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Sleep and Breathing

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10-08-2023 | Trisomy 21 | Sleep Breathing Physiology and Disorders • Original Article

Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome

Authors: Egambaram Senthilvel, Kahir Jawad, Bakeerathan Gunaratnam, Juhee N. Mian, Karim El-Kersh

Published in: Sleep and Breathing | Issue 1/2024

Abstract

Purpose

Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution.

Methods

Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea–hypopnea index (OAHI) as mild (1.5–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups.

Results

PSG data were available for 192 children with a median age of 5 years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in the supine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA.

Conclusion

Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in the supine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.

Parker SE, Mai CT, Canfield MA et al (2010) Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol 88(12):1008–1016. https://doi.org/10.1002/bdra.20735CrossRefPubMed

Sateia MJ (2014) International classification of sleep disorders. Chest 146(5):1387–1394CrossRefPubMed

Marcus CL, Brooks LJ, Draper KA et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):e714–e755. https://doi.org/10.1542/peds.2012-1672CrossRefPubMed

Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A (2016) Prevalence of obstructive sleep apnea in children with Down syndrome. Sleep 39(3):699–704. https://doi.org/10.5665/sleep.5554CrossRefPubMedPubMedCentral

Fan Z, Ahn M, Roth HL, Li L, Vaughn BV (2017) Sleep apnea and hypoventilation in patients with Down syndrome: Analysis of 144 polysomnogram studies. Children (Basel) 4(7). https://doi.org/10.3390/children4070055

Dyken ME, Lin-Dyken DC, Poulton S, Zimmerman MB, Sedars E (2003) Prospective polysomnographic analysis of obstructive sleep apnea in down syndrome. Arch Pediatr Adolesc Med 157(7):655–660. https://doi.org/10.1001/archpedi.157.7.655CrossRefPubMed

Shott SR, Amin R, Chini B, Heubi C, Hotze S, Akers R (2006) Obstructive sleep apnea: Should all children with Down syndrome be tested? Arch Otolaryngol Head Neck Surg 132(4):432–436. https://doi.org/10.1001/archotol.132.4.432CrossRefPubMed

Hill CM, Evans HJ, Elphick H et al (2016) Prevalence and predictors of obstructive sleep apnoea in young children with Down syndrome. Sleep Med Nov-Dec 27–28:99–106. https://doi.org/10.1016/j.sleep.2016.10.001CrossRef

Simpson R, Oyekan AA, Ehsan Z, Ingram DG (2018) Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nat Sci Sleep 10:287–293. https://doi.org/10.2147/NSS.S154723CrossRefPubMedPubMedCentral

10.

Lal C, White DR, Joseph JE, van Bakergem K, LaRosa A (2015) Sleep-disordered breathing in Down syndrome. Chest 147(2):570–579. https://doi.org/10.1378/chest.14-0266CrossRefPubMed

11.

Silverman M (1988) Airway obstruction and sleep disruption in Down’s syndrome. Br Med J (Clin Res Ed) 296(6637):1618–1619. https://doi.org/10.1136/bmj.296.6637.1618-aCrossRefPubMed

12.

Allanson JE, O’Hara P, Farkas LG, Nair RC (1993) Anthropometric craniofacial pattern profiles in Down syndrome. Am J Med Genet 47(5):748–752. https://doi.org/10.1002/ajmg.1320470530CrossRefPubMed

13.

Guimaraes CV, Donnelly LF, Shott SR, Amin RS, Kalra M (2008) Relative rather than absolute macroglossia in patients with Down syndrome: implications for treatment of obstructive sleep apnea. Pediatr Radiol 38(10):1062–1067. https://doi.org/10.1007/s00247-008-0941-7CrossRefPubMed

14.

van Gameren-Oosterom HB, van Dommelen P, Schonbeck Y, Oudesluys-Murphy AM, van Wouwe JP, Buitendijk SE (2012) Prevalence of overweight in Dutch children with Down syndrome. Pediatrics 130(6):e1520–e1526. https://doi.org/10.1542/peds.2012-0886CrossRefPubMed

15.

Shires CB, Anold SL, Schoumacher RA, Dehoff GW, Donepudi SK, Stocks RM (2010) Body mass index as an indicator of obstructive sleep apnea in pediatric Down syndrome. Int J Pediatr Otorhinolaryngol 74(7):768–772. https://doi.org/10.1016/j.ijporl.2010.03.050CrossRefPubMed

16.

Bull MJ, Committee on G (2011) Health supervision for children with Down syndrome. Pediatrics 128(2):393–406. https://doi.org/10.1542/peds.2011-1605CrossRefPubMed

17.

Lin CC, Tsan KW, Chen PJ (1992) The relationship between sleep apnea syndrome and hypothyroidism. Chest 102(6):1663–1667. https://doi.org/10.1378/chest.102.6.1663CrossRefPubMed

18.

Devdhar M, Ousman YH, Burman KD (2007) Hypothyroidism. Endocrinol Metab Clin North Am 36(3):595–615. https://doi.org/10.1016/j.ecl.2007.04.008CrossRefPubMed

19.

Ferri R, Curzi-Dascalova L, Del Gracco S, Elia M, Musumeci SA, Stefanini MC (1997) Respiratory patterns during sleep in Down’s syndrome:importance of central apnoeas. J Sleep Res 6(2):134–141. https://doi.org/10.1046/j.1365-2869.1997.00030.xCrossRefPubMed

20.

Bertrand P, Navarro H, Caussade S, Holmgren N, Sanchez I (2003) Airway anomalies in children with Down syndrome: endoscopic findings. Pediatr Pulmonol 36(2):137–141. https://doi.org/10.1002/ppul.10332CrossRefPubMed

21.

May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, Coticchia JM (2011) Systematic review of endoscopic airway findings in children with gastroesophageal reflux disease. Ann Otol Rhinol Laryngol 120(2):116–122. https://doi.org/10.1177/000348941112000208CrossRefPubMed

22.

Macchini F, Leva E, Torricelli M, Valade A (2011) Treating acid reflux disease in patients with Down syndrome: pharmacological and physiological approaches. Clin Exp Gastroenterol 4:19–22. https://doi.org/10.2147/CEG.S15872CrossRefPubMedPubMedCentral

23.

Carskadon MA, Pueschel SM, Millman RP (1993) Sleep-disordered breathing and behavior in three risk groups: preliminary findings from parental reports. Childs Nerv Syst 9(8):452–457. https://doi.org/10.1007/BF00393547CrossRefPubMed

24.

Beebe DW, Gozal D (2002) Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res 11(1):1–16. https://doi.org/10.1046/j.1365-2869.2002.00289.xCrossRefPubMed

25.

Loughlin GM, Wynne JW, Victorica BE (1981) Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr 98(3):435–437. https://doi.org/10.1016/s0022-3476(81)80716-0CrossRefPubMed

26.

Iber C, Ancoli-Israel S, Chesson AL, Quan SF (2017) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. vol 1. American academy of sleep medicine Westchester, IL

27.

Roland PS, Rosenfeld RM, Brooks LJ et al (2011) Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 145(1 Suppl):S1-15. https://doi.org/10.1177/0194599811409837CrossRefPubMed

28.

Marcus CL, Keens TG, Bautista DB, von Pechmann WS, Ward SL (1991) Obstructive sleep apnea in children with Down syndrome. Pediatrics 88(1):132–139CrossRefPubMed

29.

Lee CF, Lee CH, Hsueh WY, Lin MT, Kang KT (2018) Prevalence of Obstructive sleep apnea in children with Down syndrome: a meta-analysis. J Clin Sleep Med 14(5):867–875. https://doi.org/10.5664/jcsm.7126CrossRefPubMedPubMedCentral

30.

Styles M, Cole T, Dennis J, Preece M (2002) New cross sectional stature, weight, and head circumference references for Down’s syndrome in the UK and Republic of Ireland. Arch Dis Child 87(2):104–108CrossRefPubMedPubMedCentral

31.

Dudley KA, Patel SR (2016) Disparities and genetic risk factors in obstructive sleep apnea. Sleep Med 18:96–102. https://doi.org/10.1016/j.sleep.2015.01.015CrossRefPubMed

32.

Hanna N, Hanna Y, Blinder H, Bokhaut J, Katz SL (2022) Predictors of sleep disordered breathing in children with Down syndrome: a systematic review and meta-analysis. Eur Respir Rev 31(164). https://doi.org/10.1183/16000617.0026-2022

33.

Senthilvel E, Krishna J (2011) Body position and obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med 7(2):158–162CrossRefPubMedPubMedCentral

34.

da Rocha M, Ferraz RCM, Chen VG, Moreira GA, Fujita RR (2017) Clinical variables determining the success of adenotonsillectomy in children with Down syndrome. Int J Pediatr Otorhinolaryngol 102:148–153CrossRefPubMed

35.

Attal P, Chanson P (2010) Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab 95(2):483–495CrossRefPubMed

36.

Kumar HVM, Schroeder JW Jr, Gang Z, Sheldon SH (2014) Mallampati score and pediatric obstructive sleep apnea. J Clin Sleep Med 10(9):985–990CrossRefPubMedPubMedCentral

37.

Nisbet LC, Phillips NN, Hoban TF, O’Brien LM (2014) Effect of body position and sleep state on obstructive sleep apnea severity in children with Down syndrome. J Clin Sleep Med 10(1):81–88. https://doi.org/10.5664/jcsm.3368CrossRefPubMedPubMedCentral

38.

El-Kersh K, Cavallazzi R, Patel PM, Senthilvel E (2016) Effect of sleep state and position on obstructive respiratory events distribution in adolescent children. J Clin Sleep Med 12(4):513–517. https://doi.org/10.5664/jcsm.5678CrossRefPubMedPubMedCentral

39.

Santoro JD, Del Rosario J, Osterbauer B, Gillett ES, Don DM (2021) Sleep positions in children with Down syndrome and obstructive sleep apnea. Sleep Med 81:463–465CrossRefPubMed

40.

Lackey TG, Tholen K, Pickett K, Friedman N (2023) Residual OSA in Down syndrome: does body position matter? J Clin Sleep Med 19(1):171–177. https://doi.org/10.5664/jcsm.10288CrossRefPubMedPubMedCentral

41.

Hsieh A, Gilad A, Wong K, Cohen M, Levi J (2019) Obstructive sleep apnea in children with Down syndrome: screening and effect of guidelines. Clin Pediatr (Phila) 58(9):993–999. https://doi.org/10.1177/0009922819845333CrossRefPubMed

42.

Knollman PD, Heubi CH, Meinzen-Derr J et al (2019) Adherence to guidelines for screening polysomnography in children with Down syndrome. Otolaryngol Head Neck Surg 161(1):157–163. https://doi.org/10.1177/0194599819837243CrossRefPubMedPubMedCentral

Title: Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome
Authors: Egambaram Senthilvel
Kahir Jawad
Bakeerathan Gunaratnam
Juhee N. Mian
Karim El-Kersh
Publication date: 10-08-2023
Publisher: Springer International Publishing
Keywords: Trisomy 21
Sleep Apnea
Polysomnography
Hypothyroidism
Published in: Sleep and Breathing / Issue 1/2024
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-023-02900-6

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