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Multisystem approach for management of OSA in Down syndrome: a case report
Christina E Finch1, Nikhila Raol2, Steven M Roser3
1Department of Pediatrics, Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia.
Insights
Children with Down syndrome often have severe obstructive sleep apnea (OSA). A multisystem surgical approach, addressing craniofacial and bariatric factors, successfully resolved OSA in a young patient.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Sleep Disorders
- Craniofacial Surgery
Background:
- Obstructive sleep apnea (OSA) affects a high percentage of children with Down syndrome (DS).
- Common predisposing factors in DS include craniofacial hypoplasia, macroglossia, hypotonia, and obesity.
- Current treatments primarily focus on upper airway soft tissues, such as adenotonsillectomy and CPAP therapy.
Observation:
- A case report details a child with Down syndrome experiencing severe OSA.
- The patient presented with multiple anatomical and physiological factors contributing to their OSA.
- Previous treatments targeting only soft tissues were insufficient.
Findings:
- A comprehensive, multisystem surgical intervention was implemented.
- This approach included upper airway soft tissue, orthognathic, maxillofacial, and bariatric surgeries.
- The severe OSA was resolved without the need for continuous positive airway pressure (CPAP).
Implications:
- This case highlights the potential of a broader surgical strategy for managing complex OSA in Down syndrome.
- Addressing craniofacial and bariatric aspects alongside airway surgery may offer a more definitive solution.
- Further research into multisystem approaches could improve treatment outcomes for this vulnerable population.
Abstract:
Obstructive sleep apnea (OSA) is common in children with Down syndrome, with reported prevalence rates as high as 69-76%. Multiple factors predispose children with Down syndrome for OSA, including craniofacial hypoplasia (maxillary and mandibular), airway abnormalities, macroglossia, generalized hypotonia, airway hypotonia, adenotonsillar hypertrophy, and obesity. Despite the fact that the pathophysiology for OSA in children with Down syndrome is multifactorial in nature, treatment methods have focused on soft tissue in the upper airway using adenotonsillectomy and/or continuous positive airway pressure therapy. Here we present a case of a patient with Down syndrome whose severe OSA was approached in a multisystem manner, including upper airway soft tissue, orthognathic, maxillofacial, and bariatric surgery, resulting in resolution of the OSA without reliance on a continuous positive airway pressure device.
Citation:
Finch CE, Raol N, Roser SM, Leu RM. Multisystem approach for management of OSA in Down syndrome: a case report. J Clin Sleep Med. 2024;20(3):471-473.
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