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Adherence to Guidelines for Screening Polysomnography in Children with Down Syndrome
Philip D Knollman1, Christine H Heubi1,2,3, Jareen Meinzen-Derr4
11 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Summary
New guidelines led to earlier polysomnography (PSG) for children with Down syndrome (DS) to screen for obstructive sleep apnea (OSA). While PSG rates and OSA prevalence remained similar, children underwent the procedure at a younger age post-guidelines.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Rare Diseases
- Clinical Practice Guidelines
Background:
- Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS).
- The American Academy of Pediatrics (AAP) issued guidelines in 2006 recommending universal screening for OSA in children with DS by age 4.
- Early diagnosis and treatment of OSA are crucial for improving health outcomes in children with DS.
Purpose of the Study:
- To evaluate the impact of the 2006 AAP guidelines on the utilization and timing of polysomnography (PSG) for OSA screening in children with DS.
- To compare the percentage of children with DS undergoing PSG and the mean age at the time of their first PSG before and after the guideline implementation.
- To assess changes in the rate of diagnosed OSA in children with DS following the introduction of universal screening recommendations.
Main Methods:
- A retrospective cohort study was conducted at a single tertiary pediatric hospital.
- Patients with DS born before (2000-2006) and after (2007-2012) the AAP guideline introduction were identified.
- Data on PSG performance, age at first PSG, and OSA diagnosis were extracted and compared between the two cohorts.
Main Results:
- Overall, 61% of children with DS underwent PSG. The mean age at first PSG significantly decreased from 5.3 years pre-guidelines to 3.4 years post-guidelines (P < .0001).
- A higher proportion of children in the post-guidelines cohort underwent their first PSG between ages 1 and 4 years (67.4% vs 52.1%, P < .0001).
- There was no significant difference in the percentage of children receiving PSG (63.4% vs 59.4%, P = .26) or the rate of OSA (79.8% vs 75.9%, P = .32) between the pre- and post-guidelines groups.
Conclusions:
- The AAP guidelines have successfully shifted the timing of OSA screening with PSG to an earlier age in children with DS.
- Despite the earlier screening, the overall rate of PSG utilization and the prevalence of OSA in this population did not change significantly.
- These findings underscore the importance of guideline implementation in clinical practice for timely diagnostic procedures in children with DS.
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