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Should We Screen Earlier for Sleep Apnea in Infants with Down Syndrome?

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Editor’s Note: Dr. Morgan Irwin-Weyant is a resident physician in pediatrics at the University of Virginia. She will be entering her fellowship in pediatric emergency medicine this summer. - Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

For pediatric patients with Down syndrome, obstructive sleep apnea (OSA) is more common than congenital heart disease, hypothyroidism, and hematologic malignancies, but those latter conditions are screened for in infancy, while OSA is not. Instead, current AAP recommendations recommend screening for OSA with polysomnography (PSG) before age 4 years.

By recommending age 4 as the cutoff, are we potentially missing more severe sleep apnea or even the opportunity for a better study if it is performed in infancy?

To answer this question, Dr. Katelyn Seither and colleagues at Indiana University and the University of Cincinnati performed a retrospective cohort study of 397 children with Down syndrome born at Cincinnati Children’s Hospital Medical Center between 2013 and 2019. Their findings are being early released this week in an article in Pediatrics entitled, “Sleep Apnea in Children with Down Syndrome” (10.1542/peds.2022-058771). The authors evaluated demographics and whether PSG was performed. If PSG was performed, the age of the patient, results, and resulting interventions (if the PSG results were abnormal) were analyzed.

The authors found that 59% of the cohort had a PSG, and of those evaluated, over 90% of these children were diagnosed with OSA, and 60% had moderate or severe OSA.

Failure to thrive, aspiration, and laryngomalacia were significantly associated with moderate-severe OSA, suggesting that patients who present with these symptoms should be screened with PSG. Additionally, infants younger than 6 months were disproportionally affected by severe OSA as compared to older children.

For children with Down syndrome, particularly those with feeding and airway concerns, screening for OSA during the first year of life may be helpful.

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