Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

doi:10.3390/children8111074

Review

. 2021 Nov 22;8(11):1074.

doi: 10.3390/children8111074.

Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Erica Gastelum^{1

2}, Marcus Cummins^{1

2}, Amitoj Singh^{1

2}, Michael Montoya^{2

3}, Gino Luis Urbano⁴, Mary Anne Tablizo^{5

6}

Affiliations

¹ School of Medicine, University of California San Francisco, Fresno, CA 94143, USA.
² Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA.
³ School of Medicine, University of California Davis, Sacramento, Fresno, CA 95817, USA.
⁴ School of Medicine and Public Health, Ateneo de Manila University, Pasig 1604, Philippines.
⁵ Department of Pulmonology, Valley Children's Hospital, Madera, CA 93720, USA.
⁶ Department of Pulmonology, Stanford Children's Health, Lucille Packard Children's Hospital, Palo Alto, CA 94304, USA.

PMID: 34828787
PMCID: PMC8619133
DOI: 10.3390/children8111074

Review

Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Erica Gastelum et al. Children (Basel). 2021.

. 2021 Nov 22;8(11):1074.

doi: 10.3390/children8111074.

Authors

Erica Gastelum^{1

2}, Marcus Cummins^{1

2}, Amitoj Singh^{1

2}, Michael Montoya^{2

3}, Gino Luis Urbano⁴, Mary Anne Tablizo^{5

6}

Affiliations

¹ School of Medicine, University of California San Francisco, Fresno, CA 94143, USA.
² Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA.
³ School of Medicine, University of California Davis, Sacramento, Fresno, CA 95817, USA.
⁴ School of Medicine and Public Health, Ateneo de Manila University, Pasig 1604, Philippines.
⁵ Department of Pulmonology, Valley Children's Hospital, Madera, CA 93720, USA.
⁶ Department of Pulmonology, Stanford Children's Health, Lucille Packard Children's Hospital, Palo Alto, CA 94304, USA.

PMID: 34828787
PMCID: PMC8619133
DOI: 10.3390/children8111074

Abstract

Children with Down syndrome (DS) are at high risk for developing obstructive sleep apnea (OSA) compared to children without DS. The negative impact of OSA on health, behavior, and cognitive development in children with DS highlights the importance of timely and effective treatment. Due to the higher prevalence of craniofacial and airway abnormalities, obesity, and hypotonia in patients with DS, residual OSA can still occur after exhausting first-line options. While treatment commonly includes adenotonsillectomy (AT) and continuous positive airway pressure (CPAP) therapy, additional therapy such as medical management and/or adjuvant surgical procedures need to be considered in refractory OSA. Given the significant comorbidities secondary to untreated OSA in children with DS, such as cardiovascular and neurobehavioral consequences, more robust randomized trials in this patient population are needed to produce treatment guidelines separate from those for the general pediatric population of otherwise healthy children with OSA. Further studies are also needed to look at desensitization and optimization of CPAP use in patients with DS and OSA.

Keywords: Down syndrome; adenotonsillectomy; continuous positive airway pressure; obstructive sleep apnea; pediatric; trisomy 21.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Flow chart of study selection. DS: Down Syndrome.

See this image and copyright information in PMC

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References

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1. Maris M., Verhulst S., Wojciechowski M., Van de Heyning P., Boudewyns A. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome. Sleep. 2016;39:699–704. doi: 10.5665/sleep.5554. - DOI - PMC - PubMed
1. Lee C.F., Lee C.H., Hsueh W.Y., Lin M.T., Kang K.T. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome: A Meta-Analysis. J. Clin. Sleep Med. 2018;14:867–875. doi: 10.5664/jcsm.7126. - DOI - PMC - PubMed

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[1] Parker S.E., Mai C.T., Canfield M.A., Rickard R., Wang Y., Meyer R.E., Anderson P., Mason C.A., Collins J.S., Kirby R.S., et al. National Birth Defects Prevention Network. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res. A Clin. Mol. Teratol. 2010;88:1008–1016. doi: 10.1002/bdra.20735. - DOI - PubMed

[2] Parker S.E., Mai C.T., Canfield M.A., Rickard R., Wang Y., Meyer R.E., Anderson P., Mason C.A., Collins J.S., Kirby R.S., et al. National Birth Defects Prevention Network. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res. A Clin. Mol. Teratol. 2010;88:1008–1016. doi: 10.1002/bdra.20735. - DOI - PubMed

[3] Weijerman M.E., de Winter J.P. Clinical practice. The care of children with Down syndrome. Eur. J. Pediatrics. 2010;169:1445–1452. doi: 10.1007/s00431-010-1253-0. - DOI - PMC - PubMed

[4] Weijerman M.E., de Winter J.P. Clinical practice. The care of children with Down syndrome. Eur. J. Pediatrics. 2010;169:1445–1452. doi: 10.1007/s00431-010-1253-0. - DOI - PMC - PubMed

[5] Qubty W.F., Mrelashvili A., Kotagal S., Lloyd R.M. Comorbidities in infants with obstructive sleep apnea. J. Clin. Sleep Med. 2014;10:1213–1216. doi: 10.5664/jcsm.4204. - DOI - PMC - PubMed

[6] Qubty W.F., Mrelashvili A., Kotagal S., Lloyd R.M. Comorbidities in infants with obstructive sleep apnea. J. Clin. Sleep Med. 2014;10:1213–1216. doi: 10.5664/jcsm.4204. - DOI - PMC - PubMed

[7] Maris M., Verhulst S., Wojciechowski M., Van de Heyning P., Boudewyns A. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome. Sleep. 2016;39:699–704. doi: 10.5665/sleep.5554. - DOI - PMC - PubMed

[8] Maris M., Verhulst S., Wojciechowski M., Van de Heyning P., Boudewyns A. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome. Sleep. 2016;39:699–704. doi: 10.5665/sleep.5554. - DOI - PMC - PubMed

[9] Lee C.F., Lee C.H., Hsueh W.Y., Lin M.T., Kang K.T. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome: A Meta-Analysis. J. Clin. Sleep Med. 2018;14:867–875. doi: 10.5664/jcsm.7126. - DOI - PMC - PubMed

[10] Lee C.F., Lee C.H., Hsueh W.Y., Lin M.T., Kang K.T. Prevalence of Obstructive Sleep Apnea in Children with Down Syndrome: A Meta-Analysis. J. Clin. Sleep Med. 2018;14:867–875. doi: 10.5664/jcsm.7126. - DOI - PMC - PubMed

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Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

Affiliations

Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome

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Abstract

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