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Wijayaratne PR, Williams K, Davey MJ, Horne RSC, Nixon GM. Prediction of obstructive sleep apnoea in children and adolescents with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:880-892. [PMID: 37382027 DOI: 10.1111/jir.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is common in children and adolescents with Down syndrome (DS). Clinical guidelines recommend that all children with DS have polysomnography (PSG) for assessment of OSA by the age of 4 years, but access is limited and testing may be burdensome for children and families. METHODS The purpose of this prospective cross-sectional cohort study was to identify a model to predict OSA in this group that could be tested in an external population to triage children and adolescents with DS for PSG. These models were based on a comprehensive set of potential predictive demographic, anthropometric, quality of life and sleep-related variables. RESULTS The results of this study show the predictive power of a model based on the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in determining moderate-severe OSA in children and adolescents with DS. This model exhibits high sensitivity (82%), specificity (80%), positive predictive value (75%) and negative predictive value (86%). CONCLUSIONS We demonstrate the utility of a tool containing the sleep disordered breathing subscale of the Pediatric Sleep Survey Instrument and sleep fragmentation quantified using actigraphy in identifying children and adolescents with DS who have moderate/severe OSA.
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Affiliation(s)
- P R Wijayaratne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - K Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - M J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - R S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - G M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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Horne RS, Shetty M, Vandeleur M, Davey MJ, Walter LM, Nixon GM. Assessing sleep in children with Down syndrome: Comparison of parental sleep diaries, actigraphy and polysomnography. Sleep Med 2023; 107:309-315. [PMID: 37271108 DOI: 10.1016/j.sleep.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study compared measurements of sleep and wake assessed with actigraphy, sleep diary and polysomnography in children with Down syndrome (DS) and also compared measures of actigraphic sleep recording in children with DS and typically developing (TD) children. METHODS Children with DS aged 3-19 years (N = 44) referred for assessment of sleep disordered breathing (SDB) underwent overnight polysomnography, together with 1 week of actigraphy with sleep diary. Actigraphy data from the children with DS were compared with data collected from TD children, matched for age and sex. RESULTS 22 children (50%) with DS completed >3 consecutive nights of actigraphy with a matched sleep diary. There were no differences between bedtimes, wake times or time in bed on weeknights, weekends or over 7 nights between actigraphy and sleep diary. Total sleep time was over estimated by the sleep diary by almost 2 h and the number of night awakenings under-reported. Compared to matched TD children (N = 22), there was no difference in total sleep time, however children with DS fell asleep more quickly (p < 0.001), had more awakenings (p = 0.001) and more time awake after sleep onset (p = 0.007). Children with DS exhibited less variability in both bedtimes and wake times, and fewer had >1 h sleep schedule variability. CONCLUSIONS Parental sleep diaries over-estimate total sleep time but accurately report bed and wake times compared to actigraphy in children with DS. Children with DS have more regular sleep patterns than TD children of the same age, which is important for optimising daytime functioning. The reasons behind this warrant further investigation.
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Affiliation(s)
- Rosemary Sc Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
| | - Marisha Shetty
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Moya Vandeleur
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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Alma MA, Nijenhuis-Huls R, de Jong Z, Ulgiati AM, de Vries A, Dekker AD. Detecting sleep apnea in adults with Down syndrome using WatchPAT: A feasibility study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 129:104302. [PMID: 35853354 DOI: 10.1016/j.ridd.2022.104302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In daily practice, sleep apnea is underdiagnosed in people with Down syndrome. The WatchPAT can detect sleep apnea in a less invasive way. AIM This study aimed to evaluate the feasibility of the WatchPAT to detect sleep apnea in individuals with Down syndrome. METHODS AND PROCEDURES Thirty-one participants with Down syndrome (aged 18+) were included. Sleep apnea was detected with the WatchPAT and compared to results of the STOP-Bang Questionnaire (current practice). Experiences of participants, caregivers and clinicians were studied using a combination of quantitative and qualitative methods. OUTCOMES AND RESULTS Among the 68% of participants who accepted the WatchPAT, sleep apnea was detected in 95% of participants. Younger participants and participants with mild/moderate intellectual disabilities were more likely to accept the device. STOP-Bang did not detect most cases of sleep apnea. For the degree of sleep apnea, interrater reliability was substantial (k = 0.71) to almost perfect (k = 0.91). Considering experiences, caregivers and clinicians were predominantly positive about the WatchPAT. CONCLUSIONS Our study showed that the WatchPAT is a promising device to detect sleep apnea in people with Down syndrome. Compared to polysomnography, detection with this device is less invasive and less burdensome for people with Down syndrome. Furthermore, the WatchPAT is a relatively accessible solution to implement in care institutions.
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Affiliation(s)
- Manna A Alma
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands; Department of Health Sciences, Applied Health Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rixt Nijenhuis-Huls
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands
| | - Zarah de Jong
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands
| | - Aurora M Ulgiati
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands
| | - Anja de Vries
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands
| | - Alain D Dekker
- Department of Practice-oriented Scientific Research (PWO), Alliade, Heerenveen, The Netherlands; Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Ioan I, Weick D, Sevin F, Sanlaville D, De Fréminville B, Schweitzer C, Akkari M, Coutier L, Putois B, Thieux M, Franco P. Pulse transit time as a diagnostic test for OSA in children with Down syndrome. J Clin Sleep Med 2022; 18:119-128. [PMID: 34170228 PMCID: PMC8807910 DOI: 10.5664/jcsm.9510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Children with Down syndrome (DS) are at risk of obstructive sleep apnea (OSA), but the access to sleep lab polysomnography (PSG) is limited. Simplified techniques are needed, such as polygraphy coupled with pulse transit time (PTT-PG) that detects respiratory events and the total autonomic arousals index (PTTAI). Our objective was to assess the ability of PTT-PG compared with PSG to diagnose OSA in children with DS. METHODS In this prospective multicenter study, patients with DS underwent a full-night PSG coupled with PTT. Sleep questionnaires (Sleep Disturbance Scale for Children and Pediatric Sleep Questionnaire) were filled by parents. PSG and PTT-PG results were compared to test their sensibility and specificity to diagnose OSA. RESULTS A total of 53 patients with DS were included; their median age was 9.3 years. An obstructive apnea-hypopnea index (OAHI) by PSG > 1 event/h was found in 36 (68%) patients, OAHI was > 1 and < 5 events/h in 18 patients (34%), ≥ 5 and < 10 events/h in 11 patients (21%), and ≥ 10 events/h in 7 patients (13%). OAHI was larger on PSG than on PTT-PG (P = .0005). For OSA diagnosis, the sensitivity was excellent for OAHI by PTT-PG if the added total PTTAI was > 1 event/h (1.0) and the specificity was high for the Pediatric Sleep Questionnaire (0.88) and OAHI > 1 event/h on PTT-PG (1.0). CONCLUSIONS More than two-thirds of children with DS referred for screening by a genetics specialist had OSA diagnosed by PSG. With its excellent sensitivity and specificity, PTT-PG could be a good and simplified alternative to PSG to diagnose OSA in children with DS. CITATION Ioan I, Weick D, Sevin F, et al. Pulse transit time as a diagnostic test for OSA in children with Down syndrome. J Clin Sleep Med. 2022;18(1):119-128.
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Affiliation(s)
- Iulia Ioan
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - Diane Weick
- Service d’Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l’Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, and U1028, CNRL, Université de Lyon 1, Lyon, France
| | - François Sevin
- Service d’Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l’Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, and U1028, CNRL, Université de Lyon 1, Lyon, France
| | - Damien Sanlaville
- Département de Génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte De Fréminville
- Service de Génétique, CHU de St. Etienne, Centre de Référence Maladies Rares des Anomalies du Développement et des Syndromes Malformatifs de l’Inter Région Centre Est, Rhône Alpes Auvergne, France
| | - Cyril Schweitzer
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France
| | | | - Laurianne Coutier
- Service de Pneumologie Infantile, Allergologie et Centre de Référence en Mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Benjamin Putois
- Service d’Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l’Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, and U1028, CNRL, Université de Lyon 1, Lyon, France
| | - Marine Thieux
- Service d’Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l’Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, and U1028, CNRL, Université de Lyon 1, Lyon, France,U1028, Lyon Neuroscience Research Center (CNRL), Lyon, University Lyon 1, France
| | - Patricia Franco
- Service d’Épileptologie Clinique, des Troubles du Sommeil et de Neurologie Fonctionnelle de l’Enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, and U1028, CNRL, Université de Lyon 1, Lyon, France,U1028, Lyon Neuroscience Research Center (CNRL), Lyon, University Lyon 1, France,Address correspondence to: Patricia Franco, MD, PhD, Service Epilepsie, Sommeil, Explorations Fonctionnelles, Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, 59, Boulevard Pinel, 69500 Lyon, France;
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McConnell EJ, Hill EA, Celmiņa M, Kotoulas SC, Riha RL. Behavioural and emotional disturbances associated with sleep-disordered breathing symptomatology in children with Down's syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:875-880. [PMID: 32893933 DOI: 10.1111/jir.12765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Down's syndrome (DS) predisposes to sleep-disordered breathing (SDB). In children with DS, behavioural and emotional disturbances secondary to SDB are often assumed to result from cognitive impairment alone. Our aim was to explore the relationship of behavioural and emotional disturbances with SDB in a population of children with DS. METHODS A modified sleep questionnaire, Epworth Sleepiness Scale (ESS), Paediatric ESS and the short form of the developmental behaviour checklist (DBC-P24) were sent to 261 carers of children aged 4 to 15 years with DS in 2012. RESULTS Of 120 participants, 25% had probable SDB. In children with probable SDB compared to those without nocturnal symptoms, the total behaviour problem score (TBPS) was significantly higher (20.3 ± 8.6/48 vs. 12 ± 7.5/48; P = 0.002) as was the PaedESS (7.7 ± 5.6/24 vs. 2.8 ± 3.5/24; P = 0.002). For every increase in frequency of choking attacks, snoring and night awakenings, the TBPS increased by 1.37, 1.28 and 1.75 points, respectively, indicating worsening behaviour. The TBPS was found to decrease by 1.31 points for every hour more of self-reported sleep duration (r = -0.25, P = 0.017). CONCLUSIONS SDB symptoms and shorter self-reported sleep duration are highly prevalent among children with DS and are independently associated with worsening behaviour using the TBPS.
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Affiliation(s)
- E J McConnell
- Sleep Research Unit, Department of Sleep Medicine, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
| | - E A Hill
- Sleep Research Unit, Department of Sleep Medicine, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
| | - M Celmiņa
- Sleep Research Unit, Department of Sleep Medicine, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
| | - S-C Kotoulas
- Sleep Research Unit, Department of Sleep Medicine, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
| | - R L Riha
- Sleep Research Unit, Department of Sleep Medicine, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
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