Introduction Hypotonia is common in infants with Trisomy 21. This can cause masticatory and oropharyngeal muscle weakness increasing the risk for dysphagia and sleep disordered breathing. Data describing the occurrence of dysphagia and sleep disordered breathing in infants with Trisomy 21 is limited. This study aims to determine the frequency and severity of dysphagia and its relationship to polysomnogram parameters in infants with Trisomy 21. Methods Retrospective chart review of patients with Trisomy 21 <12 months old that underwent polysomnography at Seattle Children’s Hospital between October 1, 2015-August 23, 2021. Data collected included: sex, age, presence of dysphagia, recommended thickener type and polysomnographic data. Results A total of 526 polysomnograms in patients with Trisomy 21 were performed. Forty-one studies were identified in <12 months old. Results in mean ± SD showed: age 6.5 months + 3, 66% were male and 73% were diagnosed with dysphagia through a video fluoroscopic swallow study. In those with dysphagia, 16% can tolerate thin liquids, 20% prescribed nectar-thick, 7% prescribed honey-thick and 57% were G-tube dependent. In patients with dysphagia compared to those without dysphagia: there was higher total AHI of 43.3 +/- 35.3 vs. 22.6 +/- 10.6 (p=0.006), oAHI of 39.7 +/- 35.5 vs. 17.2 +/- 11.6 (p=0.004), CAI of 3.4 +/- 3.4 vs. 3.4 +/- 1.8 (p=0.11), oxygen saturation nadir of 78.6 +/- 10.6 vs. 83.1 +/- 6.6 (p=0.11) and percentage total sleep time TcCO2 >50 mmHg of 44.6 +/- 42.6 vs. 31 +/- 40.3 (p=0.44). Worse dysphagia was positively correlated with a higher oAHI (r=0.38, p=0.03). Conclusion There is a high incidence of dysphagia and sleep disordered breathing in infants with Trisomy 21. Dysphagia severity correlated with oAHI severity. Dysphagia in OSA can be due to the sensory and motor changes of the pharynx with impaired swallow-breathing mechanism. Chronic microaspiration can also result in decreased pulmonary reserve from lower airway inflammation or lung parenchymal disease, which may lead to worse sleep disordered breathing. Current guidelines suggest screening at school age or when there are clinical symptoms of OSA in Trisomy 21. However, results suggest the need to evaluate and intervene earlier especially in infants with dysphagia. Support (If Any)
Introduction Obstructive sleep apnea(OSA) is an established risk factor for atrial fibrillation(AF), necessitating early diagnosis and management. Home-based sleep-monitoring technology has become a mainstream diagnostic modality. Peripheral arterial tonometry (PAT) device is increasingly being used to screen for OSA in patients with AF. Our study aimed to examine the accuracy of Watch-PAT (WP) in OSA evaluation, and night-to-night variability of sleep characteristics as measured by WP when used during consecutive night sleep studies. Methods Patients with history of AF undergoing clinically indicated PSG were prospectively enrolled and had concurrent WP while undergoing PSG. Patients then were studied again using WP over two consecutive days at home. We compared agreement of OSA severity(defined as no OSA[AHI (apnea hypopnea index)<5], mild OSA[15>AHI³5], moderate OSA[30>AHI³15], severe OSA[AHI>30]) and total sleep time(TST) using Cohen’s Kappa(K) for categorical and Bland-Altman plots for continuous variables. To further characterize PSG versus WP, the cohort was stratified into paroxysmal versus persistent AF types. 1A/1B hypopnea scoring criteria was defined as per AASM. Results Our cohort included 24 patients with AF(80% male, mean age 68y). Most patients had clinically defined OSA(AHI³5). Patients with persistent AF had more severe OSA than those with paroxysmal AF (severe OSA present in 60% vs. 29%). Comparison of PSG to concurrently conducted WP in the lab showed substantial agreement in OSA severity by both 1A(K=0.623) and 1B(0.706) criteria. Percent difference in TST between PSG versus WP in the paroxysmal AF versus persistent groups was not statistically significant(p=0.387). Comparing two consecutive at-home WP tests showed substantial agreement in OSA severity measures(1A=0.872,1B=0.889). Bland-Altman plots for TST and sleep architecture showed ³95% of residuals within 2 standard-deviations, suggesting intertester agreement. Confidence intervals were broad in these plots reflecting our small sample size. Conclusion Our findings demonstrate that WP is a reasonable alternative to PSG, particularly if using the 1B criteria to diagnose OSA. Additionally, our results show that persistent versus paroxysmal AF does not seem to affect the results of WP tests. Night to night variability of OSA measures and TST was small. Future studies should verify the results of our study in a larger cohort. Support (If Any)
Introduction Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. Data describing PSG parameters in this age group is limited. The purpose of this study is to examine the frequency of SDB, gas exchange abnormalities and comorbidities in this patient population. Methods This is a retrospective chart review of children ages 2-4 years with DS who underwent first PSG at Seattle Children’s Hospital from 2015-2021. Data collected included demographics, comorbidities and PSG parameters: obstructive apnea hypopnea index (oAHI), central apnea index (CAI), time spent with CO2 levels > 50 mmHg, percentage of time spent with saturations < 88% and saturation nadir. Data is presented by descriptive statistics and comparison by unpaired t test. Results A total of 154 children underwent PSG during the study period and 75 met the inclusion criteria. Mean age was 3.03 years (SD 0.805), 56% were male and 54.7% were caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%) and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). 94.7% met criteria for pediatric OSA, 9.5% met criteria for central apnea, and 9.5% met criteria for hypoventilation. Only 1 child met criteria for hypoxemia. 60% had surgical intervention with 89% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages and no significant difference in OSA or CSA in children with or without hypothyroidism or dysphagia (p>0.05). Conclusion Children with DS ages 2-4 years have high frequency of OSA. The most commonly encountered comorbidities were cardiac and dysphagia. Among those with OSA, more than half underwent surgical intervention, highlighting the importance of early diagnosis. Our previously published work showed that in infants with DS, dysphagia is correlated with severity of OSA. However, this was not shown in this abstract suggesting a potential larger contribution of other factors, such as adenotonsillar hypertrophy. Support (if any)
Introduction Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement. Methods Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete. Results Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI >1 but < 5) and 7/25 (28%) with moderate-severe OSA (oAHI > 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy. Conclusion Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB. Support None
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