title: Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea.
abstract: To review the literature for studies examining polysomnography (PSG) outcomes in patients with Down syndrome (DS) and obstructive sleep apnea (OSA) following adenotonsillectomy (T&A), and to review our experience with these patients.
  
  
  
  PubMed-NCBI, Scopus, Ovid, EBSCO, Cochrane, and EMBASE databases; tertiary academic center medical records.
  
  
  
  A systematic review of the medical literature identified articles reporting objective outcomes following T&A for OSA treatment in patients with DS. Articles were critically appraised to assess level of evidence and bias, and the results of articles were summarized. A case series of confirmed patients with DS and OSA was conducted, evaluating T&A efficacy by comparing pre- and posttreatment PSG data.
  
  
  
  Six articles were identified, which demonstrated some improvement after T&A in the treatment of OSA; however, subjects frequently had persistent disease. At our institution, preoperative Apnea-Hypopnea Index (AHI) improved from 13.75 (interquartile range [IQR] = 6.65-23.43) to 3.5 (IQR = 1.96-9.63) postoperatively; P = 0.004. Ten percent of patients had preoperative AHIs < 5; this proportion increased to 60% following surgery. Twenty percent of patients had postoperative AHIs < 1.
  
  
  
  There is little objective data in the medical literature addressing T&A efficacy in treating OSA in patients with DS patients. Patients show objective improvement in sleep parameters following T&A for OSA. Adenotonsillectomy should be suggested as a first-line treatment for children with DS and OSA, keeping in mind that monotherapy may be insufficient. Future studies utilizing objective measures are required to further quantify the effect in this patient population.
  
  
  
  Laryngoscope, 127:1465-1470, 2017.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Saint Louis University, St. Louis, MO, U.S.A.
authors.forename: Zachary
authors.identifier: 0000-0003-4005-7186
authors.initials: Z
authors.lastname: Farhood
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Saint Louis University, St. Louis, MO, U.S.A.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Isley
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, U.S.A.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Ong
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, U.S.A.
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Saint Louis University, St. Louis, MO, U.S.A.
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Camilon
authors.affiliation: Department of Otolaryngology, University at Buffalo, The State University of New York, Buffalo, NY, U.S.A.
authors.forename: Angela C
authors.initials: AC
authors.lastname: LaRosa
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Saint Louis University, St. Louis, MO, U.S.A.
authors.forename: David R
authors.initials: DR
authors.lastname: White
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004314:Down Syndrome / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011184:Postoperative Period; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Down syndrome; adenotonsillectomy; obstructive sleep apnea; tonsillectomy