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Sleep related upper airway obstruction in a cohort with Down's syndrome
V A Stebbens1, J Dennis, M P Samuels
1National Heart and Lung Institute, Royal Brompton Hospital, London.
Insights
Sleep-related upper airway obstruction (UAO) is common in children with Down syndrome. This study found that 31% of young children with Down syndrome experienced UAO, showing increased breathing difficulties during sleep.
Area of Science:
- Pediatrics
- Sleep Medicine
- Genetics
Background:
- Children with Down syndrome often exhibit craniofacial differences that may predispose them to airway issues.
- Sleep-related upper airway obstruction (UAO) is a recognized concern in this population, but prevalence data is limited.
Purpose of the Study:
- To determine the prevalence of sleep-related upper airway obstruction (UAO) in a cohort of children with Down syndrome.
- To characterize the clinical and polysomnographic features of UAO in this population.
Main Methods:
- A cohort of 34 children with Down syndrome underwent clinical assessment, parental questionnaires, and overnight polysomnography.
- Polysomnography included monitoring chest wall movements and arterial oxygen saturation (SaO2).
- A subset of younger children received repeated assessments until age 2.
Main Results:
- 31% (10 of 32) of children with Down syndrome were diagnosed with sleep-related UAO.
- Children with Down syndrome showed increased stridor, chest wall recession, and indicators of increased upper airway resistance during sleep.
- Reduced baseline SaO2 and frequent episodes of SaO2 ≤ 90% were observed, even with persistent respiratory effort.
Conclusions:
- Sleep-related upper airway obstruction is a significant and common problem in children with Down syndrome.
- Early and repeated assessments are crucial for identifying UAO in this vulnerable population.
- Findings highlight the need for proactive screening and management of UAO in children with Down syndrome.
Abstract:
The prevalence of sleep related upper airway obstruction (UAO) was studied in a cohort of 34 children with Down's syndrome from a geographically defined area. Thirty two (94%) of the children, ranging in age between 0.1 and 4.9 years (median 1.4), underwent full clinical assessment for UAO including parental questionnaires and overnight tape recordings of chest wall movements and arterial oxygen saturation (SaO2). Compared with controls, children with Down's syndrome had (a) an increased incidence of stridor and chest wall recession during sleep, (b) an increased frequency of a pattern on inspiration indicating increased upper airway resistance, (c) a reduced baseline oxygen saturation (having excluded recordings on four children with potential for right to left intracardiac shunting), and (d) an increased number of episodes with SaO2 less than or equal to 90% despite continued chest wall movements. At their initial assessment seven children (22%) had evidence of UAO. The 18 youngest children (less than or equal to 1.7 years) underwent repeated recordings and clinical assessment until they had all reached 2 years of age. A further three were found to have developed UAO. Sleep related UAO is a common problem in children with Down's syndrome, occurring in 10 of 32 (31%) of this population based sample.