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

Abstract

The objectives are to explore the demographic and polysomnographic features of children with Down syndrome and to determine the predictive factors associated with severe sleep apnea. A total of 81 children with Down syndrome referred for full-night polysomnography were analyzed. In addition, parental interviews were performed for each child. Data were available for 81 children, with a mean age of 4.8 years. Severe obstructive sleep apnea was determined in 53.1%. Age, sex, exposure to second-hand smoke, clinical findings, anthropometric features, and the presence of comorbidities were not predictors of severe obstructive sleep apnea. Children who were exposed to second-hand smoke had more sleep-related symptoms. Even in children without symptoms, the prevalence of severe obstructive sleep apnea was 40%. Moreover, 86% of parents had no previous information regarding possible sleep breathing disorders in their children. Clinically significant central apnea was present in 10 patients (12.3%). Conclusion : Our results demonstrate that severe obstructive sleep apnea is common in children with Down syndrome, even in children without a history of symptoms of sleep apnea. It is not possible to predict patients with severe apnea; thus, screening of children with Down syndrome beginning from young ages is very important. Central apneas could be a part of the spectrum of sleep abnormalities in Down syndrome.

The Rapid Evaluation of Down Syndrome With Quantitative Fluorescence Polymerase Chain Reaction (QF-PCR): A Pilot Study Among the Population in Eastern Uttar Pradesh, India

“…The average age of the children included in the study was 25.95 ±23.55 months. Caregivers took more time to report, usually when the child was more than two years of age, as symptoms became more pronounced, e.g., developmental milestones not being achieved [ 20 ]. The mosaic DS indicates a diverse age distribution with varied clinical features, indicating the need for comprehensive care and support across different developmental stages [ 21 ].…”

Características miofuncionais orofaciais e polissonográficas de crianças com Síndrome de Down e apneia obstrutiva do sono: estudo piloto

“…No entanto, uma vez que foram considerados os 10 itens originais do protocolo, as crianças típicas com AOS expressaram uma pontuação mais baixa do que as crianças com SD e AOS deste estudo, sugerindo um maior comprometimento miofuncional orofacial das crianças deste estudo, o que é compatível com a literatura por se tratar de crianças com SD (4,6,11,23) . Estudos demonstram dificuldade ou não conseguem comprovar que fatores como idade, sexo, exposição ao cigarro, achados clínicos, dados antropométricos e presença de comorbidades, a não ser a doença cardíaca congestiva, sejam considerados preditivos da severidade da AOS em crianças com SD (23,24) . Entretanto, até o momento, nunca fora investigada e identificada a correlação apresentada nesse estudo piloto entre alterações nos aspectos miofuncionais orofaciais e a gravidade da AOS.…”

Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors

“…Midfacial and mandibular hypoplasia, shortened palate, macroglossia, narrowed lumen of the nasopharynx, and pharyngeal hypotonia are the most relevant physical features of DS children that, in addition to adenotonsillar hypertrophy and obesity, predispose to OSA and hypoventilation [47,48]. The prevalence of OSA in children with DS is very high compared to that in the general population, ranging between 31% and 79% in different studies [48][49][50][51][52][53][54][55], while CSA and nocturnal hypoventilation are less common in this population. In a recent casecontrol study, Sawatari et al evaluated the data from 51 children with DS and 63 healthy controls through overnight pulse oximetry measurement and parent-completed questionnaires on the presence of SDB-related signs.…”

“…Furthermore, OSA also seems to be more prevalent in infants with no snoring or witnessed apnea [49][50][51]. The high SDB prevalence in children with DS and the lack of clinical and biomarker predictors in diagnosing OSA support the recommendation for routine polysomnographic/polygraphic screening of children with Down syndrome by the age of 4 years, even sooner in symptomatic subjects [3,51]. Achondroplasia is the most frequent skeletal dysplasia, with an incidence of 1 in 10,000-30,000 newborn infants [58,59].…”

“…Nevertheless, the author highlighted the difficulty in predicting SDB only from clinical evaluation (i.e., adenotonsillar hypertrophy, dental examination, BMI) and sleep behaviors, probably due to the poor quality of the evidence [ 57 ]. Furthermore, OSA also seems to be more prevalent in infants with no snoring or witnessed apnea [ 49 , 50 , 51 ]. The high SDB prevalence in children with DS and the lack of clinical and biomarker predictors in diagnosing OSA support the recommendation for routine polysomnographic/polygraphic screening of children with Down syndrome by the age of 4 years, even sooner in symptomatic subjects [ 3 , 51 ].…”