Developmental changes in obstructive sleep apnea and sleep architecture in Down syndrome

Authors

Ryan Kahanowitch, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Hector Aguilar, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Miriam Weiss, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Jenny Lew, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Qi Pan, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Maria Camila Ortiz-Vergara, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Oscar Rodriguez, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.
Gustavo Nino, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

7-1-2023

Journal

Pediatric pulmonology

Volume

58

Issue

7

DOI

10.1002/ppul.26405

Keywords

Down syndrome; REM; Trisomy 21; obstructive sleep apnea

Abstract

BACKGROUND: Down syndrome (DS, also known as Trisomy 21) is a condition associated with abnormal neurodevelopment and a higher risk for sleep apnea. Our study sought to better understand and characterize the age-related developmental differences in sleep architecture and obstructive sleep apnea (OSA) severity in children with DS compared to euploid individuals. METHODS: Retrospective review of polysomnograms in over 4151 infants, children, and adolescents in the pediatric sleep center at Children's National Hospital in Washington D.C. (0-18 years) including 218 individuals with DS. RESULTS: The primary findings of our study are that: (1) severe OSA (obstructive apnea-hypopnea index ≥ 10/h) was more prevalent in the DS group (euploid 18% vs. DS 34%, p < 0.001) with the highest OSA severity being present in young children (<3 years old) and adolescents (>10 years old), (2) abnormalities in sleep architecture in children with DS were characterized by a prolonged rapid-eye movement (REM) sleep onset latency (SOL) (euploid 119 min vs. DS 144 min, p < 0.001) and greater arousal indexes (euploid 10.7/h vs. DS 12.2/h, p < 0.001), (3) developmental changes in the amount of REM sleep or slow wave sleep were not different in DS individuals relative to euploid children, (4) multivariate analyses showed that OSA and REM sleep latency differences between DS and euploid individuals were still present after adjusting by age, biological sex, and body mass index. CONCLUSION: Severe OSA is highly prevalent in children with DS and follows an age-dependent "U" distribution with peaks in newborns/infants and children >10 years of age. Children with DS also have disturbances in sleep architecture characterized by a longer REM SOL and elevated arousal indexes. As sleep cycle generation and continuity play crucial roles in neuroplasticity and cognitive development, these findings offer clinically relevant insights to guide anticipatory guidance for infants, children, and adolescents with DS.

APA Citation

Kahanowitch, Ryan; Aguilar, Hector; Weiss, Miriam; Lew, Jenny; Pan, Qi; Ortiz-Vergara, Maria Camila; Rodriguez, Oscar; and Nino, Gustavo, "Developmental changes in obstructive sleep apnea and sleep architecture in Down syndrome" (2023). GW Authored Works. Paper 3169.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3169

Department

Pediatrics