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Sleep Apnea Specific Hypoxic Burden in Children With Down Syndrome and Typically Developing Children

Lisa M Walter1, Dhruv Bhatnagar1, Miles B H Ong1

  • 1Department of Paediatrics, Monash University, Melbourne, Australia.

Journal of Sleep Research
|March 18, 2025
PubMed

Insights

Hypoxic burden (HB) impacts children with obstructive sleep apnea (OSA). Higher HB in children with Down syndrome (DS) correlates with dampened autonomic function, highlighting the need for OSA treatment in this population.

Area of Science:

  • Pediatric Sleep Medicine
  • Cardiology
  • Genetics

Background:

  • Hypoxic burden (HB) quantifies respiratory event-related desaturations and is linked to cardiovascular disease in adults with obstructive sleep apnea (OSA).
  • HB has not been evaluated in typically developing (TD) children with OSA or in children with Down syndrome (DS), who exhibit a higher prevalence and severity of OSA-related hypoxia.
  • Children with DS face increased risks for OSA and associated cardiovascular complications.

Purpose of the Study:

  • To investigate the relationship between hypoxic burden (HB) and heart rate variability (HRV) in children with Down syndrome (DS) and typically developing (TD) children with OSA.
  • To compare HB levels between children with DS and TD children across different OSA severity groups.
  • To determine if HB predicts HRV, an indicator of cardiovascular health, in these pediatric populations.

Main Methods:

  • Overnight polysomnography was conducted on 44 children (3-19 years) with DS and matched TD children.
  • Participants were categorized into primary snoring (PS), Mild OSA, or Moderate/Severe (MS) OSA groups.
  • Heart rate variability (HRV) was analyzed using power spectral analysis, and regression analysis assessed the predictive value of HB on HRV.

Main Results:

  • Children with MS OSA in both groups exhibited significantly higher HB than those with PS or Mild OSA.
  • Children with DS and PS or Mild OSA had elevated HB compared to their TD counterparts, with no significant difference in the MS OSA groups.
  • Hypoxic burden (HB) was found to predict dampened sympathetic and parasympathetic activity specifically in children with DS (R² = 0.12, p = 0.03).

Conclusions:

  • Children with DS and PS or Mild OSA demonstrate higher hypoxic burden (HB) than TD children.
  • Elevated HB in children with DS is associated with reduced autonomic function, suggesting potential cardiovascular implications.
  • These findings underscore the critical importance of identifying and treating obstructive sleep apnea (OSA) in children with Down syndrome (DS) to mitigate adverse effects on autonomic function.

Keywords:
autonomic cardiovascular controlblood pressureheart rate variabilityobstructive sleep apneapediatric

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