title: Characterization of Sleep Architecture in Down Syndrome Patients Pre and Post Airway Surgery.
abstract: OBJECTIVE
  To define obstructive sleep architecture patterns in Down syndrome (DS) children as well as changes to sleep architecture patterns postoperatively.
  
  
  METHODS
  The study was a retrospective review.
  
  
  METHODS
  Forty-five pediatric DS patients who underwent airway surgery between 2003 and 2014 at a tertiary children's hospital for obstructive sleep apnea (OSA) were investigated. Postoperative changes in respiratory parameters and sleep architecture (SA) were assessed and compared to general pediatric normative data using paired t-tests and Wilcoxon signed-rank test.
  
  
  RESULTS
  Twenty-two out of 45 of the participants were male. Thirty participants underwent tonsillectomy and adenoidectomy, four adenoidectomy, 10 tonsillectomy, and one base of tongue reduction. The patients were divided into two groups based on age (<6 years & >6 years) and compared to previously published age matched normative SA data. DS children in both age groups spent significantly less time than controls in rapid eye movement (REM) and N1 (p<0.02). Children younger than six spent significantly less time in N2 than previously published healthy controls (p<0.0001). Children six years of age or older spent more time than controls in N3 (p=0.003). Airway surgery did not significantly alter SA except for an increase in time spent in N1 (p=0.007). Surgery did significantly reduce median apnea hypopnea index (AHI) (p=0.004), obstructive apnea-hypopnea index (OAHI) (p=0.006), hypopneas (p=0.005), total apneas (p<0.001), and central apneas (p=0.02), and increased the lowest oxygen saturation (p=0.028).
  
  
  CONCLUSIONS
  DS children are a unique population with different SA patterns than the general pediatric population. Airway intervention assists in normalizing both central and obstructive events as well as sleep architecture stages.
authors.affiliation: Otolaryngology, UPMC.
authors.forename: Mark
authors.initials: M
authors.lastname: Mims
authors.affiliation: Michigan Pediatric Ear, Nose and Throat Associates, Children's Hospital of Michigan, Detroit Medical Center.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Otolaryngology, Children's Hospital of Pittsburgh.
authors.forename: Dennis
authors.initials: D
authors.lastname: Kitsko
authors.affiliation: Otolaryngology, Children's Hospital of Pittsburgh.
authors.forename: Amber
authors.initials: A
authors.lastname: Shaffer
authors.affiliation: Otolaryngology, Children's Hospital of Pittsburgh.
authors.forename: Sukgi
authors.initials: S
authors.lastname: Choi
keywords: airway surgery; down syndrome; sleep apnea; sleep architecture