Co-Occurring Conditions and Sleep Symptoms Associated With Obstructive Sleep Apnea in Children With Down Syndrome

Sleep disordered breathing (SDB) is prevalent in children with Down syndrome (DS). The American Academy of Pediatrics recommends that all children with DS undergo a polysomnogram between 3 and 4 years of age irrespective of symptoms. Our objective is to describe the clinical symptoms and breathing patterns of children with DS based on their polysomnogram results.

A large, single-center retrospective study evaluated SDB in children with DS at moderate altitude between 1642 and 2087 m above sea level. The primary outcome was obstructive apnea hypopnea index (OAHI). Secondary outcomes included central apnea index (CAI), gas exchange, sleep symptoms, and co-occurring condition(s). Associations between OSA severity and caregiver-reported sleep symptoms and co-occurring conditions were explored.

Of the 526 children (mean age = 5.69 years) with valid polysomnogram results, 419 (79.7%) were diagnosed with OSA based on the criteria of OAHI ≥ 2 events/h and 268 (51.0%) with moderate/severe OSA. Mean OAHI was 10.1 events/h (SD 14.1). Witnessed apnea was positively associated with moderate/severe OSA, whereas restless sleep was negatively associated. There is a significant positive association between higher body mass index (BMI) category and more severe OSA (p = 0.02). Conversely, there was a negative association between moderate/severe OSA and a history of feeding difficulties (p = 0.037).

In this large cohort of children with DS, we confirm a high prevalence of OSA. Additionally, caregiver-reported witnessed apneic events occurring most nights and BMI category severity were associated with worsened OSA severity.