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J Clin Sleep Med. 2014 Jan 15;10(1):81-8. doi: 10.5664/jcsm.3368.

Effect of body position and sleep state on obstructive sleep apnea severity in children with Down syndrome.

Author information

1
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia.
2
Comprehensive Sleep Network Inc., Seattle, WA.
3
Department of Neurology, University of Michigan Sleep Disorders Centre, Ann Arbor, MI.
4
Department of Neurology, University of Michigan Sleep Disorders Centre, Ann Arbor, MI ; Department of Oral and Maxillofacial Surgery, University of Michigan Sleep Disorders Center, Ann Arbor, MI.

Abstract

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.

KEYWORDS:

Down syndrome; sleep position

PMID:
24426825
PMCID:
PMC3869075
DOI:
10.5664/jcsm.3368
[Indexed for MEDLINE]
Free PMC Article

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