Down syndrome (DS) is a common genetic syndrome associated with a higher risk for sleep-disordered breathing. We aimed to reveal the age-related developmental difference in sleep architecture and polysomnographic phenotypes and identify the predictors of severe obstructive sleep apnea (OSA) in children with DS.
This cross-sectional study included children aged 3-18 with DS who underwent diagnostic polysomnography from 2013-2023. We collected demographic data, sleep symptoms, and polysomnographic results. We analyzed the prevalence of sleep-disordered breathing categorized by age group and used multivariable logistic regression to identify predictors of severe OSA.
Among 95 children, 56.8% had severe OSA and 24.2% had sleep-related hypoventilation. Of those with OSA, 50.5% had positional OSA, and 55.8% had rapid eye movement (REM)-related OSA. Categorized by age groups, children aged 12 -18 years had the highest rates of sleep-disordered breathing compared to other age groups: 75.0% for severe OSA and 82.6% for positional OSA. Age (adjusted OR (95% CI) = 1.24 (1.08-1.43), p = 0.002) and tonsillar hypertrophy (adjusted OR (95% CI) = 3.28 (1.22-8.86), p = 0.019) were significantly associated with severe OSA.
Sleep-disordered breathing was most frequently diagnosed in children with DS aged 12-18 years compared to other age groups, with a positive correlation between age and OSA severity. Our data support proper surveillance polysomnography for those with tonsillar hypertrophy and during adolescence, even for children with DS who had an initial negative PSG by four years of age.
Competing Interests
CONFLICT OF INTEREST DISCLOSURES: The authors have no conflicts of interest relevant to this article to disclose.