Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

Abstract

Abstract:Objective:Individuals diagnosed with Down syndrome (DS) are predisposed to obstructive sleep apnea (OSA). The aim of this study is to assess the prevalence of OSA and factors associated with OSA in this population. Study Design:Systematic literature review and meta-analysis. Methods:Studies of DS and OSA in the English language through May 2017 were reviewed. Since parental report of symptoms has limited validity related to the diagnosis of OSA, only studies using in laboratory polysomnography to diagnose OSA were included. Results:Twenty three studies examining OSA among 1,469 people with DS were found. Among ten studies using community referred samples, 71.5% of people with DS had OSA, compared to 69.6% in referred community samples suspected of having respiratory events. There was an inverse relationship between apnea hypopnea index (AHI) cutoffs and OSA prevalence as higher cutoffs were associated with somewhat lower prevalence.Examining age groups, adults had a higher prevalence of OSA (90.0%) compared to infants (66.5%) and children between 2-21 years of age (69.9%). Oxygen desaturation and gender did not affect prevalence.Although surgery had less effect on successfully treating OSA among DS individuals compared to those without DS in prior studies, lingual tonsillectomy had the greatest effect (mean AHI decrease of 9.0). Conclusion:OSA appears to occur frequently in children and adults with DS. Untreated, OSA may contribute to health problems and premature death, highlighting the potential importance of identifying OSA among people with DS.Even after traditional surgeries (i.e., adenotonsillectomy, tonsillectomy, adenoidectomy), repeating PSG is highly recommended as residual OSA can persist

Sleep disordered breathing in children with Down syndrome in the Republic of Ireland

“…Unsurprisingly, parents of older children participating in this study who had received a formal diagnosis of OSAS had experienced a longer duration of symptoms compared with their younger peers. Children with OSAS that is left untreated or undiagnosed risk significant health issues (Ridore et al, 2017). These morbidities can impact on a child's schooling (Hill, 1889; Stranks & Crowe, 2015; Tauman & Gozal, 2011), be irreversible and can continue to impact into adulthood (Capdevila, Kheirandish‐Gozal, Dayyat, & Gozal, 2008; Stranks & Crowe, 2015).…”

“…OSAS is much more common in children and adolescents with DS with an estimated prevalence of 50-75% compared with 1.2-5.7% of the general population (Bassell, Phan, Leu, Kronk, & Visootsak, 2015;Marcus et al, 2012;Pandit & Fitzgerald, 2012;Simpson, Oyekan, Ehsan, & Ingram, 2018;Tan, Gozal, & Kheirandish-Gozal, 2013). Various etiological factors have been identified including variations in anatomy, ventilatory volume differences, and muscle tone (Bassell et al, 2015;Chang & Chae, 2010;Pandit & Fitzgerald, 2012;Ridore et al, 2017).…”

Tongue-Based Procedures in Treating Refractory Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-Analysis

“…1 There is an increased risk of OSA in both children and adults with Down Syndrome (DS). 1,2 In the pediatric population, the reported prevalence of OSA ranges between 55 to 97% for children with DS compared to 1 to 4% of children without DS. 3 For the adult population, the prevalence of OSA is estimated to be 35% to 42% for adults with DS compared to 12% for adults without DS.…”

Hypoglossal Nerve Stimulator Placement for Pediatric Trisomy 21 Patients with Refractory Obstructive Sleep Apnea: A Case Series

“…Patients with trisomy 21 are predisposed to an increased risk of obstructive sleep apnea (OSA) at baseline with as many as 70% meeting criteria [1]. Tonsillectomy, adenoidectomy, and/or lingual tonsillectomies are often performed in patients with adenotonsillar hypertrophy to improve symptoms.…”

“…Tonsillectomy, adenoidectomy, and/or lingual tonsillectomies are often performed in patients with adenotonsillar hypertrophy to improve symptoms. However, the majority of patients with trisomy 21 will continue to have ongoing airway obstruction after surgical intervention [1][2][3][4]. Persistent hypotonia, macroglossia, lingual tonsillar hypertrophy, maxillary hypoplasia, obesity, and hypothyroidism all contribute to the continued airway obstruction [1].…”