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Lingual Tonsillectomy Can Help Pediatric Patients with Down Syndrome and Persistent OSA

What are the changes in sleep-related respiratory outcomes following lingual tonsillectomy (LT) in children with Down syndrome (DS) and persistent obstructive sleep apnea (OSA) following adenotonsillectomy (T&A)?

Bottom line
In children with DS, who have persistent OSA after T&A and lingual tonsil hypertrophy, LT significantly improved AHI, oAHI, and O2 saturation nadir.

Background: Although OSA prevalence in the general pediatric population is low, the prevalence is much higher in children with DS, where an estimated 40% to 80% are affected. T&A is the first-line treatment in children with OSA, but persistent OSA is common after surgery in children with DS. LT has been shown to improve OSA in patients with lingual tonsil hypertrophy and persistent OSA after T&A.

Study design: Retrospective case series review of 21 children with DS who underwent polysomnography before and after LT at a tertiary care center from 2003 to 2013.

Setting: Cincinnati Children’s Hospital Medical Center, Ohio.

Synopsis: OSA severity was defined by oAHI (sum of the obstructive apneas, mixed apneas, and hypopneas, divided by the total sleep time). The median AHI was 9.1 events/hour (range, 3.8 to 43.8 events/hour) before surgery and 3.7 (range, 0.5 to 24.4 events/hour) after surgery. The median overall AHI and oAHI improvement was 5.1 events/hour (range, -2.9 to 41 events/hour) and 5.3 events/hour (range, -2.9 to 41 events/hour), respectively. The mean oxygen saturation nadir improved from 84% to 89%, but without significant changes in the mean percent time with CO2 > 50 mm Hg, central index or REM sleep percentage. After surgery, the oAHI was Limitations include a small sample size, the study’s retrospective nature, and generalizability concerns (90% of the cohort was white, evaluation limited to children who underwent both pre- and post-operative PSG),

Citation: Prosser JD, Shott SR, Rodriguez O, et al. Polysomnographic outcomes following lingual tonsillectomy for persistent obstructive sleep apnea in down syndrome. Laryngoscope. 2017;127:520–524.