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Obstructive sleep apnea in children with Down syndrome: contribution of upper airway and chemosensitivity

  • Clinical Research Article
  • Published:
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Abstract

Background

The high prevalence of obstructive sleep apnea syndrome (OSAS) in children with Down syndrome (DS) has been attributed to a reduced upper airway size, while the role of ventilatory control is unclear. The objectives of our case–control study were to evaluate the upper airway reduction in children with DS and moderate to severe OSAS as compared to typically developing (TD) children with similar OSAS severity and to evaluate the degree of chemical loop gain modifications including its components: controller and plant gains (CG, PG).

Methods

Thirteen children with DS were matched for age, sex, OSAS severity and ethnicity with 26 TD children. They had undergone acoustic rhinometry and pharyngometry, chemical LG obtained during awake tidal breathing measurement and hypercapnic–hyperoxic ventilatory response testing.

Results

As compared to TD, children with DS depicted reduced oropharyngeal dimensions, significantly lower CG and LG and no different PG. Their hypercapnic ventilatory response slopes were not different.

Conclusions

We concluded that the decreased CG in DS was related to decreased peripheral chemoreceptor sensitivity, and while central chemosensitivity was normal, the former explained the increased end-tidal PCO2 observed in children with DS as compared to TD. Pharyngeal dimensions are reduced in children with DS and OSAS.

Impact

  • Reduced upper airway size and nocturnal alveolar hypoventilation in children with Down syndrome (DS) have been previously reported.

  • We confirmed that children with DS and moderate-to-severe OSA have reduced oropharyngeal size as compared to typically developing children with similar OSAS severity and demonstrated decreased peripheral chemosensitivity explaining the alveolar hypoventilation observed in children with DS.

  • Central chemosensitivity appears to be intact in children with DS and moderate to severe OSAS

  • Our results support growing evidence that Down syndrome is associated with autonomic nervous system dysfunction.

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Fig. 1: Flow chart of the study.
Fig. 2: Loop gain parameters in children with DS and TD children.
Fig. 3: Mean central apnea duration according to study cohort.

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Data availability

The data that support the findings of this study are available from the corresponding author upon request. The data are not publicly available because they contain information that may compromise the privacy of the research participants.

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Authors and Affiliations

  1. Université de Paris-Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, F-75019, Paris, France

    Plamen Bokov, Benjamin Dudoignon & Christophe Delclaux

  2. AP-HP, Hôpital Robert Debré, Service d’Oto-Rhino-Laryngologie, F-75019, Paris, France

    Imene Boujemla

  3. AP-HP, Hôpital Robert Debré, Service de Stomatologie et Chirurgie Plastique, F-75019, Paris, France

    Jacques Dahan

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  1. Plamen Bokov
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  2. Imene Boujemla
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  3. Jacques Dahan
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  4. Benjamin Dudoignon
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  5. Christophe Delclaux
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Contributions

P.B. conceived and designed the research; P.B., I.B., J.D., and C.D. performed the measurements; P.B. and C.D. analyzed the data; all authors interpreted results of the experiments; P.B. prepared the figures; P.B., B.D., and C.D. drafted the manuscript; all authors edited and revised the manuscript; all authors approved the final version of the manuscript.

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Correspondence to Plamen Bokov.

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A written consent was not required from the included subjects. The subjects and their parents were informed of the collection of their prospective data for research purposes, and they could request to be exempted from this study as per French law (non-interventional research).

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Bokov, P., Boujemla, I., Dahan, J. et al. Obstructive sleep apnea in children with Down syndrome: contribution of upper airway and chemosensitivity. Pediatr Res 94, 1990–1997 (2023). https://doi.org/10.1038/s41390-023-02718-8

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