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Published on: December 6, 2016
Sleep Architecture in Children With Down Syndrome With and Without Obstructive Sleep Apnea
Christine H Heubi1,2,3, Philip Knollman1,3, Susan Wiley4,5
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Children with Down syndrome often exhibit poor sleep architecture, including low sleep efficiency and high arousal index. Obstructive sleep apnea did not significantly alter these sleep patterns in this study population.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Developmental Disorders
Background:
- Down syndrome is associated with various health complications, including sleep-disordered breathing.
- Characterizing polysomnographic sleep architecture is crucial for understanding sleep disturbances in this population.
Purpose of the Study:
- To define the polysomnographic sleep architecture in children with Down syndrome.
- To compare sleep findings between children with Down syndrome who have obstructive sleep apnea and those who do not.
Main Methods:
- Retrospective case series analysis of electronic health records from a single tertiary pediatric hospital (2005-2018).
- Inclusion criteria: patients with Down syndrome (age ≥12 months) undergoing polysomnography, excluding titration and split-night studies.
- Data collected included sleep efficiency, latency, total sleep time, REM latency, REM sleep time, arousal index, and time spent supine.
Main Results:
- A total of 397 children with Down syndrome were analyzed; 79.4% had obstructive sleep apnea.
- Significant proportions exhibited poor sleep: 32.5% had sleep efficiency <80%, 75.6% had an elevated arousal index, and 15.9% had total sleep time <360 minutes.
- No significant differences in sleep variables were found between children with and without obstructive sleep apnea; REM sleep time decreased with age.
Conclusions:
- Children with Down syndrome frequently present with multiple markers of poor sleep architecture, irrespective of obstructive sleep apnea status.
- A substantial percentage of these children experience clinically significant sleep disturbances, highlighting the need for comprehensive sleep assessments.
Objective:
To characterize polysomnographic sleep architecture in children with Down syndrome and compare findings in those with and without obstructive sleep apnea.
Study Design:
Case series with retrospective review.
Setting:
Single tertiary pediatric hospital (2005-2018).
Methods:
We reviewed the electronic health records of patients undergoing polysomnography who were referred from a specialized center for children with Down syndrome (age, ≥12 months). Continuous positive airway pressure titration, oxygen titration, and split-night studies were excluded.
Results:
A total of 397 children were included (52.4% male, 81.6% Caucasian). Mean age at the time of polysomnography was 4.7 years (range, 1.4-14.7); 79.4% had obstructive sleep apnea. Sleep variables were reported as mean (SD) values: sleep efficiency, 85% (11%); sleep latency, 29.8 minutes (35.6); total sleep time, 426 minutes (74.6); rapid eye movement (REM) latency, 126.8 minutes (66.3); time spent in REM sleep, 22% (7%); arousal index, 13.3 (5); and time spent supine, 44% (28%). There were no significant differences between those with obstructive sleep apnea and those without. Sleep efficiency <80% was seen in 32.5%; 34.3% had a sleep latency >30 minutes; 15.9% had total sleep time <360 minutes; and 75.6% had an arousal index >10/h. Overall, 69.2% had ≥2 metrics of poor sleep architecture. REM sleep time <20% was seen in 35.3%. REM sleep time decreased with age.
Conclusion:
In children with Down syndrome, 32.5% had sleep efficiency <80%; 75.6% had an elevated arousal index; and 15.9% had total sleep time <360 minutes. More than a third of the patients had ≥3 markers of poor sleep architecture. There was no difference in children with or without obstructive sleep apnea.
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