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Breath Collection from Children for Disease Biomarker Discovery
Published on: February 14, 2019
Treatment and persistence/recurrence of sleep-disordered breathing in children with Down syndrome
Joy Nehme1, Robert LaBerge1, Mary Pothos1
1Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
Insights
Sleep-disordered breathing (SDB) in children with Down syndrome frequently persists or recurs, regardless of initial treatment or diagnosis factors. Ongoing polysomnography (PSG) is essential for monitoring this vulnerable population.
Area of Science:
- Pediatric Pulmonology
- Genetics and Genetic Diseases
- Sleep Medicine
Background:
- Sleep-disordered breathing (SDB) is prevalent in children with Down syndrome.
- The long-term course and recurrence patterns of SDB in this population are not well-established.
Purpose of the Study:
- To characterize polysomnography (PSG) findings, treatments, and SDB persistence/recurrence in children with Down syndrome.
- To identify predictors of SDB persistence or recurrence in this cohort.
Main Methods:
- Retrospective longitudinal cohort study of children with Down syndrome who underwent PSG between 2004 and 2014.
- SDB defined by apnea-hypopnea index (AHI). Predictors evaluated included age, BMI Z-score, and initial AHI.
- Interventions such as adenotonsillectomy (T&A) and positive airway pressure (PAP) were analyzed.
Main Results:
- Of 120 children with SDB, 54 had follow-up PSGs; 73.3% experienced SDB persistence or recurrence.
- Children undergoing T&A were younger than those receiving PAP (median 6.2 vs 12.5 years).
- SDB persistence/recurrence was not associated with age, AHI, or BMI Z-score at initial diagnosis.
Conclusions:
- SDB frequently persists or recurs in children with Down syndrome.
- Adenotonsillectomy was performed at a younger age compared to positive airway pressure therapy.
- Longitudinal PSG monitoring is crucial for managing SDB in children with Down syndrome due to high recurrence rates.
Objective:
Sleep-disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long-term outcomes are not well-described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence.
Methods:
A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)-mixed (apnea-hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z-score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB.
Results:
Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive-mixed AHI (P = .01). Thirty-five of fifty-four (65%) were initially diagnosed with OSA-mixed SDB. After first PSG, 67 of 120 had OSA-mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA-mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z-score at first SDB.
Conclusion:
Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z-score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.
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