Sleep-disordered breathing in children with down syndrome

S3C – Sleep Disordered Breathing in Children
SLEEP DISORDERED BREATHING IN CHILDREN WITH DOWN SYNDROME

Dg Zuraini Sahadan
Sultan Idris Shah Serdang Hospital, Selangor, Malaysia

Sleep disordered breathing is commonly observed in children with Down syndrome (DS) and can lead to significant behavioural and cognitive morbidities. Obstructive sleep apnoea(OSA) affects 30% to 70% of pediatric patients with DS. 

The pathophysiology of OSA in DS is multifactorial, with contributions from upper airway anatomic narrowing and collapsibility in the setting of hypotonia. Additionally, medical comorbidities, including hypothyroidism, gastroesophageal reflux, aspiration, recurrent respiratory infections, and seizures contribute to OSA through multiple mechanisms. Infants with DS are predisposed to airway obstruction and gas exchange abnormalities during sleep because of anatomic and physiologic features, including preferential high-resistance nasal breathing and a lower apneic threshold, and may have more severe OSA compared with older children with DS. Progressive obesity is also another risk factor in adolescents with DS. 

Since the presence of SDB in children could be a risk factor for attention difficulty, disturbance of normal intellectual development and exacerbation of cardiovascular diseases, early detection and treatment of SDB is recommended especially in DS children. Even though polysomnography(PSG) is the gold standard in diagnosing SDB, it has several disadvantages including its high cost and the difficulty in performing the test with many sensors, especially in children with DS who also have intellectual disability. Initial screening with pulse oximetry could be an alternative tool for cases in which a diagnostic multichannel PSG study is difficult to perform and inaccessible. It might provide patients early access to essential therapy for SDB