Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome

Highlights • Children with Down syndrome underwent polysomnography and echocardiography. • Those with obstructive sleep apnea (OSA) were randomized to actual or sham continuous positive airway pressure (CPAP). • Subjects had a high rate of OSA, despite previous adenotonsillectomy. • There was a low...

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Published inSleep medicine Vol. 17; pp. 18 - 24
Main Authors Konstantinopoulou, Sofia, Tapia, Ignacio E, Kim, Ji Young, Xanthopoulos, Melissa S, Radcliffe, Jerilynn, Cohen, Meryl S, Hanna, Brian D, Pipan, Mary, Cielo, Christopher, Thomas, Allison J, Zemel, Babette, Amin, Raouf, Bradford, Ruth, Traylor, Joel, Shults, Justine, Marcus, Carole L
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.01.2016
Subjects
Adolescent
Cardiovascular Diseases - etiology
Child
Continuous Positive Airway Pressure
Down syndrome
Down Syndrome - complications
Female
Humans
Male
Neurology
Noninvasive ventilation
Polysomnography
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - physiopathology
Sleep Apnea, Obstructive - therapy
Sleep Medicine
Sleep Wake Disorders - etiology
Sleep-disordered breathing
Young Adult
AASM
TST
American Academy of Sleep Medicine
Noninvasive ventilation
Down syndrome
IQR
interquartile range
total sleep time
Sleep-disordered breathing
EMG
electromyogram
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Abstract Highlights • Children with Down syndrome underwent polysomnography and echocardiography. • Those with obstructive sleep apnea (OSA) were randomized to actual or sham continuous positive airway pressure (CPAP). • Subjects had a high rate of OSA, despite previous adenotonsillectomy. • There was a low rate of pulmonary hypertension. • Diastolic dysfunction correlated with OSA severity and improved with CPAP.
AbstractList OBJECTIVE/BACKGROUNDChildren with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive sleep apnea syndrome (OSAS). We hypothesized that OSAS was associated with cardiovascular dysfunction and sleepiness in children with DS, and that this dysfunction was partly reversible. PATIENTS/METHODSA total of 23 children with DS, aged 8-19 years, were evaluated with polysomnography, echocardiography, and measurement of brain natriuretic peptide (BNP). Children having OSAS were randomized to four months of actual or sham continuous positive airway pressure (CPAP) in a double-blinded fashion. RESULTSOf the total participants, 20 (87%) had OSAS. On echocardiography, no participant was found to have pulmonary hypertension, and all participants had a BNP <10 pg/mL. The early/tissue Doppler (E/e') of the lateral mitral annulus, a measure of worse left ventricular (LV) diastolic function, correlated with the arousal index (r = 0.42, p = 0.043) and apnea hypopnea index (AHI; r = 0.61, p = 0.002) and inversely with the SpO2 nadir (r = -0.61, p = 0.002). Participants with OSAS had a high pediatric Epworth score [median interquartile range (IQR) = 8(4,9)],correlating with the arousal index (r = 0.49, p = 0.016). At four months, there were no changes in cardiovascular outcomes or sleepiness between those on actual versus sham CPAP. Hours of actual CPAP use was associated with improved E/e' mitral lateral (r = -0.48, p = 0.044), but surprisingly also correlated with LV mass z-score (r = 0.54, p = 0.018). CONCLUSIONSIn children with DS, LV diastolic function correlated with OSAS severity, with improvement with CPAP use. There was a tendency towards increased sleepiness in those with OSAS, which correlated with the arousal index. Larger studies are warranted to confirm these findings.
Children with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive sleep apnea syndrome (OSAS). We hypothesized that OSAS was associated with cardiovascular dysfunction and sleepiness in children with DS, and that this dysfunction was partly reversible. A total of 23 children with DS, aged 8-19 years, were evaluated with polysomnography, echocardiography, and measurement of brain natriuretic peptide (BNP). Children having OSAS were randomized to four months of actual or sham continuous positive airway pressure (CPAP) in a double-blinded fashion. Of the total participants, 20 (87%) had OSAS. On echocardiography, no participant was found to have pulmonary hypertension, and all participants had a BNP <10 pg/mL. The early/tissue Doppler (E/e') of the lateral mitral annulus, a measure of worse left ventricular (LV) diastolic function, correlated with the arousal index (r = 0.42, p = 0.043) and apnea hypopnea index (AHI; r = 0.61, p = 0.002) and inversely with the SpO2 nadir (r = -0.61, p = 0.002). Participants with OSAS had a high pediatric Epworth score [median interquartile range (IQR) = 8(4,9)],correlating with the arousal index (r = 0.49, p = 0.016). At four months, there were no changes in cardiovascular outcomes or sleepiness between those on actual versus sham CPAP. Hours of actual CPAP use was associated with improved E/e' mitral lateral (r = -0.48, p = 0.044), but surprisingly also correlated with LV mass z-score (r = 0.54, p = 0.018). In children with DS, LV diastolic function correlated with OSAS severity, with improvement with CPAP use. There was a tendency towards increased sleepiness in those with OSAS, which correlated with the arousal index. Larger studies are warranted to confirm these findings.
Highlights • Children with Down syndrome underwent polysomnography and echocardiography. • Those with obstructive sleep apnea (OSA) were randomized to actual or sham continuous positive airway pressure (CPAP). • Subjects had a high rate of OSA, despite previous adenotonsillectomy. • There was a low rate of pulmonary hypertension. • Diastolic dysfunction correlated with OSA severity and improved with CPAP.
•Children with Down syndrome underwent polysomnography and echocardiography.•Those with obstructive sleep apnea (OSA) were randomized to actual or sham continuous positive airway pressure (CPAP).•Subjects had a high rate of OSA, despite previous adenotonsillectomy.•There was a low rate of pulmonary hypertension.•Diastolic dysfunction correlated with OSA severity and improved with CPAP. Children with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive sleep apnea syndrome (OSAS). We hypothesized that OSAS was associated with cardiovascular dysfunction and sleepiness in children with DS, and that this dysfunction was partly reversible. A total of 23 children with DS, aged 8–19 years, were evaluated with polysomnography, echocardiography, and measurement of brain natriuretic peptide (BNP). Children having OSAS were randomized to four months of actual or sham continuous positive airway pressure (CPAP) in a double-blinded fashion. Of the total participants, 20 (87%) had OSAS. On echocardiography, no participant was found to have pulmonary hypertension, and all participants had a BNP <10 pg/mL. The early/tissue Doppler (E/e') of the lateral mitral annulus, a measure of worse left ventricular (LV) diastolic function, correlated with the arousal index (r = 0.42, p = 0.043) and apnea hypopnea index (AHI; r = 0.61, p = 0.002) and inversely with the SpO2 nadir (r = −0.61, p = 0.002). Participants with OSAS had a high pediatric Epworth score [median interquartile range (IQR) = 8(4,9)],correlating with the arousal index (r = 0.49, p = 0.016). At four months, there were no changes in cardiovascular outcomes or sleepiness between those on actual versus sham CPAP. Hours of actual CPAP use was associated with improved E/e' mitral lateral (r = −0.48, p = 0.044), but surprisingly also correlated with LV mass z-score (r = 0.54, p = 0.018). In children with DS, LV diastolic function correlated with OSAS severity, with improvement with CPAP use. There was a tendency towards increased sleepiness in those with OSAS, which correlated with the arousal index. Larger studies are warranted to confirm these findings.
Author Traylor, Joel
Shults, Justine
Zemel, Babette
Tapia, Ignacio E
Thomas, Allison J
Amin, Raouf
Pipan, Mary
Cielo, Christopher
Radcliffe, Jerilynn
Bradford, Ruth
Cohen, Meryl S
Marcus, Carole L
Hanna, Brian D
Konstantinopoulou, Sofia
Kim, Ji Young
Xanthopoulos, Melissa S
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Keywords AASM
TST
American Academy of Sleep Medicine
Noninvasive ventilation
Down syndrome
IQR
interquartile range
total sleep time
Sleep-disordered breathing
EMG
electromyogram
Language English
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Snippet Highlights • Children with Down syndrome underwent polysomnography and echocardiography. • Those with obstructive sleep apnea (OSA) were randomized to actual...
•Children with Down syndrome underwent polysomnography and echocardiography.•Those with obstructive sleep apnea (OSA) were randomized to actual or sham...
Children with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive sleep apnea...
OBJECTIVE/BACKGROUNDChildren with Down syndrome (DS) have a high rate of pulmonary hypertension and sleepiness. They also have a high prevalence of obstructive...
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StartPage 18
SubjectTerms Adolescent
Cardiovascular Diseases - etiology
Child
Continuous Positive Airway Pressure
Down syndrome
Down Syndrome - complications
Female
Humans
Male
Neurology
Noninvasive ventilation
Polysomnography
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - physiopathology
Sleep Apnea, Obstructive - therapy
Sleep Medicine
Sleep Wake Disorders - etiology
Sleep-disordered breathing
Young Adult
Title Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome
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https://dx.doi.org/10.1016/j.sleep.2015.09.014
https://www.ncbi.nlm.nih.gov/pubmed/26847969
https://search.proquest.com/docview/1762962704
Volume 17
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