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Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). We aimed to assess OSA prevalence in a single center cohort of children with DS, identify associated risk factors of obstructive respiratory events, and examine the influence of different sleep stages and body positions on respiratory events distribution.

Methods

Single center retrospective study that included children with DS who underwent overnight polysomnogram (PSG). OSA severity was categorized by obstructive apnea–hypopnea index (OAHI) as mild (1.5–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). A logistic regression analysis was used to examine the association between OSA-related risk factors in normal and abnormal OAHI category and in REM and Non-REM predominant AHI groups.

Results

PSG data were available for 192 children with a median age of 5 years (IQR 7). OSA prevalence was 82.3% (27.1% mild, 19.8% moderate, and 35.4% severe). A logistic regression model identified BMI and being an African American as significant predictors for OAHI severity. In children with OSA, the median OAHI was 7.6 and obstructive respiratory events were more common in REM sleep and in the supine position. The median REM OAHI was 20 events/h (IQR: 24.4), whereas the median Non-REM OAHI was 5.2 events/h (IQR: 12.6 p < 0.0001). Similarly, supine OAHI was 11.6 (IQR: 19.3) and off supine OAHI was 6.6 (IQR: 11.6, p = 0.0004). Age was a significant predictor (p = 0.012) for Non-REM predominant OSA which was present in 15.2% of children with OSA.

Conclusion

Children with DS have a high prevalence of OSA. Higher BMI and being an African American were significant associated risk factors for higher OAHI. Obstructive respiratory events in children with DS occur predominantly in REM sleep and in the supine position. Non-REM predominant distribution of respiratory events was noted in older children with DS.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AAP:

American Academy of Pediatrics

AASM:

American Academy of Sleep Medicine

AHI:

Apnea-hypopnea index

BMI:

Body mass index

CAI:

Central apnea index

DS:

Down syndrome

CO2:

Carbon dioxide

OAHI:

Obstructive apnea–hypopnea index

OSA:

Obstructive sleep apnea

PSG:

Polysomnogram

REM:

Rapid eye movements

IQR:

Interquartile range

T&A:

Adenotonsillectomy

TO:

Tonsillectomy

WASO:

Wake after sleep onset

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Acknowledgements

The authors would like to thank Andrea Shewmaker for support with some of the data collection for this study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Louisville and Norton Children Medical Group, 9880 Angies Way Suite 300, Louisville, KY, 40241, USA

    Egambaram Senthilvel & Kahir Jawad

  2. Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, USA

    Bakeerathan Gunaratnam

  3. Baptist Health, Louisville, KY, USA

    Juhee N. Mian

  4. Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Karim El-Kersh

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  1. Egambaram Senthilvel
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Egambaram Senthilvel, Karim El-Kersh and Juhee Mian. Data were analyzed by Kahir Jawad and Bakeerathan Gunaratnam. The first draft of the manuscript was written by Egambaram Senthilvel and all authors all authors read and approved the final manuscript.

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Correspondence to Egambaram Senthilvel.

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This retrospective chart review study involving human participant were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the University of Louisville and Norton Healthcare approved this study.

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Senthilvel, E., Jawad, K., Gunaratnam, B. et al. Prevalence, associated risk factors, and respiratory event distribution of obstructive sleep apnea in children with Down syndrome. Sleep Breath 28, 251–260 (2024). https://doi.org/10.1007/s11325-023-02900-6

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