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. 2023 Jan 1;19(1):171-177.
doi: 10.5664/jcsm.10288.

Residual OSA in Down syndrome: does body position matter?

Taylor G Lackey  1 , Kaitlyn Tholen  2 , Kaci Pickett  3 , Norman Friedman  4   5
Affiliations

Residual OSA in Down syndrome: does body position matter?

Taylor G Lackey et al. J Clin Sleep Med. .

Abstract

Study objectives: To examine children with Down syndrome with residual obstructive sleep apnea (OSA) to determine if they are more likely to have positional OSA.

Methods: A retrospective chart review of children with Down syndrome who underwent adenotonsillectomy at a single tertiary children's hospital was conducted. Children with Down syndrome who had a postoperative polysomnogram with obstructive apnea-hypopnea index (OAHI) > 1 event/h, following adenotonsillectomy with at least 60 minutes of total sleep time were included. Patients were categorized as mixed sleep (presence of ≥ 30 minutes of both nonsupine and supine sleep), nonsupine sleep, and supine sleep. Positional OSA was defined as an overall OAHI > 1 event/h and a supine OAHI to nonsupine OAHI ratio of ≥ 2. Group differences are tested via Kruskal-Wallis test for continuous variables and Fisher's exact tests for categorical.

Results: There were 165 children with Down syndrome who met inclusion criteria, of which 130 individuals had mixed sleep. Patients who predominately slept supine had a greater OAHI than mixed and nonsupine sleep (P = .002). Sixty (46%) of the mixed-sleep individuals had positional OSA, of which 29 (48%) had moderate/severe OSA. Sleeping off their backs converted 14 (48%) of these 29 children from moderate/severe OSA to mild OSA.

Conclusions: Sleep physicians and otolaryngologists should be cognizant that the OAHI may be an underestimate if it does not include supine sleep. Positional therapy is a potential treatment option for children with residual OSA following adenotonsillectomy and warrants further investigation.

Citation: Lackey TG, Tholen K, Pickett K, Friedman N. Residual OSA in Down syndrome: does body position matter? J Clin Sleep Med. 2023;19(1):171-177.

Keywords: Down syndrome; child; obstructive sleep apnea; persistent obstructive sleep apnea; polysomnogram; positional obstructive sleep apnea; sleep position; sleep study; tonsillectomy; trisomy 21.

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Conflict of interest statement

All authors have seen and approved the manuscript. The authors report no conflicts of interest. Work for this study was performed at Children’s Hospital of Colorado (CHCO) and University of Colorado Anschutz Medical Campus. This study was funded by the Children’s Hospital Center for Research in Outcomes in Children’s Surgery.

Figures

Figure 1
Figure 1. Obstructive apnea-hypopnea index (OAHI) distribution by sleep stage and position for positional obstructive sleep apnea (POSA) and non-POSA cohorts.
Median OAHI was greater in the non-POSA cohort (*P < .05). POSA patients had a lower rapid eye movement nonsupine OAHI compared to non-POSA patients (***P < .001). NREM = nonrapid eye movement, REM = rapid eye movement.
Figure 2
Figure 2. Positional obstructive sleep apnea (OSA) rates for overall mixed sleep OSA categories.
See this image and copyright information in PMC

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