Prediction of obstructive sleep apnoea in children and adolescents with Down syndrome

Area of Science:

• Pediatric Sleep Medicine
• Genetics and Sleep Disorders
• Diagnostic Tool Development

Background:

• Obstructive sleep apnoea (OSA) is highly prevalent in children and adolescents with Down syndrome (DS).
• Current clinical guidelines recommend polysomnography (PSG) for OSA assessment in children with DS by age 4.
• Limited access to PSG and the burden of testing pose significant challenges for families.

Purpose of the Study:

• To develop and validate a predictive model for moderate-to-severe OSA in children and adolescents with Down syndrome.
• To identify key demographic, anthropometric, quality of life, and sleep-related variables for OSA prediction.
• To establish a tool for triaging children with DS for PSG, improving diagnostic accessibility.

Main Methods:

• Prospective cross-sectional cohort study design.
• Utilized a comprehensive dataset including demographic, anthropometric, quality of life, and sleep-related variables.
• Developed predictive models incorporating the Pediatric Sleep Survey Instrument (PSSI) and actigraphy-based sleep fragmentation.

Main Results:

• A predictive model combining the PSSI sleep disordered breathing subscale and actigraphy-quantified sleep fragmentation demonstrated significant accuracy in identifying moderate-to-severe OSA.
• The model achieved high sensitivity (82%), specificity (80%), positive predictive value (75%), and negative predictive value (86%).
• This model effectively identifies children and adolescents with DS who have moderate/severe OSA.

Conclusions:

• A validated tool incorporating the PSSI and actigraphy can effectively identify moderate-to-severe OSA in children and adolescents with Down syndrome.
• This approach offers a promising alternative or adjunct to PSG for OSA screening in this population.
• The findings support the utility of this tool in clinical practice for improved OSA management in children with DS.