Obstructive Sleep Apnea in Children With Down Syndrome

Abstract

Children with Down syndrome have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), yet the type and severity of OSAS in this population has not been characterized. Fifty-three subjects with Down syndrome (mean age 7.4 ± 1.2 [SE] years; range 2 weeks to 51 years) were studied. Chest wall movement, heart rate, electrooculogram, end-tidal Po2 and Pco2, transcutaneous Po2 and Pco2, and arterial oxygen saturation were measured during a daytime nap polysomnogram. Sixteen of these children also underwent overnight polysomnography. Nap polysomnograms were abnormal in 77% of children; 45% had obstructive sleep apnea (OSA), 4% had central apnea, and 6% had mixed apneas; 66% had hypoventilation (end-tidal Pco2, >45 mm Hg) and 32% desaturation (arterial oxygen saturation <90%). Overnight studies were abnormal in 100% of children, with OSA in 63%, hypoventilation in 81%, and desaturation in 56%. Nap studies significantly underestimated the presence of abnormalities when compared to overnight polysomnograms. Seventeen (32%) of the children were referred for testing because OSAS was clinically suspected, but there was no clinical suspicion of OSAS in 36 (68%) children. Neither age, obesity, nor the presence of congenital heart disease affected the incidence of OSA, desaturation, or hypoventilation. Polysomnograms improved in all 8 children who underwent tonsilletomy and adenoidectomy, but they normalized in only 3. It is concluded that children with Down syndrome frequently have OSAS, with OSA, hypoxemia, and hypoventilation. Obstructive sleep apnea syndrome is seen frequently in those children in whom it is not clinically suspected. It is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with Down syndrome.

Accuracy of Parental Perception of Nighttime Breathing in Children with Down Syndrome

“…In 1991, Marcus et al evaluated a cohort of 53 children with either overnight or nap PSG. 16 Although 68% of the children were asymptomatic, most of them still had an abnormal PSG results. Dyken et al evaluated a cohort of 19 children who were consecutively seen in a developmental DS clinic (8 of 19 had a previous adenotonsillectomy).…”

Effect of Adenotonsillectomy on Central and Obstructive Sleep Apnea in Children with Down Syndrome

“…It is estimated that up to 80% of patients with DS have OSA compared with 1% to 4% in the nonsyndromic population 5‐9 . Relative macroglossia, microstomia, midface hypoplasia, and a narrowed pharyngeal inlet are some of the dysmorphic features that, along with adenotonsillar encroachment and generalized hypotonia, are believed to contribute to the increased prevalence of OSA in patients with DS 10,11 …”

“…3,4 It is estimated that up to 80% of patients with DS have OSA compared with 1% to 4% in the nonsyndromic population. [5][6][7][8][9] Relative macroglossia, microstomia, midface hypoplasia, and a narrowed pharyngeal inlet are some of the dysmorphic features that, along with adenotonsillar encroachment and generalized hypotonia, are believed to contribute to the increased prevalence of OSA in patients with DS. 10,11 Central sleep apnea is an event in the absence of inspiratory effort that lasts for at least 20 seconds or the duration of 2 breaths and is associated with an arousal or a .3% oxygen desaturation.…”

Predictors of OSA following adenotonsillectomy in children with trisomy 21

“…Several studies, in healthy children, also reported that BMI negatively influences T&A outcomes, 21,22 nevertheless no study was capable of showing that in children with trisomy 21, 7,16,23,24 pointing out that factors such as hypotonia and craniofacial anatomy are probably more relevant in these children. Prospective studies lack and are necessary to better understand these findings in children with trisomy 21 and OSA.…”