Treatment and persistence/recurrence of sleep‐disordered breathing in children with Down syndrome

Authors:
Publisher website
Google Scholar
Abstract
Objective: Sleep‐disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long‐term outcomes are not well‐described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence.Methods: A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)‐mixed (apnea‐hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z‐score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB.Results: Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive‐mixed AHI (P = .01). Thirty‐five of fifty‐four (65%) were initially diagnosed with OSA‐mixed SDB. After first PSG, 67 of 120 had OSA‐mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA‐mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z‐score at first SDB.Conclusion: Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z‐score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.

This publication has 21 references indexed in Scilit: