Journal des troubles du sommeil et de la thérapie
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Effect of Weight and Obstructive Sleep Apnea Severity on Sleep Surgery Outcomes in Children with Down Syndrome

Xue Zhao, Woravipa Ayudhaya, Fauziya Hassan, Jeffrey J Stanley

Objectives: To assess the effect of weight status and obstructive sleep apnea (OSA) severity on polysomnographic (PSG) outcomes following sleep surgery inclusive of adenotonsillectomy (AT) in children with Trisomy 21.
Methods: A retrospective chart review was completed on thirty-six children ages 1-13 years with Trisomy 21 and OSA who underwent at a tertiary care academic hospital between 2005 to 2015 and had both preoperative and postoperative PSGs. Postoperative changes in apnea hypopnea index (AHI) and other PSG parameters, including percentage of various sleep stages, were compared between children who were normal weight, overweight and obese.
Results: The mean preoperative AHIs for normal weight, overweight and obese children were 15.6, 12.2 and 15.0, respectively while the mean postoperative AHIs were 10.6, 9.4 and 10.2, respectively. Improvement in AHI was significant only among children with severe OSA (AHI >10), but not among children with mild (AHI 1.5 to 5) or moderate OSA (AHI 5 to 10), both with and without controlling for weight status (p=0.01, p=0.009). There were no significant differences in postoperative PSG parameters comparing obese vs. non-obese and overweight vs. normal weight children.
Conclusion: Weight status does not appear to affect sleep surgery outcomes in children with Trisomy 21. This subset of children was found to have persistent OSA following sleep surgery regardless of weight. Other factors associated with Trisomy 21, such as macroglossia, glossoptosis and hypotonia, may play a greater role in the pathogenesis of OSA in this patient population. Only those children with severe OSA were found to have a significant improvement in AHI after sleep surgery, inclusive of AT.