Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Gastelum, Erica; Cummins, Marcus; Singh, Amitoj; Montoya, Michael J.; Urbano, Gino Luis; Tablizo, Mary Anne

doi:10.3390/children8111074

Cited by 13 publications

(8 citation statements)

References 63 publications

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“…PAP therapy is the first choice for this population, although it is often not well tolerated. The use of PAP therapies and/or other therapies, high flow nasal cannula and hypoglossal nerve stimulation may be alternative treatments in cases with problematic adherence to PAP 264 .…”

Section: Sleep Breathing Disorders In Pediatricsmentioning

confidence: 99%

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Frange¹,

Franco²,

Brasil³

et al. 2022

Sleep Sci

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This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

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Section: Sleep Breathing Disorders In Pediatricsmentioning

confidence: 99%

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Frange¹,

Franco²,

Brasil³

et al. 2022

Sleep Sci

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“…Children 2024, 11, 651 2 of 13 airway abnormalities, such as laryngomalacia and tracheomalacia; celiac disease; hearing and vision disorders; hypothyroidism; obesity; and obstructive sleep apnea (OSA) [3].…”

Section: Introductionmentioning

confidence: 99%

Sleep-Disordered Breathing and Associated Comorbidities among Preschool-Aged Children with Down Syndrome

Kolstad,

DelRosso,

Tablizo

et al. 2024

Children

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Children with Down syndrome (DS) are at high risk of sleep-disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. This retrospective study examined the frequency of SDB, gas exchange abnormalities, co-morbidities, and surgical management in children with DS aged 2–4 years old at Seattle Children’s Hospital from 2015–2021. A total of 153 children underwent PSG, with 75 meeting the inclusion criteria. The mean age was 3.03 years (SD 0.805), 56% were male, and 54.7% were Caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%), and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). In total, 94.7% met the criteria for pediatric OSA, 9.5% met the criteria for central apnea, and 9.5% met the criteria for hypoventilation. Only one child met the criteria for hypoxemia. Overall, 60% had surgical intervention, with 88.9% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages. Children aged 2–4 years with DS have a high frequency of OSA. The most commonly encountered co-morbidities were cardiac and swallowing dysfunction. Among those with OSA, more than half underwent surgical intervention, with improvements in their obstructive apnea hypopnea index, total apnea hypopnea index, oxygen saturation nadir, oxygen desaturation index, total arousal index, and total sleep duration. This highlights the importance of early diagnosis and appropriate treatment. Our study also suggests that adenotonsillar hypertrophy is still a large contributor to upper airway obstruction in this age group.

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“…The distinct dysmorphic features of DS, including mid‐face and mandibular hypoplasia, relatively large and medially positioned tonsils, and relative macroglossia result in a significant reduction in the size of the upper airway, which combined with obesity and hypotonia, common in DS, increases the risk of OSA (Shott et al, 2006; Subramanyam et al, 2016). As in typically developing children, the first line of treatment for OSA is adenotonsillectomy, however, a greater number of children with DS have residual OSA after surgery and often require further treatment (Bhattacharjee et al, 2010; Gastelum et al, 2021). The disease severity threshold for treatment of OSA in children with DS is not established and the impact of sub‐curative treatment on outcomes has also not been examined.…”

Section: Introductionmentioning

confidence: 99%

Follow‐up of children with Down syndrome and sleep disordered breathing and the effects of treatment on actigraphically recorded sleep, quality of life, behaviour, and daytime functioning

Horne

Shetty

Davey

et al. 2023

Journal of Sleep Research

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SummaryChildren with Down syndrome are at increased risk of obstructive sleep disordered breathing, which has deleterious effects on daytime functioning. We aimed to examine the effects of treatment of sleep disordered breathing on sleep quality and daytime functioning in children with Down syndrome, and hypothesised that these would be improved. Thirty‐four children completed a baseline study and a follow‐up 2 years later. Measures at both time points included 7 days of actigraphy and parents completed a number of questionnaires assessing sleep, behaviour, daytime functioning, and quality of life. All children had overnight polysomnography at baseline; 15 children (44%) were treated. At baseline the treated group had more severe sleep disordered breathing compared with the untreated group: obstructive apneoa–hypopnoea index 29.3 ± 38.2 events/h versus 3.3 ± 5.2 events/h (p < 0.01). Actigraphy showed no significant differences in total sleep time, sleep efficiency, sleep schedules from baseline to follow up in either group. The sleep disturbance (p < 0.01) and total problems (p < 0.05) scales on the OSA‐18 and the sleep disordered breathing subscale on the Paediatric Sleep Problem Survey Instrument (p < 0.01) improved in the treated children. There were no changes in any measure in the untreated children. Treatment of sleep disordered breathing improves symptoms, sleep disturbance and quality of life in children with Down syndrome, but has no demonstrable impact on actigraphic sleep measures or daytime behaviour or function. In contrast, children who were not treated, despite having less severe disease at baseline, had increased sleep disruption and no change in quality of life.

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Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Cited by 13 publications

References 63 publications

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Sleep-Disordered Breathing and Associated Comorbidities among Preschool-Aged Children with Down Syndrome

Follow‐up of children with Down syndrome and sleep disordered breathing and the effects of treatment on actigraphically recorded sleep, quality of life, behaviour, and daytime functioning

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