Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

Abstract

Introduction and Aim Obstructive sleep apnea syndrome (OSAS) is frequent in children with Down syndrome (DS) and polysomnography (PSG) is recommended for all children with DS. However PSG is not always available and alternative diagnostic methods are needed. The aim of the study was to evaluate the feasibility and validity of home polygraphy (HPG) in children with DS. Methods A national DS association was contacted and children aged 6 to 18 years who accepted to participate were recruited. Otorhinolaryngologic evaluation, in‐lab PSG and HPG were performed. OSAS was diagnosed by PSG with an apnea‐hypopnea index (AHI) more than or equal to 1. OSAS severity was classified as moderate‐to‐severe if AHI was more than or equal to 5. Receiver operating characteristic curves were calculated for HPG using PSG as the gold standard. Results Nineteen children (12 girls) completed the study. Median age was 11.3 years. Demographic and clinical characteristics were similar in children with and without OSAS. Eighty‐nine percent of HPG studies were technically acceptable at the initial night and the success rate was 100% when two failed studies were repeated. PSG revealed OSAS in six (32%) children, two had mild and four had moderate‐to‐severe OSAS. All four patients with moderate‐to‐severe OSAS diagnosed with PSG have been diagnosed with the same severity on HPG. HPG had 100% sensitivity and 83% specificity when AHI ≥ 3 was set as diagnostic criteria. Conclusion HPG is a feasible and reliable test of OSAS in children with DS and may be useful in diagnosis and treatment of patients with moderate‐to‐severe OSAS in this patient group.

Sleep Disorders in Adults with Down Syndrome

“…Polygraphy for children with DS shows a slightly lower OSA prevalence than polysomnography [ 38 ]. Sensitivity and specificity of polygraphy were higher when diagnosing moderate to severe OSA [ 50 ]. Validation of this test in adults with DS has not yet been performed.…”

Obstructive sleep apnea in children with Down syndrome: is it possible to predict severe apnea?

“…Down syndrome (DS), which is caused by an additional copy of chromosome 21, is the most common chromosomal abnormality in children, occurring in an estimated one in 700 births [ 1 – 5 ]. Obstructive sleep apnea (OSA) is a frequent condition in people with DS, with an estimated rate between 55 and 97% [ 2 , 6 , 7 ]. There are many underlying predisposing factors for OSA in DS such as midfacial hypoplasia, relative macroglossia, glossoptosis, pharyngeal hypotonia, tonsillar hypertrophy, laryngomalacia, and obesity [ 8 – 10 ].…”

Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

“…A multicenter study investigated the use of home pulse oximetry (HPO) to identify children with DS at increased risk for OSA and reported a sensitivity for moderate-to-severe OSA up to 96% depending on the HPO parameters used [29]. The use of home polygraphy has also garnered interest, and one study in children with DS reported a 100% sensitivity and 83% specificity when AHI ≥ 3 was used for the diagnosis of OSA [30]. This will likely miss mild OSA, and it has not yet been determined at what threshold OSA results in sequalae.…”