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Volume 10 No. 01
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Scientific Investigations

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

http://dx.doi.org/10.5664/jcsm.3368

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).

Design:

Retrospective review.

Setting:

Sleep disorders laboratory of a tertiary medical center.

Participants:

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).

Conclusion:

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.

Citation:

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.




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