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Obstructive sleep apnea in children with Down syndrome: contribution of upper airway and chemosensitivity

Plamen Bokov1, Imene Boujemla2, Jacques Dahan3

  • 1Université de Paris-Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, F-75019, Paris, France. plamen.bokov@aphp.fr.

Pediatric Research
|July 10, 2023
PubMed

Insights

Children with Down syndrome (DS) and obstructive sleep apnea syndrome (OSAS) have smaller airways and reduced peripheral chemosensitivity, leading to hypoventilation. This study compared airway size and ventilatory control in children with DS versus typically developing children with OSAS.

Area of Science:

  • Pediatric Pulmonology
  • Genetics and Genetic Disorders
  • Sleep Medicine

Background:

  • Obstructive sleep apnea syndrome (OSAS) is highly prevalent in children with Down syndrome (DS), often linked to reduced upper airway size.
  • The contribution of ventilatory control to OSAS in DS remains unclear.

Purpose of the Study:

  • To compare upper airway dimensions in children with DS and moderate-to-severe OSAS against typically developing (TD) children with similar OSAS severity.
  • To evaluate modifications in chemical loop gain (LG), including controller gain (CG) and plant gain (PG), in children with DS.

Main Methods:

  • A case-control study matched 13 children with DS to 26 TD children based on age, sex, OSAS severity, and ethnicity.
  • Methods included acoustic rhinometry, pharyngometry, awake tidal breathing measurements for chemical LG, and hypercapnic-hyperoxic ventilatory response testing.

Main Results:

  • Children with DS showed reduced oropharyngeal dimensions compared to TD children.
  • Significantly lower controller gain (CG) and loop gain (LG) were observed in children with DS, while plant gain (PG) was not different.
  • Hypercapnic ventilatory response slopes did not differ between the groups.

Conclusions:

  • Decreased CG in DS is linked to reduced peripheral chemoreceptor sensitivity, explaining increased end-tidal PCO2 and alveolar hypoventilation.
  • Pharyngeal dimensions are reduced in children with DS and OSAS.
  • Results suggest autonomic nervous system dysfunction in Down syndrome.
Abstract

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