Children with Down syndrome and mild OSA: treatment with medication versus observation.

Children with Down syndrome and mild OSA: treatment with medication versus observation.:

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Children with Down syndrome and mild OSA: treatment with medication versus observation.

J Clin Sleep Med. 2020 Feb 11;:

Authors: Yu W, Sarber KM, Howard JJM, Huang G, Hossain MM, Heubi CH, Lu X, Simakajornboon N

Abstract

STUDY OBJECTIVES: Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). Anti-inflammatory medications have been shown to be an effective treatment for mild OSA in otherwise healthy children. However, the efficacy in children with DS and mild OSA has not been investigated. Our aim was to examine the polysomnographic changes of children with DS and mild OSA treated with medication.

METHODS: A retrospective chart review was performed in children with DS (<18 years) and mild OSA (obstructive apnea-hypopnea index [oAHI] ≤5 events/hour) diagnosed by polysomnography (PSG) between 2006 and 2018. Patients were included if they were treated with medications (intranasal corticosteroids and/or montelukast) or by observation with a duration of at least 3 months and had baseline and follow-up PSGs. Demographic data, co-morbid diagnoses and PSG data were collected and analyzed.

RESULTS: Forty-five children met inclusion criteria. In the medication group, 29 children were identified. The median age was 7.4 (IQR 4.9-9.3) years. In the observation group, 16 children were identified. The median age was 4.0 (IQR 3.2-5.3) years. The median time from baseline to follow-up PSG was 14.0 (IQR 10.0-22.9) months for the medication group and 10.5 (IQR 6.5-33.5) months for the observation group. There were no significant changes in the median oAHI from the baseline to follow-up PSG in either the medication group [2.8 (IQR 2.2-3.6) vs 3.5 (IQR 1.4-4.8) events/h; P=0.25] or the observation group [2.3 (IQR 1.3-3.1) vs 2.9 (IQR 1.9-6.8) events/h; P=0.12]. Similarly, there were no significant differences in AHI, oxygen nadir or ETCO₂ between the groups (P=0.07-1).

CONCLUSIONS: In our cohort, medication therapy did not significantly improve polysomnographic measures in children with DS and mild OSA. Several factors such as hypotonia and relative macroglossia may explain the ineffectiveness of medical therapy for OSA in this population. Further prospective studies are necessary to confirm these results and to evaluate if a sub-group of DS children may benefit from medical therapy.

PMID: 32043964 [PubMed - as supplied by publisher]