Down syndrome and pediatric obstructive sleep apnea surgery: A national cohort

Abstract

2c. Laryngoscope, 1963-1969, 2018.

Outcomes Assessment of Multi-Level Sleep Surgery in Syndromic Versus Non-Syndromic Children

“…Ong et al similarly demonstrated that while T&A remained the most common procedure performed, the trend toward other site surgery has increased over time. 7 They also demonstrated that this increase was greater in children with Down syndrome when compared to non-syndromic children and that the overall proportion of other site surgeries such as supraglottoplasty, tongue base reduction and genioglossus advancements was greater within the syndromic population. Similarly, our results indicate that syndromic children underwent T&A only much less often than non-syndromic children (79% vs 94%).…”

“…This design is similar to the Ong et al paper from 2017 based on the senior author’s involvement in both investigations. 7 Levels of sleep surgery within each cohort were stratified into T&A, T&A plus other site surgery and other site surgery only for statistical comparison. Table 1 delineates the list of surgeries within the other site category, as well as the procedure code(s) used.…”

“…This selection of surgeries is also similar to the Ong et al investigation. 7 Outcome measures assessed included overall length of stay (LOS), total cost (TC) and disposition. Disposition was broken down into routine versus non-routine with routine disposition indicating a home/self-care discharge (cite KID webpage).…”

“…[2][3][4][5][6] Among both adult and pediatric OSA patients, the incidence of surgery to address multi-level airway obstruction has increased over the past two decades. 7,8 Despite an increased use of surgical interventions to address obstruction outside of the tonsils and adenoids in children, the risk, efficacy, and indications for multi-level sleep surgery treatments are poorly understood. 1 The American Academy of Pediatrics (AAP) included the following gaps in evidence in their guideline for the management of persistent OSA in children: (1) A need for research regarding the risk of persistent and recurrent OSA after tonsillectomy, (2) Delineation of which patients would benefit from postoperative PSG, (3) The effectiveness of newer surgical treatments.…”

Getting Personal with Down Syndrome and Obstructive Sleep Apnea

“…12 Beyond these two treatment modalities that were pioneered decades ago, a range of novel therapeutic approaches including additional upper airway surgery (such as lingual tonsillectomy and tongue base reduction), medical therapies with leukotriene receptor antagonists and intranasal corticosteroids, heated high flow nasal cannula, and hypoglossal nerve stimulator implantation have been trialed with variable success as alternative treatments for PAP-intolerant individuals with OSA refractory to AT. [13][14][15][16][17][18] In the present era of increasingly personalized medicine, much progress has been made in identifying anatomic and functional OSA phenotypes in the general adult population to better predict response to various treatment modalities. 19 However, treatment of OSA in children-particularly those with DS-lags behind and often involves a trial and error approach that can impose unnecessary surgical risks and/or delays in achieving optimal OSA treatment.…”