Volume 53, Issue 10 pp. 1414-1421

ORIGINAL ARTICLE

Sleep disordered breathing and ventilatory support in children with Down syndrome

Federica Trucco MD,

Corresponding Author

Federica Trucco MD

orcid.org/0000-0002-1147-0126

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

Pediatric Neurology and Muscle Disease Unit, Istituto Giannina Gaslini, Genova, Italy

Correspondence

Federica Trucco, MD, Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St, SW3 6NP, London, UK.

Email: [email protected]; [email protected]

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Michelle Chatwin PhD,

Michelle Chatwin PhD

Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom

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Thomas Semple MD,

Thomas Semple MD

Department of Radiology, Royal Brompton Hospital, London, United Kingdom

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Mark Rosenthal MD, MB ChB, FRCP, FRCPCH,

Mark Rosenthal MD, MB ChB, FRCP, FRCPCH

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

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Andrew Bush MBBS, MA, MD, FHEA, FRCP, FRCPCH, FAPSR, ATSF,

Andrew Bush MBBS, MA, MD, FHEA, FRCP, FRCPCH, FAPSR, ATSF

orcid.org/0000-0001-6756-9822

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

National Heart and Lung Institute, Imperial College, London, United Kingdom

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Hui-Leng Tan MBBChir MD (res),

Hui-Leng Tan MBBChir MD (res)

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

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Federica Trucco MD,

Corresponding Author

Federica Trucco MD

orcid.org/0000-0002-1147-0126

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

Pediatric Neurology and Muscle Disease Unit, Istituto Giannina Gaslini, Genova, Italy

Correspondence

Federica Trucco, MD, Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St, SW3 6NP, London, UK.

Email: [email protected]; [email protected]

Search for more papers by this author

Michelle Chatwin PhD,

Michelle Chatwin PhD

Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom

Search for more papers by this author

Thomas Semple MD,

Thomas Semple MD

Department of Radiology, Royal Brompton Hospital, London, United Kingdom

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Mark Rosenthal MD, MB ChB, FRCP, FRCPCH,

Mark Rosenthal MD, MB ChB, FRCP, FRCPCH

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

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Andrew Bush MBBS, MA, MD, FHEA, FRCP, FRCPCH, FAPSR, ATSF,

Andrew Bush MBBS, MA, MD, FHEA, FRCP, FRCPCH, FAPSR, ATSF

orcid.org/0000-0001-6756-9822

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

National Heart and Lung Institute, Imperial College, London, United Kingdom

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Hui-Leng Tan MBBChir MD (res),

Hui-Leng Tan MBBChir MD (res)

Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

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First published: 10 July 2018

https://doi.org/10.1002/ppul.24122

Citations: 54

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Abstract

Study Objectives

Obstructive sleep apnoea (OSAS) in children with Down syndrome (DS) is now well recognized, but other forms of sleep disordered breathing (SDB) in this population are less well described. Anecdotally, respiratory support for SDB treatment in this population is not easily tolerated. We aimed to characterize the types of SDB in children with DS referred to a tertiary respiratory center and to assess the effectiveness and adherence to respiratory support.

Methods

Retrospective study of DS patients <18 years old under follow-up at a tertiary respiratory center. Anthropometrics, comorbidities, sleep study results, and details of respiratory support were collected. Satisfactory adherence to oxygen (O₂), Continuous Positive Airway Pressure (CPAP), or bilevel noninvasive ventilation (NIV) was defined as use >4 h/night for >50% nights.

Results

Sixty patients were included, median age 1.5 (0.7-5.3) years; 49 (82%) had congenital heart disease, 16 (27%) pulmonary hypertension, 28 (47%) gastroesophageal reflux, 38 (63%) swallowing impairment; 16/17 who underwent CT scanning had evidence of aspiration. Forty-two had SDB: 27 (61%) OSAS (10 mild, 5 moderate, 12 severe), 11 (25%) central apnoeas, 19 (32%) nocturnal hypoventilation. Twenty-six had baseline saturations <95%. Lower SpO₂ correlated with pulmonary hypertension (r² = 0.1, P = 0.04). Thirty-nine (65%) patients started respiratory support (14 O₂, 18 CPAP, 7 NIV) and 22 (56%) have regularly used it. After a 1.9 years follow up 11/24 had satisfactory adherence to CPAP/NIV (average use 8 h/night).

Conclusions

Our results confirm the high prevalence of OSAS in children with DS. A significant number also have low baseline saturations, central apnoeas, and nocturnal hypoventilation. Contrary to popular belief, more than half of children with DS had satisfactory adherence to respiratory support.

CONFLICTS OF INTEREST

The authors have no conflicts of interest relevant to this article to disclose.

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Volume53, Issue10

October 2018

Pages 1414-1421

Sleep disordered breathing and ventilatory support in children with Down syndrome

Abstract

Study Objectives

Methods

Results

Conclusions

CONFLICTS OF INTEREST

REFERENCES

Citing Literature

References

Information

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Sleep disordered breathing and ventilatory support in children with Down syndrome

Abstract

Study Objectives

Methods

Results

Conclusions

CONFLICTS OF INTEREST

REFERENCES

Citing Literature

References

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