0768 Role of Drug Induced Sleep Endoscopy and Sleep Surgery in Management of Persistent Obstructive Sleep Apnea Following Adenotonsillectomy in Children with Down Syndrome

Abstract

Introduction: Children with Down Syndrome are at increased risk of persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillectomy (T&A) and require multidisciplinary evaluation. Methods: The aim of this study is to characterize clinical characteristics, polysomnography findings, DISE findings, and repeat sleep surgery performed to treat residual OSAS in a cohort of patients with Down Syndrome. We performed a retrospective chart review of children evaluated between August 2014-October 2017. Results: 15 children with Down Syndrome met the study criteria with residual OSAS (OAHI >; 1/hour). The mean age was 10.5 years (range 1-19 years), and 73% were male. Significant co-morbidities included congenital heart disease s/p repair (33.3%), hypothyroidism (26.6%), overweight or obesity (46.6%), autism (13.3%), asthma (13.3%). The mean baseline OAHI after T&A was 19.7/hour (median 17, range 1.9-63) with REM OAHI 30/hour (median 27.5, range 4-80). Five (33.3%) patients were started on CPAP due to severe OSAS. All 15 patients underwent DISE which revealed a multilevel obstruction including: hypertrophied inferior nasal turbinates (33%), adenoidal regrowth (33%), soft palate redundancy (13% patients), lingual tonsillar hypertrophy (86.7%), severe glossoptosis (60%), occult largynomalacia or epiglottic retroflexion (40%), and sublgottic edema (6.7%). The sleep surgery performed based on the DISE findings included: inferior nasal turbinectomy (13.3%) revision adenoidectomy (26.7%), lingual tonsillectomy (73.3%), supraglottoplasty (13.3%), epiglotopexy (33.3%), tongue base reduction (60%), partial glossectomy (26.6%), and palatoplasty (13.3%). 10 patients had post-operative PSGs performed which revealed improvement in mean post-operative OAHI to 9.4/hour (median 2.3, range 0-53), with REM OAHI of 20.3/hour (median 7.2, range 0-73). The mean reduction in OAHI was 15.5/hour. Two patients showed complete resolution of OSAS with AHI <1/hour, and two patients were able to discontinue CPAP therapy. Conclusion: Children with Down Syndrome are at increased risk of persistent OSAS after T&A, and DISE is an important tool in evaluation. Our study revealed all patients had a multilevel obstruction, and DISE-guided sleep surgery is useful in treatment of persistent OSAS.