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Down Syndrome Abstract
of the Month: Mar 2004

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Prevalence of sleep-disordered breathing in children with Down syndrome

de Miguel-Diez J, Villa-Asensi JR, Alvarez-Sala JL
Sleep. 2003 Dec 15;26(8):1006-9

Dept. of Pulmonology, Hospital General Universitario Gregorio Maranon, Universidad Complutense de Madrid, Spain

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STUDY OBJECTIVES: To assess the prevalence of sleep-disordered breathing in a nonselected group of children with Down syndrome and to determine significant predisposing factors for this condition. DESIGN: Prospective study. SETTING: Tertiary care university hospital in Madrid, Spain. PATIENTS: The study population included 108 consecutive children with Down syndrome (mean [SD] age, 7.9 [4.5] years; range, 1-18 years) independently of whether or not suggestive clinical features of sleep-disordered breathing were present. INTERVENTIONS: In addition to history, physical examination, and lateral radiographs of the nasopharynx, all participants underwent an overnight cardiorespiratory polygraphy at the hospital using a portable ambulatory device (Apnoescreen II plus). An apnea-hypopnea index of at least 3 was required for defining the presence of sleep-disordered breathing. RESULTS: The prevalence of sleep-disordered breathing was 54.6%, with a significantly higher prevalence in boys (64.7%) than in girls (38.5%). The group with sleep-disordered breathing was significantly younger (6.4 [3.9] years) than those with normal polysomnographic recordings (9.6 [4.6] years). In the multivariate analysis, age (less than 8 years old), male sex and tonsillar hyperplasia were significantly associated with sleep-disordered breathing. Body mass index, adenoid hyperplasia, previous tonsillectomy or adenoidectomy, congenital heart disease, malocclusion, and macroglossia did not affect the prevalence of sleep-disordered breathing. CONCLUSIONS: The prevalence of sleep-disordered breathing in children with Down syndrome is very high, particularly in boys. Tonsillar hyperplasia may play a role in the pathophysiology of sleep-disordered breathing in these patients. Adenoid hyperplasia, obesity, and congenital heart disease were not important risk factors for sleep-disordered breathing.

My comments:

It's been known for some time that children and adults with Down syndrome have a greater risk of obstructive sleep apnea (OSA), but most of the studies done were on people with DS who had been referred to either sleep centers or ear, nose and throat doctors initially. This study looked at all children with DS who had attended a local DS Clinic in Madrid. Two-thirds of all boys with DS and one-third of girls with DS had sleep-disordered breathing. The researchers define "sleep-disordered breathing" as a complete cessation of breathing for 10 or more seconds or a 50% reduction in airflow accompanied by a decrease of at least 4% in saturation of oxygenation (pulse oximeter).

There are two major limitations to this study. First of all, there is a broad range of what can be defined as sleep-disordered breathing. Had the authors decided to make their diagnosis based on 3 desaturations of oxygen per hour instead, then up to 78% of the children studied would have been diagnosed with OSA. Second, the equipment used in this study has been validated in adults but not yet validated for children.

The higest incidence occurred in the pre-toddler range, indicating that growth of the facial structures helps decrease OSA over time.
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