0753 Polysomnography Outcomes Following Adenotonsillectomy in Children With Down Syndrome: Effects Of Weight And Obstructive Sleep Apnea Severity

Abstract

Introduction: This study was deigned to assess the effect of weight and severity of obstructive sleep apnea (OSA) on polysomnography (PSG) outcomes following adeno-tonsillectomy (AT) in children with Trisomy 21. Children with Trisomy 21 have an increased likelihood of persistent OSA following AT due in part to underlying hypotonia and macroglossia. In addition, weight status is known to influence the results of AT in non-Trisomy 21 patients. Methods: This retrospective chart review completed at a tertiary care academic hospital examined thirty-six children aged 1-13 years with Trisomy 21 and OSA who underwent AT between 2005 and 2015. All study patients had both pre- and postoperative PSGs. Pre- and postoperative changes in apnea hypopnea index (AHI) and changes in other sleep parameters recorded on PSG, including arousal index and percentage of various sleep stages were compared between children who were of normal weight, overweight and obese. Results: The mean preoperative AHIs for normal weight, overweight and obese children were 15.6, 12.2 and 15.0, respectively while their mean postoperative AHI were 10.6, 9.4 and 10.2, respectively (p>;0.05). Improvement in AHI was only significant among children with severe OSA (AHI >; 10), but not for those with mild OSA (AHI 1.5 to 5) or moderate OSA (AHI 5 to 10), both with and without controlling for weight status (p=0.01, p=0.009). There was no significant change in sleep parameters among obese vs. non-obese and non-normal weight (overweight + obese) vs. normal weight children (p>;0.05). Conclusion: Weight status does not appear to significantly affect the results of AT in children with Trisomy 21. This subset of children have persistent OSA following AT regardless of weight. This may be a result of other more influential factors associated with this diagnosis, such as underlying hypotonia and macroglossia. Only Trisomy 21 children with severe OSA were found to have a significant improvement in AHI following adeno-tonsillectomy.