Issue Navigator

Volume 10 No. 01
Earn CME
Accepted Papers

Scientific Investigations

Effect of Body Position and Sleep State on Obstructive Sleep Apnea Severity in Children with Down Syndrome

Lauren C. Nisbet, Ph.D.1; Nicole N. Phillips, M.D.2; Timothy F. Hoban, M.D., F.A.A.S.M.3; Louise M. O'Brien, Ph.D., M.S.3,4
1The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; 2Comprehensive Sleep Network Inc., Seattle, WA; 3Department of Neurology, University of Michigan Sleep Disorders Centre, Ann Arbor, MI; 4Department of Oral and Maxillofacial Surgery, University of Michigan Sleep Disorders Center, Ann Arbor, MI

Study Objectives:

To investigate the influence of sleep position and sleep state on obstructive sleep apnea (OSA) severity in in children with Down syndrome (DS).


Retrospective review.


Sleep disorders laboratory of a tertiary medical center.


Children with Down syndrome and typically developing children matched for age, gender, apneahypopnea index (AHI), and year of polysomnogram.

Measurements and Results:

Sleep variables from baseline polysomnography. Sensor-recorded position (supine, prone, lateral) was expressed as the percentage of total sleep time. The AHI was calculated in each sleep state (NREM, REM), position, and position-sleep state combination. Of 76 DS subjects (55% male) the median age and AHI were 4.6 years (range 0.2-17.8 years) and 7.4 events/h (range 0-133). In all subjects, AHI was higher in REM than NREM (p < 0.05); however, the NREM AHI was higher in DS subjects than controls (p < 0.05). Compared to controls, the percentage of prone sleep was greater in DS subjects (p < 0.05), but the percentage of supine or non-supine (prone plus lateral) sleep was no different. For DS subjects alone, NREM AHI was higher in supine than non-supine sleep (p < 0.05).


In DS and non-DS children alike, respiratory events are predominantly REM related. However, when matched for OSA severity, children with DS have a higher NREM AHI, which is worse in the supine position, perhaps indicating a positional effect compounded by underlying hypotonia inherent to DS. These findings illustrate the clinical importance of NREM respiratory events in the DS population and implications for treatment options.


Nisbet LC; Phillips NN; Hoban TF; O'Brien LM. Effect of body position and sleep state on obstructive sleep apnea severity in children with Down syndrome. J Clin Sleep Med 2014;10(1):81-88.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership