Body mass index as an indicator of obstructive sleep apnea in pediatric Down syndrome (original) (raw)
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Sleep Architecture in Children With Down Syndrome With and Without Obstructive Sleep Apnea
Otolaryngology–Head and Neck Surgery, 2020
ObjectiveTo characterize polysomnographic sleep architecture in children with Down syndrome and compare findings in those with and without obstructive sleep apnea.Study DesignCase series with retrospective review.SettingSingle tertiary pediatric hospital (2005-2018).MethodsWe reviewed the electronic health records of patients undergoing polysomnography who were referred from a specialized center for children with Down syndrome (age, ≥12 months). Continuous positive airway pressure titration, oxygen titration, and split-night studies were excluded.ResultsA total of 397 children were included (52.4% male, 81.6% Caucasian). Mean age at the time of polysomnography was 4.7 years (range, 1.4-14.7); 79.4% had obstructive sleep apnea. Sleep variables were reported as mean (SD) values: sleep efficiency, 85% (11%); sleep latency, 29.8 minutes (35.6); total sleep time, 426 minutes (74.6); rapid eye movement (REM) latency, 126.8 minutes (66.3); time spent in REM sleep, 22% (7%); arousal index, ...
Children
Patients with Down syndrome (DS) are at risk for both obstructive sleep apnea (OSA) and central sleep apnea (CSA); however, it is unclear how these components evolve as patients age and whether patients are also at risk for hypoventilation. A retrospective review of 144 diagnostic polysomnograms (PSG) in a tertiary care facility over 10 years was conducted. Descriptive data and exploratory correlation analyses were performed. Sleep disordered breathing was common (seen in 78% of patients) with an average apnea-hypopnea index (AHI) = 10. The relative amount of obstructive apnea was positively correlated with age and body mass index (BMI). The relative amount of central sleep apnea was associated with younger age in the very youngest group (0-3 years). Hypoventilation was common occurring in more than 22% of patients and there was a positive correlation between the maximum CO 2 and BMI. Sleep disordered breathing, including hypoventilation, was common in patients with DS. The obstructive component increased significantly with age and BMI, while the central component occurred most in the very young age group. Due to the high risk of hypoventilation, which has not been previously highlighted, it may be helpful to consider therapies to target both apnea and hypoventilation in this population.
Obstructive sleep apnea in adults with Down syndrome
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2009
A high proportion of children with Down syndrome (DS) have the obstructive sleep apnea syndrome (OSAS). Although adults with DS have many predisposing factors for OSAS, this population has not been well studied. We hypothesized that OSAS is common in adults with DS, and that the severity of OSAS is worse in DS adults who are more obese. Cohort study. Sleep laboratory. 16 adults with DS underwent evaluation for sleep disordered breathing. Polysomnographic results were compared to a retrospective sample of adult patients referred for clinically suspected OSAS. Polysomnograms were abnormal in 94% of DS subjects. The median apnea hypopnea index (AHI) was 37/h (range 0-118). The median arterial oxygen saturation nadir was 75% (23% to 95%), and the median peak end-tidal CO2 was 58 (47-66) mm Hg. There was a significant correlation between body mass index and AHI (r = 0.53, p < 0.05). Sixty-three percent had an Epworth score > 10. The AHI and saturation nadir were significantly worse...
Paediatria Croatica
The aim of the study was to assess sleep architecture and breathing in sleep in children with Down syndrome. The study was conducted by using overnight video-polysomnography (V-PSG) in children with Down syndrome and age-matched children from the general population. Analysis of polysomnographic parameters revealed that compared to the norms of healthy age-and maturitymatched children from the general population, children with Down syndrome had significantly shorter sleep latency (p=0.007), shorter total sleep time (p=0.004), lower sleep efficiency (p=0.010), less NREM1 sleep phase (p=0.0002), less NREM3 sleep phase (p=0.034), less REM sleep (p=0.034) in favour of more NREM2 phase but not significantly (p=0.069), and spent more time awake after sleep onset (p=0.0002). Children with Down syndrome had significantly more obstructive sleep apnoeas and hypopnoeas per hour (higher obstructive sleep apnoeas and hypopnoeas index) (p=0.008), but less central sleep apnoea per hour (lower central apnoeas index) (p=0.041), which led to the nonsignificantly lower total apnoea-hypopnoea index (p=0.762) in children with Down syndrome. The mean and longest apnoea duration did not differ significantly between these two groups. Children with Down syndrome had a significantly lower mean and nadir oxygen saturation (p=0.008 and p=0.001, respectively). In conclusion, the majority of respiratory complications in children with Down syndrome can be prevented by raising awareness of sleep disturbances in children with Down syndrome among their parents and health care providers and by introducing early routine V-PSG in the follow up of these children.
Screening for Obstructive Sleep Apnea in Children with Down Syndrome
The Journal of Pediatrics, 2014
To compare symptoms of obstructive sleep apnea (OSA) and polysomnography (PSG) results in children with Down syndrome and typically developing children. A total of 49 children with Down syndrome referred for PSG between 2008 and 2012 were matched with typically developing children of the same sex, age, and OSA severity who had undergone PSG in the same year. A parent completed a sleep symptom questionnaire for each child. Sleep quality and measures of gas exchange were compared between the matched groups. The 98 children (46 females, 52 males) had mean age of 6.2 years (range, 0.3-16.9 years). Fourteen children had primary snoring, and 34 had OSA (9 mild, 7 moderate, and 19 severe). Children with Down syndrome had more severe OSA compared with 278 typically developing children referred in 2012. Symptom scores were not different between the matched groups. Those with Down syndrome had a higher average pCO2 during sleep (P = .03) and worse McGill oximetry scores. Compared with closely matched typically developing children with OSA of comparable severity, children with Down syndrome had a similar symptom profile and slightly worse gas exchange. Referred children with Down syndrome had more severe OSA than referred typically developing children, suggesting a relative reluctance by parents or doctors to investigate symptoms of OSA in children with Down syndrome. These findings highlight the need for formal screening tools for OSA in children with Down syndrome to improve detection of the condition in this high-risk group.
The nocturnal-polysomnogram and “non-hypoxic sleep-disordered-breathing” in children
Sleep Medicine, 2018
Objective: To characterize sleep-disordered breathing patterns not related to hypoxia resulting in fragmented sleep in children. Methods: We reviewed the polysomnogram (PSG) data of children with sleep complaints who were being evaluated for sleep-disordered breathing and had an apnea-hypopnea-index ≤ 3. These data were compared to the recordings of the same children with nasal CPAP administered for one night and to 60 control subjects (children without any sleep complaints). A subgroup of children was monitored with esophageal manometry, but nasal cannula flow data was recorded in all cases. Results: Abnormal breathing patterns, particularly flow limitation, could be seen with more severity and frequency compared to apnea or hypopnea. The observed abnormal breathing patterns were associated with EEG disturbances. Conclusions: Patterns such as flow-limitation, mouth-breathing, changes in inspiratory and expiratory time, rib-cage and expiratory muscle activity, transcutaneous CO2 electrode changes and snoring noises are all variables that should be systematically reviewed when analyzing nocturnal PSG. Current scoring guidelines emphasizes apnea-hypopnea and hypoxic-sleep disordered breathing and therefore treatment is often much delayed in this population of children with evidence of abnormal breathing patterns. Analysis of the various patterns of abnormal breathing noted above allows recognition of "non-hypoxic" sleep-disordered-breathing (SDB).
European Respiratory Journal, 2012
Overnight polysomnography (PSG) is an expensive procedure which can only be used in a minority of cases, although it remains the gold standard for the diagnosis of sleep disordered breathing (SDB). The objective of this study was to develop a simple, PSG-validated tool to screen SDB, thus reducing the use of PSG. For every participant we performed PSG and a sleep clinical record was completed. The sleep clinical record consists of three items: physical examination, subjective symptoms and clinical history. The clinical history analyses behavioural and cognitive problems. All three items were used to create a sleep clinical score (SCS). We studied 279 children, mean¡SD age 6.1¡3.1 years, 63.8% male; 27.2% with primary snoring and 72.8% with obstructive sleep apnoea (OSA) syndrome. The SCS was higher in the OSA syndrome group compared to the primary snoring group (8.1¡9.6 versus 0.4¡0.3, p,0.005), correlated with apnoea/hypopnoea index (p50.001) and had a sensitivity of 96.05%. Positive and negative likelihood ratios were 2.91 and 0.06, respectively. SCS may effectively be used to screen patients as candidates for PSG study for suspected OSA syndrome, and to enable those with a mild form of SDB to receive early treatment.
Sleep related breathing disorders in adults with Down syndrome
Down Syndrome Research and Practice, 2003
Background. While the prevalence of obstructive sleep apnoea syndrome among children with Down syndrome is reported to vary from 30 to 50%, the nocturnal respiratory patterns of adults with Down syndrome is not well known. Objectives. The aim of this study is to evaluate sleep-related breathing disorders in a sample of adults with Down syndrome. Methods. We studied the nocturnal respiratory patterns of 6 adults with Down syndrome, aged 28-53 years. All participants were monitored for 8 hours using a 12 channel polysomnograph. Respiratory events (apnoeic and hypopnoeic) were classified as obstructive or central, in relation to the presence or the absence of paradoxical breathing. Results. All participants had respiratory pauses during sleep. 5 of them had an apnoea/hypopnoea index >10, justifying the diagnosis of sleep apnoea syndrome. About 85% of the respiratory events were apnoeic, the others being hypopnoeic. Among all the respiratory events 89.2% were obstructive, whereas only 10.8% were central. The central events were almost always organised in very low and regular sequences and respiration frequently showed a true periodic pattern, consisting of short periods of augmented breath followed by central events causing oxygen desaturation. Conclusions. According to the literature and in conjunction with the current study's results it could be hypothesised that the nocturnal respiratory pattern of adults with Down syndrome depends on several pathogenetic factors such as age, severity of upper airway abnormalities, body mass index (BMI), other pathological conditions and age-related brainstem dysfunction.