Positional obstructive sleep apnea in pediatric down syndrome: Prevalence and therapy implications.

BACKGROUND

Children with Down Syndrome (DS) may be uniquely predisposed to positional obstructive sleep apnea (POSA) due to their anatomic features. Our objective was to determine the prevalence and predisposing factors of POSA in a DS pediatric population in comparison to a control cohort.

METHODS

Overnight polysomnograms of children with and without DS were retrospectively reviewed between November 2016 and December 2023. Demographics and sleep data were collected; POSA was defined as an obstructive apnea-hypopnea index (OAHI) that was at least twice as high in the supine vs. non-supine position.

RESULTS

DS children had more severe OSA as evidenced by OAHI in different sleep states and body positions than controls. Prevalence of POSA was slightly higher in controls than DS group (48% vs. 36%, p = 0.078). The majority of control children with POSA exhibited mild OSA, while DS children with POSA had a more equal distribution in all OSA severity categories. DS was associated with a decreased odds of having POSA (OR 0.45, 95%CI: 0.2, 0.97, p = 0.042).

CONCLUSION

DS subjects demonstrated more severe OSA and a predisposition towards experiencing significant apneic events in all body positions and sleep stages. The expression of this clinical phenotype of OSA in DS children may be caused by multiple factors, but we hypothesize that it is due primarily to their hypotonia and greater airway collapsibility. Our findings suggest that positional therapy must be individualized for children with DS.