Cardiovascular complications in children with Down syndrome and sleep disordered breathing

Children with Down syndrome (DS) often present with craniofacial and neuromuscular features that increase the risk of sleep-disordered breathing (SDB), which may lead to cardiovascular morbidity. We conducted a scoping review to profile the current evidence base describing cardiovascular complications in children with DS and SDB. Findings from this work are expected to identify knowledge gaps that could inform future research and clinical care.

We performed a systematic scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Comprehensive searches of Embase, Scopus, and MEDLINE were conducted, and eligible studies included children aged 1-18 with DS and SDB reporting cardiovascular outcomes.

Seven studies involving 1,437 participants were included. Across various study designs, children with DS and SDB showed blunted autonomic responses to apneic events, impaired nocturnal dipping of heart rate and blood pressure, increased hypoxic burden even with mild OSA severity, and early signs of left ventricular diastolic dysfunction and bi-ventricular remodeling.

SDB and DS are linked to a constellation of clinical signs consistent with cardiopulmonary end-organ dysfunction and elevated clinical risk. Ongoing cardiac monitoring and use of physiologic measures beyond the apnea-hypopnea index are necessary. Addressing persistent upper airway obstruction with multimodal treatments, including surgery, positive airway pressure, and new therapies like hypoglossal nerve stimulation, may be crucial to lowering long-term cardiovascular risk in this vulnerable group.