Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success

Propst, Evan J.; Amin, Reshma; Talwar, Natasha; Zaman, Michele; Zweerink, Allison; Blaser, Susan; Zaarour, Christian; Luginbuehl, Igor; Karsli, Cengiz; Aziza, Albert; Forrest, Christopher R.; Drake, James M.; Narang, Indra

doi:10.1002/lary.26104

Cited by 54 publications

(51 citation statements)

References 30 publications

(75 reference statements)

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“…To assess the effect of AT and lingual tonsillectomy on OSA severity, 11 studies were identified for analysis [12], [43], [45], [58], [72],…”

Section: Surgery and Osa Outcomementioning

confidence: 99%

“…Four additional studies were excluded due to lack of sufficient information [55], [86]- [88], one study was excluded due to reliance on symptom improvement rather than PSG [89], and three other studies were excluded because they employed more invasive surgeries [18], [59], [78]. [12], [83], [84]. Two studies utilizing an AHI of 2 as a cutoff reported normalization for 17.8% of individuals (8/45) [58], [72].…”

Section: Surgery and Osa Outcomementioning

confidence: 99%

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Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

Ridore

Debbarma

Nazir

et al. 2017

JSDR

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Abstract:Objective:Individuals diagnosed with Down syndrome (DS) are predisposed to obstructive sleep apnea (OSA). The aim of this study is to assess the prevalence of OSA and factors associated with OSA in this population. Study Design:Systematic literature review and meta-analysis. Methods:Studies of DS and OSA in the English language through May 2017 were reviewed. Since parental report of symptoms has limited validity related to the diagnosis of OSA, only studies using in laboratory polysomnography to diagnose OSA were included. Results:Twenty three studies examining OSA among 1,469 people with DS were found. Among ten studies using community referred samples, 71.5% of people with DS had OSA, compared to 69.6% in referred community samples suspected of having respiratory events. There was an inverse relationship between apnea hypopnea index (AHI) cutoffs and OSA prevalence as higher cutoffs were associated with somewhat lower prevalence.Examining age groups, adults had a higher prevalence of OSA (90.0%) compared to infants (66.5%) and children between 2-21 years of age (69.9%). Oxygen desaturation and gender did not affect prevalence.Although surgery had less effect on successfully treating OSA among DS individuals compared to those without DS in prior studies, lingual tonsillectomy had the greatest effect (mean AHI decrease of 9.0). Conclusion:OSA appears to occur frequently in children and adults with DS. Untreated, OSA may contribute to health problems and premature death, highlighting the potential importance of identifying OSA among people with DS.Even after traditional surgeries (i.e., adenotonsillectomy, tonsillectomy, adenoidectomy), repeating PSG is highly recommended as residual OSA can persist

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“…To assess the effect of AT and lingual tonsillectomy on OSA severity, 11 studies were identified for analysis [12], [43], [45], [58], [72],…”

Section: Surgery and Osa Outcomementioning

confidence: 99%

Section: Surgery and Osa Outcomementioning

confidence: 99%

Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

Ridore

Debbarma

Nazir

et al. 2017

JSDR

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“…10 For example, although midline posterior glossectomy with or without lingual tonsillectomy has been suggested to significantly reduce AHI in children with DS who have persistent OSA following adenotonsillectomy, these procedures can lead to postoperative bleeding as well as increased postoperative hospital stay due to poor oral intake. 11 In the case of tracheostomy, significant caregiver burden and reduced mental health are also encountered. 12 Hypoglossal nerve stimulation has emerged as a novel therapy for OSA in adults.…”

Section: Introductionmentioning

confidence: 99%

Update on hypoglossal nerve stimulation in children with down syndrome and obstructive sleep apnea

et al. 2019

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Objectives/Hypothesis Hypoglossal nerve (HGN) stimulation is a novel therapy for obstructive sleep apnea (OSA) in adults. Its efficacy and safety in children with Down syndrome (DS) was previously reported in a preliminary case series of six adolescents. Study Design Case series. Methods Twenty nonobese children and adolescents (aged 10–21 years) with DS and severe OSA (apnea‐hypopnea index [AHI] >10 and <50 events/hr) despite prior adenotonsillectomy were enrolled. Participants had failed a trial of continuous positive airway pressure therapy and underwent sleep endoscopy confirming surgical candidacy. The primary outcome was to assess safety and monitor for adverse events. Secondary outcomes included efficacy in reducing AHI (% reduction in AHI), adherence to therapy, and change in a validated quality‐of‐life instrument, the OSA‐18 survey. Results All 20 children (median age = 16.0 years [interquartile range = 13–17 years], 13 male) were implanted with no long‐term complications. We report two interval adverse events, both of which were corrected with revision surgery. Twenty participants completed the 2‐month polysomnogram, with median percent reduction in titration AHI of 85% (interquartile range = 75%–92%). The median nightly usage for these children was 9.21 hours/night. There was a median change in the OSA‐18 score of 1.15, indicating a moderate, yet significant, clinical change. Conclusions HGN stimulation was safe and effective in the study population. Two minor surgical complications were corrected surgically. Overall, these data suggest that pediatric HGN stimulation appears to be a safe and effective therapy for children with DS and refractory severe OSA. Level of Evidence 4 Laryngoscope, 130:E263–E267, 2020

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“…In syndromic children—children with underlying medical disorders—persistent OSA following AT may be due to lingual tonsil hypertrophy and/or relative macroglossia in Down syndrome, Beckwith‐Wiedemann syndrome, or velocardiofacial syndrome . However, not all of these patients are cured of their OSA following lingual tonsillectomy or midline posterior glossectomy, suggesting a role for other contributing factors . Conversely, persistent OSA following AT in healthy individuals is rarely due to lingual tonsil hypertrophy or macroglossia.…”

Section: Introductionmentioning

confidence: 99%

“…12 However, not all of these patients are cured of their OSA following lingual tonsillectomy or midline posterior glossectomy, suggesting a role for other contributing factors. 13 Conversely, persistent OSA following AT in healthy individuals is rarely due to lingual tonsil hypertrophy or macroglossia.…”

Section: Introductionmentioning

confidence: 99%

Utility of brain MRI in children with sleep‐disordered breathing

et al. 2016

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Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success

Abstract: 4. Laryngoscope, 127:757-763, 2017.

Cited by 54 publications

References 30 publications

Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

Update on hypoglossal nerve stimulation in children with down syndrome and obstructive sleep apnea

Utility of brain MRI in children with sleep‐disordered breathing

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