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Polysomnographic features and OSA prevalence in adult with Down Syndrome
Oropharyngeal hypotonia, is common in individuals with Down syndrome (DS), resulting in several impairments including the total or partial obstruction of the airways during sleep, leading to snoring and to obstructive sleep apnea (OSA). It is associated with a high risk of morbidity and mortality in individuals with DS. Several works investigated the sleep disorders in children with Down syndrome, but few studies are available in this adult population.
This study aimed to assess the polysomnographic features and the prevalence of OSA in adult with Down syndrome.
Medical and dental anamnesis were performed in order to investigate the overall health, to address anthropometric data, dental status and parafunctional habits. Patients underwent the polysomnography(PSG) type II (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA). The inclusion criteria included the presence of symptoms of OSA, preserved cognitive function to respond to verbal commands and informed and written consent. The exclusion criteria included body mass index (BMI) > 35 Kg/m2, and have been exposed to physiotherapy treatment at least 6 months prior to the study.
The entire group consisted of 23 patients (14 men and 9 women), with a mean age of 22.76.5 years, mean body mass index (BMI) of 28.56.8 kg/m2 and mean neck circumference of 394.0. Moderate to severe tooth wear was present in all patients. All patients presented Mallampati IV and, 73% and 27% tonsil grade II and III, respectively. The polysomnography showed a mean apnea/hypopnea index (AIH)=42.03.0, with a mean duration of apnea and hypopnea events of 15.16.3 and 18.67.0, respectively. N3= 19.25
6.0 REM sleep=9.14.2, arousal index = 35.117.5, desaturation index (ODI)= 36.93.0, SaO2mean =92.04.0 and SaO2nadir=75.012.3. Mean sleep latency showed normal values (253.8), but mean REM latency was increased (203.078.0), with a reduced sleep efficiency (79.114.0). AIH was not correlated to BMI, neck circumference and age. All patients presented snoring. Only 2 (8.7%) did not present sleep bruxism (SB). The prevalence of OSA and SB was 100% (mild=21.7%, moderate=47.0%, severe=31.3%) and 91.3%, respectively.
Adults with DS often presents coexistent sleep disorders. Due to the high prevalence of OSA in this population, added to a high ODI and marked sleep fragmentation, adults with Down syndrome should be screened for OSA with polysomnography routinely.
down syndrome; obstructive sleep apnea; polysomnography; sleep disorders
Centro Univresitário de Anápolis Uni-Evangélica - Goias - Brasil, Hospital do Servidor Público Estadual de São Paulo-IAMSPE-HSPE - Sao Paulo - Brasil, ICT-UNESP/SJC - Sao Paulo - Brasil
Lilian Chrystiane Giannasi, Marignes T S Dutra, Sergio Roberto Nacif, Ezequiel Fernandes Oliveira, Leticia de Miguel Nazario, Pedro Ribeiro Silvestre, Luis Vicente Franco Oliveira, Miguel Angel Castillo Salgado, Jose Benedito Oliveira Amorim, Monica Fernandes Gomes