Co-Occurring Conditions and Sleep Symptoms Associated With Obstructive Sleep Apnea in Children With Down Syndrome

Abstract

Background and objectives: Sleep disordered breathing (SDB) is prevalent in children with Down syndrome (DS). The American Academy of Pediatrics recommends that all children with DS undergo a polysomnogram between 3 and 4 years of age irrespective of symptoms. Our objective is to describe the clinical symptoms and breathing patterns of children with DS based on their polysomnogram results.

Methods: A large, single-center retrospective study evaluated SDB in children with DS at moderate altitude between 1642 and 2087 m above sea level. The primary outcome was obstructive apnea hypopnea index (OAHI). Secondary outcomes included central apnea index (CAI), gas exchange, sleep symptoms, and co-occurring condition(s). Associations between OSA severity and caregiver-reported sleep symptoms and co-occurring conditions were explored.

Results: Of the 526 children (mean age = 5.69 years) with valid polysomnogram results, 419 (79.7%) were diagnosed with OSA based on the criteria of OAHI ≥ 2 events/h and 268 (51.0%) with moderate/severe OSA. Mean OAHI was 10.1 events/h (SD 14.1). Witnessed apnea was positively associated with moderate/severe OSA, whereas restless sleep was negatively associated. There is a significant positive association between higher body mass index (BMI) category and more severe OSA (p = 0.02). Conversely, there was a negative association between moderate/severe OSA and a history of feeding difficulties (p = 0.037).

Conclusions: In this large cohort of children with DS, we confirm a high prevalence of OSA. Additionally, caregiver-reported witnessed apneic events occurring most nights and BMI category severity were associated with worsened OSA severity.

Keywords: OAHI; altitude; children; down syndrome; obesity; sleep apnea.