Predictors of OSA following adenotonsillectomy in children with trisomy 21

Raposo, Diogo; Menezes, Marco; Rito, João; Trindade-Soares, Mafalda; Adónis, Cristina; Loureiro, Helena; Freire, Filipe

doi:10.1111/coa.13657

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…For qualitative and quantitative analysis, 19 studies were excluded from the meta‐analysis (five studies involved adults, four studies did not assess adenotonsillectomy effects, three lacked PSG data, two were review articles, five studies had patients that had undergone other surgeries). In the end, nine studies were included for qualitative and quantitative analysis (Abdel‐Aziz et al, 2017; Abijay et al, 2022; da Rocha et al, 2017; Ingram et al, 2017; Maris et al, 2017; Mims et al, 2017; Raposo et al, 2021; Shete et al, 2010; Thottam et al, 2015) (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…The gold standard for OSA diagnosis in children is PSG, and the results were scored and interpreted according to the American Academy of Sleep Medicine (AASM) guidelines (AASM 2012, AASM 2014) (American Academy of Sleep Medicine 2015; Berry et al, 2012). In five studies, researchers collected both AHI and o‐AHI of polysomnographic parameters; two studies defined OSA by o‐AHI > 2 (da Rocha et al, 2017; Maris et al, 2017), one defined OSA by o‐AHI > 1 (Raposo et al, 2021). The baseline mean AHI before surgery varied across studies, ranging from 7.5 to 27.9.…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the nine selected studies are shown in Table 1, and the NOS scores for the nine studies are reported in et al, 2017), one defined OSA by o-AHI > 1 (Raposo et al, 2021). The baseline mean AHI before surgery varied across studies, ranging from 7.5 to 27.9.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

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Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta‐analysis

Li¹,

Du²,

Yin³

et al. 2023

Journal of Sleep Research

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SummaryObstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea–hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta‐analysis of the AHI showed a decrease of 7.18 events/h [95% CI (−9.69, −4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (−0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by −3.21 events/hour [95% CI (−6.04, −0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%–21%) for postoperative AHI < 1 and 57% (95% CI, 51%–63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta‐analysis

Li¹,

Du²,

Yin³

et al. 2023

Journal of Sleep Research

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“…Maris et al 12 and Raposo et al 13 reported that adenotonsillectomy improves OSA in DS children, however, more than half of their patients had persistent OSA, probably due to multilevel collapse. Although many studies suggested multilevel obstruction in DS children with OSA, the debates remain regarding the main site of this obstruction, the way to detect and how to treat.…”

Section: Discussionmentioning

confidence: 97%

“…Although many studies suggested multilevel obstruction in DS children with OSA, the debates remain regarding the main site of this obstruction, the way to detect and how to treat. [11][12][13][14] Manickam et al 15 stated that DISE and cine magnetic resonance imaging (MRI) are the 2 main tools to detect site of UAO in children with OSA, whereas Clark and Ulualp 16 showed that the accuracy of both procedures is nearly the same in DS children with OSA.…”

Section: Discussionmentioning

confidence: 99%

Persistent Obstructive Sleep Apnea in Children with Down Syndrome After Adenotonsillectomy: Drug Induced Sleep Endoscopy-Directed Treatment

Abdel‐Aziz

Abdel-Naseer

Elshahawy

et al. 2022

Journal of Craniofacial Surgery

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Children with down syndrome (DS) are more liable to develop obstructive sleep apnea (OSA) which is usually treated with adenotonsillectomy. However, OSA may persist in many of those patients after the procedure. The aim of this study was to assess the efficacy of drug-induced sleep endoscopy (DISE)-directed treatment in management of DS children with persistent OSA after adenotonsillectomy. Sixteen DS children with persistent OSA after adenotonsillectomy were evaluated. DISE was done in the operating theatre to identify the site of obstruction, and surgical intervention was performed according to the finding. Polysomnographic study was used pre-and post-operatively to measure the outcome. DISE revealed obstruction in different sites of the airway. DISE-directed treatment was done according to the site of obstruction. Polysomnographic study showed postoperative significant changes for all parameters. The authors achieved improvement of overall apneahypopnea index which was normalized in seven patients (44%). In conclusion, DISE-directed treatment is an effective procedure for persistent OSA in DS children who underwent adenotonsillectomy. However, residual obstruction in those children may be due to many characteristic features that cause narrowing of the airway.

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Severe Pediatric Sleep Apnea: Drug-Induced Sleep Endoscopy Based Surgery

Mendes

Antunes

Guimarães

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Predictors of OSA following adenotonsillectomy in children with trisomy 21

Abstract: Objectives: Given that 30%-50% of children with trisomy 21 have persistent obstructive sleep apnoea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy.

Cited by 6 publications

References 29 publications

Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta‐analysis

Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta‐analysis

Persistent Obstructive Sleep Apnea in Children with Down Syndrome After Adenotonsillectomy: Drug Induced Sleep Endoscopy-Directed Treatment

Severe Pediatric Sleep Apnea: Drug-Induced Sleep Endoscopy Based Surgery

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