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. 1991 Nov;66(11):1333–1338. doi: 10.1136/adc.66.11.1333

Sleep related upper airway obstruction in a cohort with Down's syndrome.

V A Stebbens 1, J Dennis 1, M P Samuels 1, C B Croft 1, D P Southall 1
PMCID: PMC1793297  PMID: 1836718

Abstract

The prevalence of sleep related upper airway obstruction (UAO) was studied in a cohort of 34 children with Down's syndrome from a geographically defined area. Thirty two (94%) of the children, ranging in age between 0.1 and 4.9 years (median 1.4), underwent full clinical assessment for UAO including parental questionnaires and overnight tape recordings of chest wall movements and arterial oxygen saturation (SaO2). Compared with controls, children with Down's syndrome had (a) an increased incidence of stridor and chest wall recession during sleep, (b) an increased frequency of a pattern on inspiration indicating increased upper airway resistance, (c) a reduced baseline oxygen saturation (having excluded recordings on four children with potential for right to left intracardiac shunting), and (d) an increased number of episodes with SaO2 less than or equal to 90% despite continued chest wall movements. At their initial assessment seven children (22%) had evidence of UAO. The 18 youngest children (less than or equal to 1.7 years) underwent repeated recordings and clinical assessment until they had all reached 2 years of age. A further three were found to have developed UAO. Sleep related UAO is a common problem in children with Down's syndrome, occurring in 10 of 32 (31%) of this population based sample.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abraham N. G., Stebbens V. A., Samuels M. P., Southall D. P. Investigation of cyanotic/apneic episodes and sleep-related upper airway obstruction by long-term non-invasive bedside recordings. Pediatr Pulmonol. 1990;8(4):259–262. doi: 10.1002/ppul.1950080409. [DOI] [PubMed] [Google Scholar]
  2. Brown P. M., Lewis G. T., Parker A. J., Maw A. R. The skull base and nasopharynx in Down's syndrome in relation to hearing impairment. Clin Otolaryngol Allied Sci. 1989 Jun;14(3):241–246. doi: 10.1111/j.1365-2273.1989.tb00368.x. [DOI] [PubMed] [Google Scholar]
  3. Clark R. W., Schmidt H. S., Schuller D. E. Sleep-induced ventilatory dysfunction in Down's syndrome. Arch Intern Med. 1980 Jan;140(1):45–50. [PubMed] [Google Scholar]
  4. Donaldson J. D., Redmond W. M. Surgical management of obstructive sleep apnea in children with Down syndrome. J Otolaryngol. 1988 Dec;17(7):398–403. [PubMed] [Google Scholar]
  5. Guilleminault C., Stoohs R. Chronic snoring and obstructive sleep apnea syndrome in children. Lung. 1990;168 (Suppl):912–919. doi: 10.1007/BF02718227. [DOI] [PubMed] [Google Scholar]
  6. Kavanagh K. T., Kahane J. C., Kordan B. Risks and benefits of adenotonsillectomy for children with Down syndrome. Am J Ment Defic. 1986 Jul;91(1):22–29. [PubMed] [Google Scholar]
  7. Levine O. R., Simpser M. Alveolar hypoventilation and cor pulmonale associated with chronic airway obstruction in infants with Down syndrome. Clin Pediatr (Phila) 1982 Jan;21(1):25–29. doi: 10.1177/000992288202100104. [DOI] [PubMed] [Google Scholar]
  8. Loughlin G. M., Wynne J. W., Victorica B. E. Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr. 1981 Mar;98(3):435–437. doi: 10.1016/s0022-3476(81)80716-0. [DOI] [PubMed] [Google Scholar]
  9. Mugliston T. A., Mitchell D. B. Nasal obstruction in healthy neonates. Br Med J (Clin Res Ed) 1984 Dec 15;289(6459):1659–1660. doi: 10.1136/bmj.289.6459.1659-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Phillips D. E., Rogers J. H. Down's syndrome with lingual tonsil hypertrophy producing sleep apnoea. J Laryngol Otol. 1988 Nov;102(11):1054–1055. doi: 10.1017/s002221510010725x. [DOI] [PubMed] [Google Scholar]
  11. Rosenfeld R. M., Green R. P. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol. 1990 Mar;99(3 Pt 1):187–191. [PubMed] [Google Scholar]
  12. Silverman M. Airway obstruction and sleep disruption in Down's syndrome. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1618–1619. doi: 10.1136/bmj.296.6637.1618-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Southall D. P., Croft C. B., Stebbens V. A., Ibrahim H., Gurney A., Buchdahl R., Warner J. O. Detection of sleep associated dysfunctional pharyngeal obstruction in infants. Eur J Pediatr. 1989 Jan;148(4):353–359. doi: 10.1007/BF00444133. [DOI] [PubMed] [Google Scholar]
  14. Southall D. P., Stebbens V. A., Mirza R., Lang M. H., Croft C. B., Shinebourne E. A. Upper airway obstruction with hypoxaemia and sleep disruption in Down syndrome. Dev Med Child Neurol. 1987 Dec;29(6):734–742. doi: 10.1111/j.1469-8749.1987.tb08818.x. [DOI] [PubMed] [Google Scholar]
  15. Stebbens V. A., Poets C. F., Alexander J. R., Arrowsmith W. A., Southall D. P. Oxygen saturation and breathing patterns in infancy. 1: Full term infants in the second month of life. Arch Dis Child. 1991 May;66(5):569–573. doi: 10.1136/adc.66.5.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Stradling J. R., Thomas G., Warley A. R., Williams P., Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990 Feb 3;335(8684):249–253. doi: 10.1016/0140-6736(90)90068-g. [DOI] [PubMed] [Google Scholar]
  17. Strome M. Obstructive sleep apnea in Down syndrome children: a surgical approach. Laryngoscope. 1986 Dec;96(12):1340–1342. doi: 10.1288/00005537-198612000-00004. [DOI] [PubMed] [Google Scholar]
  18. Swift A. C. Upper airway obstruction, sleep disturbance and adenotonsillectomy in children. J Laryngol Otol. 1988 May;102(5):419–422. doi: 10.1017/s0022215100105249. [DOI] [PubMed] [Google Scholar]
  19. Tubman T. R., Shields M. D., Craig B. G., Mulholland H. C., Nevin N. C. Congenital heart disease in Down's syndrome: two year prospective early screening study. BMJ. 1991 Jun 15;302(6790):1425–1427. doi: 10.1136/bmj.302.6790.1425. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wilson J. M. Adenotonsillectomy: Scotland is beating England and Wales. Lancet. 1981 Apr 18;1(8225):895–896. doi: 10.1016/s0140-6736(81)92166-8. [DOI] [PubMed] [Google Scholar]

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