Long-Term Outcomes in Patients With Trisomy 21 and Obstructive Sleep Apnea.
Trisomy 21
obstructive sleep apnea
Journal
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
ISSN: 1097-6817
Titre abrégé: Otolaryngol Head Neck Surg
Pays: England
ID NLM: 8508176
Informations de publication
Date de publication:
23 Oct 2023
23 Oct 2023
Historique:
revised:
06
09
2023
received:
30
04
2023
accepted:
04
10
2023
medline:
23
10
2023
pubmed:
23
10
2023
entrez:
23
10
2023
Statut:
aheadofprint
Résumé
To better understand the long-term health implications of obstructive sleep apnea (OSA) on patients with Trisomy 21 (T21) and the role of sleep surgery as a therapeutic intervention. Retrospective large database review. The prevalence of OSA is as high as 75% in patients with T21. We sought to examine the cardiovascular, neurological, and endocrinological outcomes of patients with T21 10 years after their diagnosis of OSA. TriNetX, an electronic medical record database, was queried for health outcomes in patients with T21 after diagnosis of OSA. The group was further analyzed to identify those who underwent sleep surgery, including hypoglossal nerve stimulation, palatopharyngoplasty, or adenotonsillectomy. Ten years after diagnosis, patients with OSA and T21 had a significantly higher incidence of death, myocardial infarction, cerebral infarction, heart failure, cardiac arrhythmia, ischemic heart disease, atrial fibrillation, essential hypertension, pulmonary hypertension, diabetes mellitus, and Alzheimer's disease compared to patients with T21 alone. Patients with OSA and T21 who underwent sleep surgery had significantly reduced incidence of adverse health outcomes compared to patients using continuous positive airway pressure. Our findings suggest that patients with T21 and OSA are at higher risk of poor health outcomes, which may require closer monitoring for earlier diagnosis and management of comorbid conditions. Sleep surgery is a suitable treatment modality for mitigating the risk of adverse outcomes in this population and should be considered in patients who are eligible surgical candidates.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.
Références
Mai CT, Isenburg JL, Canfield MA, et al. National population-based estimates for major birth defects, 2010-2014. Birth Defects Res. 2019;111(18):1420-1435. doi:10.1002/bdr2.1589
Antonarakis SE, Skotko BG, Rafii MS, et al. Down syndrome. Nat Rev Dis Primers. 2020;6(1):9. doi:10.1038/s41572-019-0143-7
Dumortier L, Bricout VA. Obstructive sleep apnea syndrome in adults with Down syndrome: causes and consequences. Is it a “chicken and egg” question? Neurosci Biobehav Rev. 2020;108:124-138. doi:10.1016/j.neubiorev.2019.10.018
Chamseddin BH, Johnson RF, Mitchell RB. Obstructive sleep apnea in children with Down syndrome: demographic, clinical, and polysomnographic features. Otolaryngol Head Neck Surg. 2019;160(1):150-157. doi:10.1177/0194599818797308
De miguel-Díez J, Villa-Asensi JR, Álvarez-Sala JL. Prevalence of sleep-disordered breathing in children with Down syndrome: polygraphic findings in 108 children. Sleep. 2003;26(8):1006-1009. doi:10.1093/sleep/26.8.1006
Maris M, Verhulst S, Wojciechowski M, van de Heyning P, Boudewyns A. Prevalence of obstructive sleep apnea in children with Down syndrome. Sleep. 2016;39(3):699-704. doi:10.5665/sleep.5554
Anand V, Shukla G, Gupta N, et al. Association of sleep apnea with development and behavior in Down syndrome: a prospective clinical and polysomnographic study. Pediatr Neurol. 2021;116:7-13. doi:10.1016/j.pediatrneurol.2020.10.007
Nerfeldt P, Sundelin A. Obstructive sleep apnea in children with Down syndrome-prevalence and evaluation of surgical treatment. Int J Pediatr Otorhinolaryngol. 2020;133:109968. doi:10.1016/j.ijporl.2020.109968
Heubi CH, Knollman P, Wiley S, et al. Sleep architecture in children with Down syndrome with and without obstructive sleep apnea. Otolaryngol Head Neck Surg. 2021;164(5):1108-1115. doi:10.1177/0194599820960454
Hill CM, Evans HJ, Elphick H, et al. Prevalence and predictors of obstructive sleep apnoea in young children with Down syndrome. Sleep Med. 2016;27-28:99-106. doi:10.1016/j.sleep.2016.10.001
Porterfield L, Bacak B, Karelsky S. Sleep endoscopy patterns in six adults with Trisomy 21 and obstructive sleep apnea. Laryngoscope. 2022;132(2):485-487. doi:10.1002/lary.29867
Hyzer JM, Milczuk HA, Macarthur CJ, King EF, Quintanilla-Dieck L, Lam DJ. Drug-induced sleep endoscopy findings in children with obstructive sleep apnea with vs without obesity or Down syndrome. JAMA Otolaryngol Head Neck Surg. 2021;147(2):175. doi:10.1001/jamaoto.2020.4548
Thottam PJ, Trivedi S, Siegel B, Williams K, Mehta D. Comparative outcomes of severe obstructive sleep apnea in pediatric patients with Trisomy 21. Int J Pediatr Otorhinolaryngol. 2015;79(7):1013-1016. doi:10.1016/j.ijporl.2015.04.015
Karlik JB, Raol N, Gilbertson L. Hypoglossal nerve stimulator placement for pediatric Trisomy 21 patients with refractory obstructive sleep apnea: a case series. Children. 2020;7(8):81. doi:10.3390/children7080081
Konstantinopoulou S, Tapia IE, Kim JY, et al. Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome. Sleep Med. 2016;17:18-24. doi:10.1016/j.sleep.2015.09.014
Mallah ME, Bailey E, Trivedi M, Kremer T, Rhein LM. Pediatric obstructive sleep apnea in high-risk populations: clinical implications. Pediatr Ann. 2017;46(9):e336-e339. doi:10.3928/19382359-20170815-01
Bush D, Galambos C, Ivy DD, Abman SH, Wolter-Warmerdam K, Hickey F. Clinical characteristics and risk factors for developing pulmonary hypertension in children with Down syndrome. J Pediatr. 2018;202:212-219. doi:10.1016/j.jpeds.2018.06.031
Fortea J, Zaman SH, Hartley S, Rafii MS, Head E, Carmona-Iragui M. Alzheimer's disease associated with Down syndrome: a genetic form of dementia. Lancet Neurol. 2021;20(11):930-942. doi:10.1016/S1474-4422(21)00245-3
Hithersay R, Startin CM, Hamburg S, et al. Association of dementia with mortality among adults with down syndrome older than 35 years. JAMA Neurol. 2019;76(2):152-160. doi:10.1001/jamaneurol.2018.3616
Draheim CC, Geijer JR, Dengel DR. Comparison of intima-media thickness of the carotid artery and cardiovascular disease risk factors in adults with versus without the Down syndrome. Am J Cardiol. 2010;106(10):1512-1516. doi:10.1016/j.amjcard.2010.06.079
Alexander M, Petri H, Ding Y, Wandel C, Khwaja O, Foskett N. Morbidity and medication in a large population of individuals with Down syndrome compared to the general population. Dev Med Child Neurol. 2016;58(3):246-254. doi:10.1111/dmcn.12868
Baksh RA, Pape SE, Chan LF, Aslam AA, Gulliford MC, Strydom A. Multiple morbidity across the lifespan in people with Down syndrome or intellectual disabilities: a population-based cohort study using electronic health records. Lancet Public Health. 2023;8(6):e453-e462. doi:10.1016/S2468-2667(23)00057-9
Agiovlasitis S, Collier SR, Baynard T, et al. Autonomic response to upright tilt in people with and without Down syndrome. Res Dev Disabil. 2010;31(3):857-863. doi:10.1016/j.ridd.2010.03.002
Hill EA, Fairley DM, Williams LJ, Spanò G, Cooper SA, Riha RL. Prospective trial of CPAP in community-dwelling adults with Down syndrome and obstructive sleep apnea syndrome. Brain Sci. 2020;10(11):844. doi:10.3390/brainsci10110844
Ingram DG, Ruiz AG, Gao D, Friedman NR. Success of tonsillectomy for obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2017;13(8):975-980. doi:10.5664/jcsm.6698
Nation J, Brigger M. The efficacy of adenotonsillectomy for obstructive sleep apnea in children with Down syndrome: a systematic review. Otolaryngol Head Neck Surg. 2017;157(3):401-408. doi:10.1177/0194599817703921