title: Comparison of treatment modalities in syndromic children with obstructive sleep apnea--a randomized cohort study.
abstract: BACKGROUND
  Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention.
  
  
  OBJECTIVE
  To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA).
  
  
  METHODS
  In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year.
  
  
  RESULTS
  Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year.
  
  
  CONCLUSIONS
  On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children.
authors: Madras ENT Research Foundation (P) Ltd, Chennai, India. Electronic address: b7shyam@yahoo.com.
authors: Shyam Sudhakar
authors: SS
authors: Sudarsan
authors: Madras ENT Research Foundation (P) Ltd, Chennai, India.
authors: Vijaya Krishnan
authors: VK
authors: Paramasivan
authors: Madras ENT Research Foundation (P) Ltd, Chennai, India.
authors: Senthil Vadivu
authors: SV
authors: Arumugam
authors: Madras ENT Research Foundation (P) Ltd, Chennai, India.
authors: Sathiya
authors: S
authors: Murali
authors: Madras ENT Research Foundation (P) Ltd, Chennai, India.
authors: Mohan
authors: M
authors: Kameswaran
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009083:Mucopolysaccharidoses / Q000150:complications*; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Continuous Positive Airway Pressure; Down syndrome; ESS-C; Mucopolysaccharidoses; OSA-18; Pediatric Obstructive Sleep Apnea