Effect of body position and sleep state on obstructive sleep apnea severity in children with Down syndrome

J Clin Sleep Med. 2014 Jan 15;10(1):81-8. doi: 10.5664/jcsm.3368.


Study objectives: To investigate the influence of sleep position and sleep state on obstructive sleep apnea (OSA) severity in in children with Down syndrome (DS).

Design: Retrospective review.

Setting: Sleep disorders laboratory of a tertiary medical center.

Participants: Children with Down syndrome and typically developing children matched for age, gender, apneahypopnea index (AHI), and year of polysomnogram.

Measurements and results: Sleep variables from baseline polysomnography. Sensor-recorded position (supine, prone, lateral) was expressed as the percentage of total sleep time. The AHI was calculated in each sleep state (NREM, REM), position, and position-sleep state combination. Of 76 DS subjects (55% male) the median age and AHI were 4.6 years (range 0.2-17.8 years) and 7.4 events/h (range 0-133). In all subjects, AHI was higher in REM than NREM (p < 0.05); however, the NREM AHI was higher in DS subjects than controls (p < 0.05). Compared to controls, the percentage of prone sleep was greater in DS subjects (p < 0.05), but the percentage of supine or non-supine (prone plus lateral) sleep was no different. For DS subjects alone, NREM AHI was higher in supine than non-supine sleep (p < 0.05).

Conclusion: In DS and non-DS children alike, respiratory events are predominantly REM related. However, when matched for OSA severity, children with DS have a higher NREM AHI, which is worse in the supine position, perhaps indicating a positional effect compounded by underlying hypotonia inherent to DS. These findings illustrate the clinical importance of NREM respiratory events in the DS population and implications for treatment options.

Keywords: Down syndrome; sleep position.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Down Syndrome / complications*
  • Female
  • Humans
  • Infant
  • Male
  • Polysomnography / methods
  • Posture / physiology*
  • Prone Position / physiology
  • Retrospective Studies
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / physiopathology*
  • Sleep Stages / physiology*
  • Sleep, REM / physiology
  • Supine Position / physiology