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Published on: December 6, 2016
Early detection and treatment of obstructive sleep apnoea in infants with Down syndrome: a prospective,
Brigitte Fauroux1,2, Silvia Sacco3, Vincent Couloigner4
1Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker Enfants Malades, Paris F-75015, France.
Insights
Early obstructive sleep apnea (OSA) treatment in infants with Down syndrome (DS) significantly improved neurocognitive development and behavior. This early intervention led to better outcomes by 36 months of age.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Sleep Medicine
Background:
- Infants with Down syndrome (DS) face a high risk of obstructive sleep apnea (OSA).
- OSA in DS is linked to neurocognitive deficits and behavioral issues.
- Early intervention for OSA in DS is crucial for development.
Purpose of the Study:
- To assess the impact of early OSA treatment in infants with DS.
- To evaluate the effects on neurocognitive development and behavior.
- To compare early screening and treatment versus standard care.
Main Methods:
- Prospective, interventional, non-randomized study of 80 infants with DS.
- Screened Group (40 infants) underwent polysomnography (PSG) every 6 months from 6-36 months.
- Standard Care Group (40 infants) received a single PSG at 36 months; OSA was treated when present.
Main Results:
- The Screened Group showed significantly higher Griffiths III total scores at 36 months (p=0.009).
- Better neurocognitive and behavioral outcomes were observed in the Screened Group.
- The Standard Care Group had higher rates of moderate/severe OSA and higher apnea-hypopnea index.
Conclusions:
- Early diagnosis and treatment of OSA in infants with DS can significantly enhance neurocognitive outcomes.
- Proactive OSA management is vital for improving development in infants with DS.
- This approach may mitigate associated behavioral problems.
Background:
Infants with Down syndrome (DS) are at high risk of obstructive sleep apnoea (OSA) which is associated with neurocognitive dysfunction and behaviour problems. The aim of our study was to evaluate the effect of early OSA treatment in infants with DS on neurocognitive development and behaviour.
Methods:
In this prospective, interventional, non-randomised study, 40 infants with DS underwent polysomnography (PSG) every 6 months in room air between 6 and 36 months of age (Screened Group) and were compared to a control group of 40 infants with DS receiving standard of care and a single, systematic PSG in room air at 36 months of age (Standard Care Group). When present, OSA was treated. The primary endpoint was the total score of the Griffiths Scales of Child Development, Third Edition (Griffiths III) and its subscores at 36 months. Secondary endpoints included a battery of neurocognitive and behaviour questionnaires, and PSG outcomes.
Findings:
On the Griffiths III, the total score was significantly higher in the Screened Group compared to the Standard Care Group (difference: 4.1; 95%CI: 1.3; 7.6; p = 0.009). Results in Griffiths III subscores and secondary endpoints were in support of better neurocognitive outcomes in the Screened Group compared with the Standard Care Group. At 36 months, median (Q1; Q3) apnoea-hypopnea index was higher in the Standard Care Group (4.0 [1.5; 9.0] events/hour) compared to the Screened Group (1.0 [1.0; 3.0] events/hour, p = 0.006). Moderate and severe OSA were more frequent in the Standard Care Group as compared to the Screened Group (18.9% versus 3.7% for moderate OSA and 27.0% versus 7.4% for severe OSA).
Interpretation:
Early diagnosis and treatment of OSA in infants with DS may contribute to a significantly better neurocognitive outcome and behaviour at the age of 36 months.
Funding:
The study was funded by the Jérôme Lejeune Foundation.
