Outcomes in children with down syndrome and mild obstructive sleep apnea treated non‐surgically

Abstract

Objectives Nasal steroids, oral anti‐leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children. Methods We reviewed children (<18 years) diagnosed with DS and mild OSA (obstructive apnea‐hypopnea index [oAHI] ≥1 to <5 events/hour) treated non‐surgically (with supplemental oxygen, one medication, or observation) between 2012 and 2017. Demographic data, comorbid diagnoses, and pre‐ and posttreatment polysomnograms were analyzed. We assessed pre‐ and posttreatment oAHI, oxyhemoglobin saturation nadir, percent total sleep time (%TST) in rapid eye movement (REM), and end‐tidal carbon dioxide (ETCO2) >50 mmHg. Results Twenty‐four children met inclusion criteria; 10 treated with medication, one with oxygen, and 13 with observation (baseline oAHI was 3.5, 3.3, and 2.9 events/hour, respectively). There was no significant change in oAHI, oxyhemoglobin saturation nadir, ETCO2, or percent TST in REM after treatment for any treatment group (P = .21–.94). There was no association between reported symptoms and AHI severity or change in AHI. OSA resolved in one patient treated with observation and two treated with medication, but worsened in two each in the medication and observation groups. Resolution of OSA occurred in 20% treated with medication, 7.7% with observation, and 0% with oxygen (P = .82). Conclusion In our cohort, resolution of mild OSA was low. This suggests that consideration should be given to multimodality treatments in children with DS and mild OSA. Prospective studies will help establish effectiveness in this cohort. Level of Evidence 4 Laryngoscope, 130:1828–1835, 2020

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

“…Our results revealed no significant differences in other parameters such as sex, anthropometric measures, comorbidities, and PSG features between symptomatic and asymptomatic patients. Similarly, Howard et al reported no association between reported symptoms and the degree of AHI [ 11 ]. We found that 37% of children with OSA had no symptoms related to sleep abnormalities.…”

“…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 ]. Additionally, many other comorbid conditions contribute to the occurrence of OSA in DS, including obesity, hypothyroidism, and gastroesophageal reflux (GERD) [ 11 – 13 ]. Untreated OSA has been associated with significant morbidities in children with DS, including IQ loss [ 14 – 17 ].…”

Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

“…In the medication arm, the baseline AHI was 3.5 compared to 3.6 on subsequent PSG (p = 0.21). They found that in the observation group, the baseline AHI was 2.9 compared to 3.6 on follow-up PSG (p = 0.60) [36]. At follow up, three patients in the medication group reported an improvement in nocturnal symptoms, four reported no change, and one reported worsening of symptoms.…”

“…For pediatric patients with mild OSA or residual disease status post-AT, pharmacological interventions have been used. These include options such as intranasal corticosteroids and oral leukotriene inhibitors to reduce airway inflammation [36].…”

“…Of those, 10 patients received pharmacologic intervention, with 8 receiving montelukast and 2 receiving fluticasone. There were 13 patients who did not receive any pharmaceutical intervention [36]. Both the pharmaceutical intervention group and the observation group had a median follow-up time of 15.4 months to obtain a follow-up PSG.…”