Predictors of sleep disordered breathing in children with Down syndrome: a systematic review and meta-analysis

Abstract

Children with Down syndrome are at increased risk of sleep disordered breathing (SDB). SDB is associated with significant morbidity including neurocognitive impairment, cardiometabolic disease and systemic inflammation. The identification of clinical markers that may predict SDB is critical in facilitating early diagnosis and treatment, and ultimately, preventing morbidity. The objective of this systematic review was to identify predictors of SDB in patients with Down syndrome. A search was conducted using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health Literature. A meta-analysis was performed according to the Meta-analyses of Observational Studies in Epidemiology checklist. Our review of the literature identified inconsistent associations between a variety of variables and SDB in children with Down syndrome, although the quality of evidence was poor. Meta-analysis of age and sex identified that children with OSA were older than those without OSA, and there was a similar risk of OSA in males and females, although risk favoured males. Currently, the American Academy of Pediatrics guidelines recommend that children with Down syndrome undergo polysomnography by the age of 4 years. Our review supports the recommendation for routine screening of children with Down syndrome. However, results from our meta-analysis suggest a need for longitudinal screening to diagnose children who may develop SDB as they get older.

Características miofuncionais orofaciais e polissonográficas de crianças com Síndrome de Down e apneia obstrutiva do sono: estudo piloto

“…A identificação de marcadores clínicos com potencial de predição da AOS em crianças com SD facilitaria o diagnóstico precoce e tratamento, bem como a prevenção de morbidades. No entanto, até o momento, a literatura apresenta associação inconsistente ou frágil entre preditores clínicos e biomarcadores para a presença de AOS na referida população (23) .…”

“…No entanto, uma vez que foram considerados os 10 itens originais do protocolo, as crianças típicas com AOS expressaram uma pontuação mais baixa do que as crianças com SD e AOS deste estudo, sugerindo um maior comprometimento miofuncional orofacial das crianças deste estudo, o que é compatível com a literatura por se tratar de crianças com SD (4,6,11,23) . Estudos demonstram dificuldade ou não conseguem comprovar que fatores como idade, sexo, exposição ao cigarro, achados clínicos, dados antropométricos e presença de comorbidades, a não ser a doença cardíaca congestiva, sejam considerados preditivos da severidade da AOS em crianças com SD (23,24) . Entretanto, até o momento, nunca fora investigada e identificada a correlação apresentada nesse estudo piloto entre alterações nos aspectos miofuncionais orofaciais e a gravidade da AOS.…”

“…Dyken et al (25) afirmam haver uma associação entre IMC mais elevado em crianças mais velhas e AOS severa. A correlação entre sobrepeso e obesidade já é comprovada na população adulta, no entanto, ainda há controvérsias quando se trata de crianças (23) . Há que se considerar que o grupo estudado possui outras características influenciadoras na gravidade do distúrbio além do IMC elevado, quais sejam a própria condição genética e comprometimento da morfologia e funcionalidade das estruturas orofaríngeas e do trato respiratório (12,23) .…”

Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach

“…This is in agreement with other studies that showed that age and BMI had an inverse relationship with SpO2 [ 36 , 37 ]. Several studies have evaluated the relationship between age and AHI, or between BMI and AHI, with still controversial findings [ 38 ]. In our study, any age effect on AHI or any correlation between BMI and AHI was found.…”

Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors

“…A recent meta-analysis of 24 studies, aiming to identify predictive risk factors of SDB in patients with DS, identified older age to be associated with OSA without a clear sex predominance, although males were more likely to have OSA than females. Nevertheless, the author highlighted the difficulty in predicting SDB only from clinical evaluation (i.e., adenotonsillar hypertrophy, dental examination, BMI) and sleep behaviors, probably due to the poor quality of the evidence [ 57 ]. Furthermore, OSA also seems to be more prevalent in infants with no snoring or witnessed apnea [ 49 , 50 , 51 ].…”