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Senthilvel E, Jawad K, Gearhart AM, Naidugari JR, El-Kersh K. Adenotonsillectomy outcomes in children with down syndrome and obstructive sleep apnea: a single center study. Sleep Breath 2024:10.1007/s11325-024-03085-2. [PMID: 38896208 DOI: 10.1007/s11325-024-03085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, KY40241, USA.
| | - Kahir Jawad
- Department of Pediatrics, Norton Children's Research Institute, Affiliated with University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Alessandra M Gearhart
- Department of Pulmonary, Critical Care and Sleep Medicine, Oklahoma State University, Tulsa, OK, USA
| | - Janki R Naidugari
- University of Louisville School of Medicine, Louisville, Kentucky,, USA
| | - Karim El-Kersh
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Li Y, Du J, Yin H, Wang Y. Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta-analysis. J Sleep Res 2024; 33:e13946. [PMID: 37226964 DOI: 10.1111/jsr.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea-hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta-analysis of the AHI showed a decrease of 7.18 events/h [95% CI (-9.69, -4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (-0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by -3.21 events/hour [95% CI (-6.04, -0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%-21%) for postoperative AHI < 1 and 57% (95% CI, 51%-63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies.
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Affiliation(s)
- Yixuan Li
- Kunshan Maternity and Children's Health Care Hospital, Department of Otolaryngology, Kunshan, China
| | - Jihong Du
- Kunshan Maternity and Children's Health Care Hospital, Department of Otolaryngology, Kunshan, China
| | - Hongyu Yin
- Kunshan Maternity and Children's Health Care Hospital, Department of Otolaryngology, Kunshan, China
| | - Yang Wang
- Kunshan Maternity and Children's Health Care Hospital, Department of Otolaryngology, Kunshan, China
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Senthilvel E, Jawad K, Gunaratnam B, Mian JN, El-Kersh K. Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome. Sleep Breath 2024; 28:251-260. [PMID: 37563524 DOI: 10.1007/s11325-023-02900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution. METHODS Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1.5-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups. RESULTS PSG data were available for 192 children with a median age of 5 years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in the supine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA. CONCLUSION Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in the supine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, 40241, USA.
| | - Kahir Jawad
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, 40241, USA
| | | | | | - Karim El-Kersh
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Eitan D, Cave T, Scheffler P. Effect of adenotonsillectomy on central sleep apnea: A scoping review. Int J Pediatr Otorhinolaryngol 2024; 177:111863. [PMID: 38262224 DOI: 10.1016/j.ijporl.2024.111863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of adenotonsillectomy (A&T) on reducing central sleep apnea (CSA) in children and adolescents with obstructive sleep apnea (OSA). METHODS A review of the PubMed database was conducted. Two researchers independently reviewed the articles from the literature search and selected papers for further review if they met inclusion criteria. Included studies were prospective studies and case series whose patients were children 18 years or younger undergoing adenotonsillectomy for obstructive sleep apnea with reported pre and postoperative central apnea indexes (CAI). RESULTS Of the 107 articles initially identified, 18 underwent full length review, and ultimately 15 for final review. All studies reported marked improvement of central sleep apnea indexes after adenotonsillectomy. Two studies found resolution of CSA in 66.7 % and 73.7 % of patients respectively. The remaining four studies found significant reductions in CAI in 43.9 %-93 % of patients. The degree of reduction varied from 40.9 % to 80 %. DISCUSSION Adenotonsillectomy improves and at times resolves CSA in pediatric patients with concomitant OSA.
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Affiliation(s)
- Dana Eitan
- Creighton University School of Medicine, Phoenix, AZ, USA.
| | - Taylor Cave
- Department of Otolaryngology- Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Patrick Scheffler
- Department of Otolaryngology- Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
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Chabuz CA, Lackey TG, Pickett KL, Friedman NR. Accuracy of parental perception of nighttime breathing in children with Down syndrome after adenotonsillectomy. J Clin Sleep Med 2024; 20:237-243. [PMID: 37858282 PMCID: PMC10835771 DOI: 10.5664/jcsm.10850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Clinical practice guidelines recommend screening all children with Down syndrome for obstructive sleep apnea with polysomnography by age 4 years. Because persistent obstructive sleep apnea (obstructive apnea-hypopnea index > 1 event/h) following adenotonsillectomy (T&A) is common in children with Down syndrome, it is important to know whether clinicians can rely on parental assessment postoperatively. The primary objective is to identify accuracy of parental perception of nighttime breathing following T&A compared with preoperative assessment. METHODS Patients with Down syndrome who underwent T&A along with polysomnography prior to and after the surgical procedure were included. Parents completed a 3-question pre- and postsurgery survey regarding nighttime symptoms. The responses were categorized into 3 groups: infrequent (< 3 nights/wk), sometimes (> 3 nights/wk but < 6 nights/wk), or frequent (≥ 6 nights/wk) on at least 1 question. The primary end point was identifying the accuracy of parental perception of nighttime breathing in children with Down syndrome following T&A. RESULTS A total of 256 children met inclusion criteria, of which 117 (46%) were included. A total of 71 (68%) children had an obstructive apnea-hypopnea index > 5 events/h preoperatively compared with 55 (47%) postoperatively. There was no association between parents' perception of symptoms and obstructive sleep apnea categorization postoperatively (P > .05) or of parents' perception of symptoms improving and obstructive sleep apnea categorization improving postoperatively (P > .05). CONCLUSIONS Despite previous experience, parents are unable to predict nighttime breathing patterns following a T&A. We recommend obtaining a polysomnogram rather than relying on parental assessment to determine whether a T&A has been successful. CITATION Chabuz CA, Lackey TG, Pickett KL, Friedman NR. Accuracy of parental perception of nighttime breathing in children with Down syndrome after adenotonsillectomy. J Clin Sleep Med. 2024;20(2):237-243.
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Affiliation(s)
- Carolyn A. Chabuz
- Department of Otolaryngology – Head & Neck Surgery, University of Colorado, Aurora, Colorado
| | - Taylor G. Lackey
- Department of Otolaryngology – Head & Neck Surgery, University of Colorado, Aurora, Colorado
| | - Kaci L. Pickett
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Norman R. Friedman
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
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Almutairi N, Alshareef W, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Is adenotonsillectomy effective in improving central apnea events in patients with obstructive sleep apnea? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:5205-5217. [PMID: 37642712 DOI: 10.1007/s00405-023-08202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To evaluate the effects of adenotonsillectomy on improving central sleep apnea events in children with obstructive sleep apnea (OSA). METHODS We searched four online databases for relevant articles published from inception until October 2022. We included studies that measured the number of central apnea events per sleep and central apnea-hypopnea index (CAHI) or central apnea index (CAI) scores in children with OSA before and after adenotonsillectomy. Our primary outcomes were changes in CAI scores, the number of central apnea events per sleep, and CAHI scores after surgery. Our secondary outcomes were changes in total and mixed apnea events, improvement of sleep outcomes, and differences in oxygen or carbon dioxide saturation during sleep. We performed meta-analyses by pooling the mean changes of all included studies with a 95% confidence interval using Stata 17. Subsequently, we performed subgroup analyses based on the presence of comorbidities. RESULTS We included 22 studies comprising 1287 patients. Central and total sleep apnea parameters, except for CAHI and mixed apnea index scores, showed significant improvements after surgery. In addition, all respiratory parameters and second and third stages of non-rapid eye movement sleep showed significant postsurgical improvements. Patients with comorbidities showed significant improvements only in the total apnea-hypopnea index, oxygen desaturation index, and minimal oxygen saturation. CONCLUSION Adenotonsillectomy improves central apnea events in patients with OSA but not in those with comorbidities.
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Affiliation(s)
- Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia.
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
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Callegari MR, Dos Santos KB, de Oliveira BV, Amorim ARA, Cymrot R, Blascovi-Assis SM. Sleep assessment in adults with Down syndrome: correlation between functionality and polysomnographic findings. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:544-550. [PMID: 37379866 DOI: 10.1055/s-0043-1768670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Sleep disorders have a negative impact on health, being associated with neurocognitive problems, cardiovascular diseases and obesity, influencing children's development and learning. OBJECTIVE To assess the sleep pattern of people with Down syndrome (DS) and correlate changes with functionality and behavior. METHODS A cross-sectional study was conducted to evaluate the sleep pattern in adults with DS > 18 years old. Twenty-two participants were assessed using the Pittsburgh Sleep Quality Index, the Functional Independence Measure and the Strengths and Difficulties Questionnaire, and the 11 who presented indications of disorders by the screening questionnaires were referred to polysomnography. Statistical tests were performed using a significance level of 5%, including sample normality tests and correlation tests (sleep and functionality). RESULTS Impairment in sleep architecture was found due to an increase in the rate of awakenings in 100% of the participants, a decrease in the number of slow waves, and a high prevalence of sleep disordered breathing (SDB), with higher averages in the Apnea and Hypopnea Index (AHI) in the group. There was a negative correlation between sleep quality and global functionality (p = 0.011) and the motor (p = 0.074), cognitive (p = 0.010), and personal care (p = 0.072) dimensions in the group. Global and hyperactivity behavior changes were related to worse sleep quality (p = 0.072; p = 0.015, respectively). CONCLUSION There is an impairment in the sleep quality of adults with DS, with an increase in the rate of awakenings, a decrease in the number of slow waves, and a high prevalence of SDB affecting this population in the functional and behavioral aspects.
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Affiliation(s)
- Marilia Rezende Callegari
- Universidade Presbiteriana Mackenzie, Centro de Ciências Biológicas e da Saúde, São Paulo SP, Brazil
| | - Kelly Brito Dos Santos
- Universidade Presbiteriana Mackenzie, Centro de Ciências Biológicas e da Saúde, São Paulo SP, Brazil
| | | | - Ana Rita Avelino Amorim
- Universidade Presbiteriana Mackenzie, Centro de Ciências Biológicas e da Saúde, São Paulo SP, Brazil
| | - Raquel Cymrot
- Universidade Presbiteriana Mackenzie, Centro de Ciências Biológicas e da Saúde, São Paulo SP, Brazil
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Militi A, Nucera R, Chirieleison G, Fiorillo L, Cervino G, Portelli M. Down Syndrome children with obstructive sleep apnea. Minerva Dent Oral Sci 2022; 71:287-292. [PMID: 36321622 DOI: 10.23736/s2724-6329.22.04630-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a complex disorder with significant clinical consequences for people with Down Syndrome (DS). OSAS is frequently seen in individuals with DS and, when present, tends to be more severe than in individuals without this syndrome. EVIDENCE ACQUISITION The analysis was carried out on PubMed, Google Scholar and Cochrane library databases. The literature review identified nine studies suitable for our evaluations according to the established inclusion criteria. EVIDENCE SYNTHESIS The results of the study suggest that OSAS may be a common comorbidity in adolescents with DS; according to literature evidences a widespread screening and treatment in children with DS is undoubtedly useful. There is also evidence about an association between sleep disturbance and functional activities of daily living in children with DS. CONCLUSIONS The studies reviewed confirm that OSAS appears to occur at higher rates and greater severity in the population of children with DS. However, at present, there are no reliable clinical predictors of OSAS for this population of children.
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Affiliation(s)
- Angela Militi
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Riccardo Nucera
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giusy Chirieleison
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy -
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
- Department of Dentistry, University of Aldent, Tirana, Albania
| | - Gabriele Cervino
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Portelli
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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Abijay CA, Tomkies A, Rayasam S, Johnson RF, Mitchell RB. Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy. Otolaryngol Head Neck Surg 2021; 166:557-564. [PMID: 34253070 DOI: 10.1177/01945998211023102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Anna Tomkies
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, USA
| | - Swathi Rayasam
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
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MacDonagh L, Farrell L, O'Reilly R, McNally P, Javadpour S, Cox DW. Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome. Pediatr Pulmonol 2021; 56:1704-1715. [PMID: 33730448 DOI: 10.1002/ppul.25308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/01/2021] [Accepted: 01/20/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Children with Down syndrome (DS) have an increased prevalence of obstructive sleep apnea (OSA). Noninvasive ventilation (NIV) is a common modality of OSA treatment in this cohort. This study aimed to measure adherence and efficiency of NIV delivery in children with DS. STUDY DESIGN This was a retrospective cohort study involving 106 children with confirmed OSA and home NIV with downloadable data capacity. Children were divided into DS (n = 44) and non-DS cohorts (n = 62). Adherence, clinical outcomes apnea-hypopnoea index (AHI), positive airway pressure delivery, and leakage were recorded and compared between DS and non-DS cohorts and within the DS cohort based on past surgical history. RESULTS Significantly greater NIV usage was observed in the DS cohort, they showed more consistent use with an increased percentage of days used relative to their non-DS counterparts (78.95 ± 2.26 vs. 72.11 ± 2.14, p = .031). However, despite greater usage, poorer clinical outcomes in the form of increased AHI (p = .0493) was observed in the DS cohort, where significantly greater leakage was also shown 41.00 ± 1.61 L/min versus 36.52 ± 1.18 L/min (p = .022). Twenty children with DS had prior cardiac surgery; compliance across all parameters was significantly reduced relative to those without. CONCLUSION These data confirm that satisfactory NIV adherence is achievable in children with DS. However, we have identified excessive system leak at the machine-patient interface as a factor, which could undermine NIV efficacy in children with DS.
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Affiliation(s)
- Lauren MacDonagh
- School of Medicine, Department of Health Sciences, University College Dublin, Belfield, Dublin, Ireland
| | - Lisa Farrell
- Department of Respiratory, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Ruth O'Reilly
- Department of Respiratory, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Paul McNally
- Department of Respiratory, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Sheila Javadpour
- Department of Respiratory, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Des W Cox
- School of Medicine, Department of Health Sciences, University College Dublin, Belfield, Dublin, Ireland.,Department of Respiratory, Children's Health Ireland, Crumlin, Dublin, Ireland
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Gashmard R, Ahmadi F, Kermanshahi SMK. Coping strategies adopted by Iranian families of children with Down syndrome: A qualitative study. Medicine (Baltimore) 2020; 99:e20753. [PMID: 32664068 PMCID: PMC7360268 DOI: 10.1097/md.0000000000020753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Down syndrome (DS) is the leading cause of intellectual disability. Previous quantitative studies have examined the effects of DS on families of children with DS. This study explored the coping strategies adopted by the families of children with DS. This was a qualitative content analysis study, in which the participants were selected using purposive sampling from the families of children with DS. Semi-structured interviews were performed and collected data were analyzed. A total of 20 family members (10 mothers, 6 fathers, 2 brothers, and 2 sisters) were interviewed. Six categories were extracted in this study, namely "searching for information," "paying attention to children's healthcare needs," "concentration on spirituality," "teaching socially appropriate behavioral skills," "efforts to increase self-reliance in children," and "development of family support circle." The participating families were able to use positive adaptive mechanisms and cope well with the problems associated with having a child with DS. However, they still needed more support from healthcare providers and support organizations. Receiving more support from healthcare providers, such as nurses, can help them in better management of their children.
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Munawar S, Marston AP, Patel T, Nguyen SA, White DR. Outcomes Assessment of Multi-Level Sleep Surgery in Syndromic Versus Non-Syndromic Children. Ann Otol Rhinol Laryngol 2020; 129:556-564. [PMID: 31920116 DOI: 10.1177/0003489419900201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery. METHODS Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal-Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square. RESULTS Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all P < .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, P < .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, P > .05). CONCLUSION The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.
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Affiliation(s)
- Suqrat Munawar
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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