The prevalence of obstructive sleep apnea (OSA) is reported as being 45-76% in children with Down syndrome. In a more recent study of 138 children with Down's syndrome, researchers found 82.6% of them had OSA (Nerfeldt & Sundelin, 2020), according to their polysomnography (PSG). The following diagnoses were present:
Sleep apnea can further contribute to cognitive abilities, delayed growth, and worsening respiratory and cardiac abnormalities (Shott, retrieved 2021).
In a study by Maris et al. (2016), the prevalence of sleep problems identified by parents was evaluated using the Child Sleep Habits Questionnaire (CSHQ). In addition, an overnight polysomnography was performed to screen for obstructive sleep apnea. The parents of the 54 children completed the CSHQ and identified sleep apnea in 74% of the children; 57% were actually diagnosed with sleep apnea, indicating a lack of correlation with parental reports. The researchers also found that sleep apnea did not correlate with age or gender but with longer sleep duration and daytime sleepiness. Sleep apnea also correlated with parasomnias, unwanted events or experiences occurring during sleep, during the transition from wake to sleep, or during arousals from sleep (Cai & Bae, 2021).
It is recommended that all children and adults with DS should receive routine screening for OSA using polysomnography (Simpson et al., 2018). The following are recommended treatment options:
The primary surgical treatment for sleep apnea has been performing a T&A. However, the efficacy of that procedure has not been established.
Farhood et al. (2017) did find in a review of the literature that there was little objective data in the medical literature addressing T&A efficacy in treating OSA in patients with DS patients. In their study, they did see an improvement in sleep parameters following T&As.
While adenotonsillectomy (ATE) and adenopharyngoplasty (APP) are recommended to treat sleep apnea in children with Down's syndrome, the study by Nerfeldt and Sundelin (2020) showed no significant changes in the post-operative PSG. This was a small retrospective study that the researchers stated needed to be replicated with a larger group of children.
Instant Feedback:
Anatomical abnormalities can contribute to the occurrence of obstructive sleep apnea.
References
Cai, A. & Bai, C. J. (2021) Parasomnias. In Decision-Making in Adult Neurology by Cucchiara, B. & Price, R. S.,editors. Elsevier, 164-165.
Farhood, Z., Isley, J.W., Ong, A.A., Nguyen, S.A., Camilon, T.J., LaRosa, AC & White, D.R. (2017). Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea. Laryngoscope. 127(6), 1465-1470.
Maris, M., Verhulst, S., Wojciechowski, M., Van de Heyning, P. & Boudewyns, A. (2016). Sleep problems and obstructive sleep apnea in children with down syndrome, an overview. Otorhinolaryngology.82, 12-15.
Nerfeldt, P. & Sundelin A. (2020). Obstructive sleep apnea in children with Down syndrome - Prevalence and evaluation of surgical treatment. Int J Pediatr Otorhinolaryngol. 133, 109968.
Shott, S. Obstructive sleep apnea & Down syndrome. The National Down Syndrome Society. Retrieved on October 30, 2021. https://www.ndss.org/resources/obstructive-sleep-apnea-syndrome/
Simpson, R., Oyekan, A. A., Ehsan, Z., & Ingram, D. G. (2018). Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nature and science of sleep, 10, 287–293.
© RnCeus.com