title: Prevalence and predictors of obstructive sleep apnoea in young children with Down syndrome.
abstract: Children with Down syndrome (DS) are vulnerable to obstructive sleep apnoea (OSA) because of their unique craniofacial anatomy and hypotonia. Understanding the predictors of OSA in DS may enable targeted screening.
  
  
  
  Children with DS (n = 202) aged from six months to below six years (110 boys) were recruited from three UK children's hospitals. The clinical assessment included height, weight and tonsillar size. The parents either set up cardiorespiratory polygraphy at home or chose laboratory studies. Studies with less than four hours of interpretable data were repeated where possible. American Academy of Sleep Medicine (AASM) 2012 scoring criteria were used to derive an obstructive apnoea/hypopnoea index (OAHI). Predictors of moderate to severe OSA were examined.
  
  
  
  In total, 188/202 (93%) participants were successfully studied. Of these, 169 studies were completed at home and 19 in a sleep laboratory. Moderate to severe OSA, defined by an OAHI of >5/h, was found in 14% and mild to moderate OSA (1/h≥OAHI <5/h) was found in 59% of the children. Male gender and habitual snoring predicted OSA but did not have independent predictive power in the presence of the other factors. Age in months, body mass index (BMI) centile and tonsillar size did not predict OSA.
  
  
  
  Moderate to severe OSA is common in very young children with DS. Examination of tonsillar size did not predict OSA severity. Population-based screening for OSA is recommended in these children, and domiciliary cardiorespiratory polygraphy is an acceptable screening approach. Further research is required to understand the natural history, associated morbidity, optimal screening methodology and treatment modality for OSA in these children.
authors.affiliation: University of Southampton, UK; Southampton Children's Hospital, Southampton University Hospitals NHS Trust, UK. Electronic address: cmh2@soton.ac.uk.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Hill
authors.affiliation: Southampton Children's Hospital, Southampton University Hospitals NHS Trust, UK.
authors.forename: Hazel J
authors.initials: HJ
authors.lastname: Evans
authors.affiliation: Sheffield Children's Hospital NHS Foundation Trust, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Elphick
authors.affiliation: Evelina London Children's Hospital, Guys St Thomas's NHS Trust, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Farquhar
authors.affiliation: University of Southampton, UK.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pickering
authors.affiliation: Sheffield Children's Hospital NHS Foundation Trust, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kingshott
authors.affiliation: Southampton Centre for Biomedical Research, Southampton University Hospitals NHS Trust, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Martin
authors.affiliation: Sheffield Children's Hospital NHS Foundation Trust, UK.
authors.forename: Janine
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Evelina London Children's Hospital, Guys St Thomas's NHS Trust, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Joyce
authors.affiliation: Evelina London Children's Hospital, Guys St Thomas's NHS Trust, UK.
authors.forename: Carla
authors.initials: C
authors.lastname: Rush
authors.affiliation: Southampton Children's Hospital, Southampton University Hospitals NHS Trust, UK.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Gavlak
authors.affiliation: Evelina London Children's Hospital, Guys St Thomas's NHS Trust, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Gringras
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D004314:Down Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D012913:Snoring / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology
keywords: Cardiorespiratory polygraphy; Down syndrome; Obstructive sleep apnoea; Sleep-disordered breathing