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Predictors of OSA following Adenotonsillectomy in Children with Down Syndrome
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  • Diogo Raposo,
  • Marco MEnezes,
  • João Rito,
  • Mafalda Trindade-Soares,
  • Cristina Adónis,
  • Helena Loureiro,
  • Filipe Freire
Diogo Raposo
Hospital Professor Doutor Fernando Fonseca EPE
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Marco MEnezes
Hospital Professor Doutor Fernando Fonseca EPE
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João Rito
Hospital Professor Doutor Fernando Fonseca EPE
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Mafalda Trindade-Soares
Hospital Professor Doutor Fernando Fonseca EPE
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Cristina Adónis
Hospital Professor Doutor Fernando Fonseca EPE
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Helena Loureiro
Hospital Professor Doutor Fernando Fonseca EPE
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Filipe Freire
Hospital Professor Doutor Fernando Fonseca EPE
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Abstract

Objectives: Given that 30-50% of children with Down syndrome have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy. Design: Retrospective study. Setting: Secondary care hospital. Participants: Retrospective review of 32 children with the diagnosis of DS and OSA by polysomnography type 1 who underwent adenotonsillectomy, from January 2010 to December 2018. Main outcome and measure: Non-parametric analysis was used to compare pre and postoperative factors, regression was used to model persistent OSA and OSA severity. Results: Thirty-two children were included (17 male, median age 10.00 ± 8.00 years, median body mass index z-score 0.89 ± 1.25). Overall, adenotonsillectomy resulted in a significant improvement in median obstructive apnea-hypopnea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38 events per hour (p<0.001) and in median OSA-18 score from 85.00 ± 12.00 to 61 ± 37.75 (p<0.001). Persistent OSA was found in 56.25% of the children. Univariate regression suggests that postoperative OSA-18 score predicted persistent OSA after adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation rate, pre and postoperative OSA-18 scores correlated with OSA severity after adenotonsillectomy. However, in a multivariate model only the postoperative OSA-18 score was able to predict OSA severity after adenotonsillectomy. Conclusions: Although adenotonsillectomy results in a significant improvement of OSA in children with Down syndrome, more than half of the children had persistent OSA. The postoperative OSA-18 score predicted both persistent OSA and OSA severity after adenotonsillectomy.

Peer review status:ACCEPTED

24 Jul 2020Submitted to Clinical Otolaryngology
28 Jul 2020Submission Checks Completed
28 Jul 2020Assigned to Editor
03 Aug 2020Reviewer(s) Assigned
14 Aug 2020Review(s) Completed, Editorial Evaluation Pending
16 Aug 2020Editorial Decision: Revise Major
22 Aug 20201st Revision Received
25 Aug 2020Submission Checks Completed
25 Aug 2020Assigned to Editor
06 Sep 2020Reviewer(s) Assigned
14 Sep 2020Review(s) Completed, Editorial Evaluation Pending
20 Sep 2020Editorial Decision: Accept