0798 Frequency of Sleep Disordered Breathing and Comorbidities Among Pre-school Aged Children with Down Syndrome

Abstract

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)