Obstructive Sleep Apnea in Adults with Down Syndrome

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2009 Dec 9

PMID 19968008

Citations 51

Authors

Maria S Trois

George T Capone

Janita A Lutz

Maria C Melendres

Alan R Schwartz

Nancy A Collop

Carole L Marcus

Affiliations

Soon will be listed here.

Abstract

Objectives: A high proportion of children with Down syndrome (DS) have the obstructive sleep apnea syndrome (OSAS). Although adults with DS have many predisposing factors for OSAS, this population has not been well studied. We hypothesized that OSAS is common in adults with DS, and that the severity of OSAS is worse in DS adults who are more obese.

Design: Cohort study.

Setting: Sleep laboratory.

Participants: 16 adults with DS underwent evaluation for sleep disordered breathing.

Interventions: Polysomnographic results were compared to a retrospective sample of adult patients referred for clinically suspected OSAS.

Measurements And Results: Polysomnograms were abnormal in 94% of DS subjects. The median apnea hypopnea index (AHI) was 37/h (range 0-118). The median arterial oxygen saturation nadir was 75% (23% to 95%), and the median peak end-tidal CO2 was 58 (47-66) mm Hg. There was a significant correlation between body mass index and AHI (r = 0.53, p < 0.05). Sixty-three percent had an Epworth score > 10. The AHI and saturation nadir were significantly worse in DS than non-DS patients.

Conclusions: Adults with DS frequently have OSAS, with obstructive apnea, hypoxemia, hypoventilation, and sleep fragmentation. The severity of OSAS correlated with obesity. We speculate that the complications of untreated OSAS (cardiovascular disease, increased mortality, and neurobehavioral morbidities including daytime sleepiness and impaired cognitive function) commonly overlap with the manifestations of DS and therefore may not elicit a prompt investigation in these patients. We speculate that OSAS is an important, but potentially treatable, cause of morbidity in adults with DS.

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References

Uong E, McDonough J, Zhao H, Haselgrove J, Mahboubi S, Schwab R . Magnetic resonance imaging of the upper airway in children with Down syndrome. Am J Respir Crit Care Med. 2001; 163(3 Pt 1):731-6. DOI: 10.1164/ajrccm.163.3.2004231. View

Gibson G, Pulsinelli W, Blass J, Duffy T . Brain dysfunction in mild to moderate hypoxia. Am J Med. 1981; 70(6):1247-54. DOI: 10.1016/0002-9343(81)90834-2. View

Stebbens V, Dennis J, Samuels M, Croft C, Southall D . Sleep related upper airway obstruction in a cohort with Down's syndrome. Arch Dis Child. 1991; 66(11):1333-8. PMC: 1793297. DOI: 10.1136/adc.66.11.1333. View

Redline S, Tishler P, Schluchter M, Aylor J, Clark K, Graham G . Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999; 159(5 Pt 1):1527-32. DOI: 10.1164/ajrccm.159.5.9809079. View

Young T, Peppard P, Gottlieb D . Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165(9):1217-39. DOI: 10.1164/rccm.2109080. View

Resta O, Foschino Barbaro M, Giliberti T, Caratozzolo G, Cagnazzo M, Scarpelli F . Sleep related breathing disorders in adults with Down syndrome. Downs Syndr Res Pract. 2003; 8(3):115-9. DOI: 10.3104/reports.138. View

Kingshott R, Sime P, Engleman H, Douglas N . Self assessment of daytime sleepiness: patient versus partner. Thorax. 1995; 50(9):994-5. PMC: 1021317. DOI: 10.1136/thx.50.9.994. View

Strome M . Obstructive sleep apnea in Down syndrome children: a surgical approach. Laryngoscope. 1986; 96(12):1340-2. DOI: 10.1288/00005537-198612000-00004. View

He J, Kryger M, Zorick F, Conway W, Roth T . Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest. 1988; 94(1):9-14. View

10.

Loughlin G, Wynne J, Victorica B . Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr. 1981; 98(3):435-7. DOI: 10.1016/s0022-3476(81)80716-0. View

11.

Mohsenin V . Sleep-related breathing disorders and risk of stroke. Stroke. 2001; 32(6):1271-8. DOI: 10.1161/01.str.32.6.1271. View

12.

Telakivi T, Partinen M, Salmi T, Leinonen L, Harkonen T . Nocturnal periodic breathing in adults with Down's syndrome. J Ment Defic Res. 1987; 31 ( Pt 1):31-9. DOI: 10.1111/j.1365-2788.1987.tb01340.x. View

13.

Berry D, WEBB W, Block A, Bauer R, Switzer D . Nocturnal hypoxia and neuropsychological variables. J Clin Exp Neuropsychol. 1986; 8(3):229-38. DOI: 10.1080/01688638608401315. View

14.

Catterall J, Calverley P, Shapiro C, Flenley D, Douglas N . Breathing and oxygenation during sleep are similar in normal men and normal women. Am Rev Respir Dis. 1985; 132(1):86-8. DOI: 10.1164/arrd.1985.132.1.86. View

15.

. Indications and standards for cardiopulmonary sleep studies. American Thoracic Society. Medical Section of the American Lung Association. Am Rev Respir Dis. 1989; 139(2):559-68. DOI: 10.1164/ajrccm/139.2.559. View

16.

Aboussouan L, ODonovan P, Moodie D, Gragg L, Stoller J . Hypoplastic trachea in Down's syndrome. Am Rev Respir Dis. 1993; 147(1):72-5. DOI: 10.1164/ajrccm/147.1.72. View

17.

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328(17):1230-5. DOI: 10.1056/NEJM199304293281704. View

18.

Yang Q, Rasmussen S, Friedman J . Mortality associated with Down's syndrome in the USA from 1983 to 1997: a population-based study. Lancet. 2002; 359(9311):1019-25. DOI: 10.1016/s0140-6736(02)08092-3. View

19.

Holland A, Hon J, Huppert F, Stevens F, Watson P . Population-based study of the prevalence and presentation of dementia in adults with Down's syndrome. Br J Psychiatry. 1998; 172:493-8. DOI: 10.1192/bjp.172.6.493. View

20.

FINK G, Madaus W, Walker G . A quantitative study of the face in Down's syndrome. Am J Orthod. 1975; 67(5):540-53. DOI: 10.1016/0002-9416(75)90299-7. View