
本研究旨在评估扁桃体腺样体切除术（T&A）对唐氏综合征（DS）合并阻塞性睡眠呼吸暂停（OSA）患儿的多导睡眠图（PSG）结果，并比较 DS 患儿与年龄和性别相匹配的正常发育（非 DS）儿童 T&A 后 PSG 结果的差异。
这是一项单中心回顾性研究，纳入了接受 T&A 并具有术前和术后 PSG 的 DS 合并 OSA 患儿。比较了基线和术前术后 PSG 变量的差异与年龄和性别相匹配的非 DS 儿童组的差异。
本研究共纳入 48 例 DS 患儿，中位年龄为 5 岁（IQR 5.5），58%为男性，中位 BMI 为 18.2（IQR 3.3）。术前和术后 OAHI 分别为 17.9±26.7 和 9.1±13.6（p=0.022），非快速眼动（REM）期 AHI 分别为 13.9±19.7 和 6.9±14.2（p=0.027），差异有统计学意义。然而，睡眠结构、氧饱和度下降最低点和二氧化碳水平均无显著变化。54.2%的 DS 患儿 T&A 后仍有中重度 OSA。单因素逻辑回归显示，与治愈和轻度 OSA 组相比，每增加 1%的氧饱和度下降最低点，持续中重度 OSA 的可能性降低 28%（p=0.002）。与年龄和性别相匹配的非 DS 儿童相比，16 例 DS 儿童的 PSG 变量在术前和术后均无显著差异。
尽管接受 T&A 的 DS 合并 OSA 患儿的 OAHI 总体显著降低，但仍有一半左右的患儿存在中重度 OSA。氧饱和度下降最低点是持续中重度 OSA 的预测因素。与非 DS 儿童相比，DS 儿童术前和术后的 PSG 差异无统计学意义。
