title: Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea.
abstract: OBJECTIVE
  To evaluate the outcome of adenotonsillectomy (AT) in a cohort of children with Down syndrome (DS) and obstructive sleep apnoea (OSA).
  
  
  METHODS
  Retrospective, cross-sectional study.
  
  
  METHODS
  Tertiary care centre.
  
  
  METHODS
  Children with DS and OSA, without previous upper airway (UA) surgery.
  
  
  METHODS
  AT and full overnight polysomnography.
  
  
  RESULTS
  A significant improvement of the obstructive apnoea-hypopnoea index (oAHI) after AT was obtained. No differences in sleep efficiency or sleep fragmentation were found postoperatively. Almost half of the children had persistent OSA (oAHI ≥5/hour).
  
  
  RESULTS
  Data are presented as median (lower-upper quartile). Thirty-four children were included, median age 4.0 years (2.7-5.8), body mass index (BMI) z-score 0.81 (-0.46-1.76), and oAHI 11.4/hour (6.5-22.7). The majority presented with severe OSA (58.9%). AT was performed in 22 children, tonsillectomy in 10 and adenoidectomy in two. Postoperatively, a significant improvement of the oAHI was measured from 11.4/hour (6.5-22.7) to 3.6/hour (2.1-9.5) (p=0.001), with a parallel increase of the minimum oxygen saturation (p=0.008). Children with initially more severe OSA had significantly more improvement after UA surgery (p=0.001). Persistent OSA was found in 47.1% of the children.
  
  
  CONCLUSIONS
  AT results in a significant improvement of OSA in children with DS without a change in sleep efficiency or sleep stage distribution. Severe OSA was associated with a larger reduction of OSA severity. Almost half of the children had persistent OSA, which was not correlated to age, gender or BMI z-score.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Maris
authors.affiliation: Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Verhulst
authors.affiliation: Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
authors.forename: Marek
authors.initials: M
authors.lastname: Wojciechowski
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Van de Heyning
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
authors.forename: An
authors.identifier: http://orcid.org/0000-0002-6918-0674
authors.initials: A
authors.lastname: Boudewyns
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Down syndrome; adenotonsillectomy; obstructive sleep apnea