Early OSA intervention may lead to better outcomes in infants with Down syndrome

Key takeaways:

• Researchers analyzed 36-month outcomes from 80 infants with Down syndrome and obstructive sleep apnea.
• Moderate to severe OSA was more common in the standard care group compared with the screened group.

For infants with Down syndrome, early intervention to address obstructive sleep apnea may lead to better cognitive and behavioral outcomes at 36 months, according to new research from The Lancet.

“Patients with [Down syndrome (DS)] are predisposed to obstructive sleep apnea,” Brigitte Fauroux, MD, PhD, professor of pediatrics, Necker University Hospital in France, and colleagues wrote. “At the time of the study set up, the American Academy of Pediatrics recommended a sleep study screening in all children with DS by the age of 4 years.”

Prior research has established that infants with DS are at high risk for obstructive sleep apnea (OSA), often accompanied by neurocognitive dysfunction and behavioral issues, Fauroux and colleagues wrote. The researchers sought to evaluate impact of early OSA treatment in this pediatric population on their neurocognitive development and behavior.

The prospective, interventional clinical trial was conducted at the Jerome Lejeune Institute in Paris, an outpatient clinic specializing in children and adults with DS. The study included 80 patients with a confirmed DS diagnosis, evenly split between those who underwent polysomnography (PSG) every 6 months in room air between age 6 and 36 months (screened group) and those with DS given standard of care, as well as a single, systematic PSG in room air at 36 months (standard care group). The screened group had follow-up visits at 6, 12, 24 and 36 months.

The study’s primary endpoint was the total score of the Griffiths Scales of Child Development, Third Edition (Griffiths III) and its subscores assessed at 36 months.

Secondary endpoints included measurements from a battery of neurocognitive and behavioral questionnaires completed by a parent, including Behavior Rating Inventory of Executive Function–Preschool (BRIEF-P), the Child Behavior Checklist-Preschool (CBCL-P), and the Vineland Adaptive Behavior Scales, Second Edition (VABS-II), along with sleep-related PSG outcomes.

The researchers reported that the median score on the Griffiths III was significantly higher in the screened group compared with the standard care group (55.4 vs. 50.7), with between-group median differences also statistically significant (4.1; 95% CI, 1.3-7.6). Subscores with respect to secondary endpoints also suggested better neurocognitive outcomes in the screened group compared with the standard care group.

Fauroux and colleagues wrote that in the subgroup of those who completed the 36-month PSG, more patients and a higher percentage of patients (14 of 29; 48.3%) in the screened group underwent upper airway surgery to address OSA compared with the standard care group (1 of 40; 2.5%).

Data further showed that moderate and severe OSA were more frequently recorded among those given standard care compared with the screened group (moderate OSA: 18.9% vs. 3.7%; severe OSA: 27.0% vs. 7.4%).

“Better neurocognitive outcome and behavior is consistent with the presumed mechanism of action of [obstructive sleep apnea] treatment,” Fauroux and colleagues wrote.