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Obstructive Sleep Apnea in Children With Down Syndrome: Screening and Effect of Guidelines
Adam Hsieh1, Amir Gilad1, Kevin Wong1
11 Boston University, Boston, MA, USA.
Insights
New guidelines improved obstructive sleep apnea screening completion for children with Down syndrome (DS). While referrals remained unchanged, more children completed polysomnograms by age 4 and age 18 after the 2011 AAP recommendations.
Area of Science:
- Pediatrics
- Genetics
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is highly prevalent in children with Down syndrome (DS).
- Previous studies indicated low OSA screening rates in this population.
- The 2011 American Academy of Pediatrics (AAP) guidelines recommend OSA screening with polysomnography (PSG) by age 4 for children with DS.
Purpose of the Study:
- To evaluate the impact of the 2011 AAP guidelines on OSA screening practices in children with DS.
- To compare PSG referral and completion rates before and after the guideline publication.
Main Methods:
- Retrospective chart review of 136 patients aged 0-18 years with DS.
- Analysis of PSG referral and completion frequencies between 2006 and 2016.
- Comparison of pre- and post-2011 guideline publication data.
Main Results:
- Overall PSG referral frequency for symptomatic children with DS was unaffected by the guidelines (32%).
- PSG completion by age 18 improved post-guidelines (30% vs 19%).
- PSG completion by age 4 significantly improved post-guidelines (25% vs 0%).
Conclusions:
- The 2011 AAP guidelines led to improved timely OSA screening completion in children with DS.
- Despite unchanged referral rates, earlier PSG completion by age 4 was achieved.
- Guidelines positively impacted adherence to recommended screening timelines for this high-risk group.
Abstract:
Previous studies have shown low rates of screening for obstructive sleep apnea in children with Down syndrome (DS), a high-prevalence population. Our study investigated the impact of the 2011 American Academy of Pediatrics guidelines, which recommends screening for obstructive sleep apnea with polysomnogram by age 4 years. We conducted a retrospective chart review of patients 0 to 18 years of age with DS seen at a medical center between 2006 and 2016. Polysomnogram screening frequency was investigated and compared pre- and post-guideline publication. A total of 136 participants were identified. Thirty-two percent (44/136) of children with DS were referred for polysomnogram, all of whom had symptoms. Although overall referral frequency was unaffected, completion frequency by age 18 years improved after publication (30% [21/69] vs 19% [13/67]; P < .05). Notably, polysomnogram completion frequency by age 4 years improved after guidelines publication compared with prior (25% [17/69] vs 0% [0/67]; P < .0001).
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