# Treatment of Obstructive Sleep Apnea with Personalized Surgery in Children with Down Syndrome (TOPS-DS)

> **NIH NIH R61** · OREGON HEALTH & SCIENCE UNIVERSITY · 2022 · $1,253,610

## Abstract

Project Summary
The overall objective of this randomized clinical trial is to test the effectiveness of a novel personalized
approach to the surgical treatment of OSA in children with Down syndrome (DS). The estimated prevalence of
obstructive sleep apnea (OSA) in children with Down syndrome (DS) ranges from 31-79%, compared to 1-5%
in the general pediatric population. Adenotonsillectomy (AT) is the first line treatment for OSA in children,
however, most studies of AT outcomes have excluded children with DS. Limited available evidence
demonstrates that 50 to 90% of children with DS have persistent OSA after AT.
 Hypotonia and unfavorable craniofacial anatomy are commonly cited risk factors for failure of AT,
however, there have been few attempts to characterize the pharyngeal anatomy or mechanisms of obstruction
in this population. Drug-induced sleep endoscopy (DISE) enables direct observation of the sites and patterns
of obstruction during sedated sleep using a flexible endoscope passed through the nose into the pharynx.
Several small case series demonstrate that personalized DISE-directed surgery can be effective in treating
OSA in children with DS. Because there have been few prospective studies and no randomized trials
comparing different treatment options, there remains uncertainty about the most effective treatment for OSA in
children with DS.
It is our central hypothesis that a personalized DISE-directed surgical approach in children with DS will
be superior to the recommended first line treatment of AT. To test this hypothesis, we propose an
unprecedented randomized controlled trial of DISE-directed surgery vs AT in children with Down syndrome
ages 2-18 years with the following specific aims:
Aim 1: Compare the physiological outcomes of DISE-directed surgery vs AT in children with DS.
Hypothesis 1: DISE-directed surgery will result in a greater improvement in the obstructive apnea-hypopnea
index (OAHI) compared to the standard AT intervention after 6 months.
Aim 2: Compare the clinical outcomes of DISE-directed surgery vs AT in children with DS.
Hypothesis 2: DISE-directed surgery will result in a clinically significantly greater improvement in disease-
specific QOL (OSA18) compared to the standard AT intervention after 6 months.
This comparative effectiveness trial will be the first to directly compare a personalized surgical
approach to the standard treatment in children with DS This novel approach may improve OSA outcomes
and reduce the burden of unnecessary AT or secondary surgery for persistent OSA after an ineffective AT.

## Key facts

- **NIH application ID:** 10518290
- **Project number:** 1R61HL165345-01
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Derek J Lam
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,253,610
- **Award type:** 1
- **Project period:** 2022-09-07 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10518290

## Citation

> US National Institutes of Health, RePORTER application 10518290, Treatment of Obstructive Sleep Apnea with Personalized Surgery in Children with Down Syndrome (TOPS-DS) (1R61HL165345-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10518290. Licensed CC0.

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