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Factors associated with referral for polysomnography in children with Down syndrome
Poornima R Wijayaratne1, Katrina Williams2, Margot J Davey3
1Department of Paediatrics, Monash University, Melbourne, Australia.
Insights
Many children with Down syndrome (DS) have obstructive sleep apnea (OSA), yet not all receive recommended polysomnography (PSG) screening. Community-recruited DS children without referrals showed similar OSA rates to those clinically referred, highlighting the need for universal PSG screening.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Rare Diseases
- Clinical Research
Background:
- Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA).
- Polysomnography (PSG) is recommended for DS children by age four, but compliance with referrals is incomplete.
- Understanding referral patterns is crucial for improving OSA diagnosis in this population.
Purpose of the Study:
- To compare demographics, PSG results, OSA severity, behavior, daytime functioning, and quality of life (QOL) between children with DS referred for sleep testing and those from the community.
- To assess the impact of clinical referral on OSA diagnosis and associated outcomes in children with DS.
Main Methods:
- A comparative study included 20 children with DS referred for OSA assessment and 24 community volunteers (ages 3-19).
- Data collected included demographic and anthropometric measures, PSG parameters, and validated questionnaires for sleep symptoms, QOL, behavior, and daytime functioning.
- Statistical comparisons were made between the clinically referred and community groups.
Main Results:
- Obstructive sleep apnea (OSA) severity was similar between groups, with 50% of the clinical group and 42% of the community group having moderate/severe OSA.
- The clinically referred group exhibited higher weight and obesity indicators (BMI z-score, waist/hip circumference, neck-to-waist ratio).
- No significant differences were found in QOL, behavior, daytime functioning, or sleep symptom scores between the groups.
Conclusions:
- A substantial proportion (42%) of children with DS recruited from the community had moderate/severe OSA, despite not being clinically referred.
- Similar QOL, behavior, and daytime functioning outcomes were observed across groups, even with differing obesity metrics.
- These findings emphasize the critical importance of universal PSG screening for all children with Down syndrome to ensure timely OSA diagnosis and management.
Objectives:
Children with Down syndrome (DS) are recommended to undergo polysomnography (PSG) by the age of four years due to the high prevalence of obstructive sleep apnea (OSA) in this group, but compliance is incomplete. To further understand referral patterns for PSG in this condition, we aimed to compare demographics, PSG results, OSA severity, behavior, daytime functioning and quality of life (QOL) between children with DS referred for sleep testing and those recruited from the community.
Study Design:
Children 3-19 years with DS was included: 20 referred clinically for assessment of OSA and 24 volunteers from the community. Demographic and anthropometric data, PSG parameters, sleep-related symptoms and QOL, behavior and daytime functioning were compared between groups.
Results:
OSA severity did not differ between groups: 50% of the clinical and 42% of the community group had moderate/severe OSA. The clinical group had a higher weight z-score, BMI z-score, waist and hip circumference and neck-to-waist ratio. Questionnaire scores for daytime functioning, behavior and QOL were not different between groups.
Conclusions:
Despite not being referred for clinical sleep assessment, 42% of children with DS recruited from the community had moderate/severe OSA. There was no difference in the QOL, behavior, daytime functioning and sleep symptoms questionnaires although the clinical group had a higher BMI-Z score and overt signs of obesity. These findings underscore the importance of PSG screening of all children with DS.
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