1124 Non-Surgical Management of Obstructive Sleep Apnea in a Child with Down Syndrome

Abstract

Introduction: Obstructive Sleep Apnea (OSA) occurs in at least 30 to 75 percent of children with Down Syndrome (DS). The mechanism includes soft tissue and skeletal alterations that lead to upper airway obstruction. Untreated childhood OSA not only affects cognitive development, behavior and quality of life but can also lead to cardiovascular and metabolic consequences. Routine OSA screening and evaluation should be performed and addressed in all DS children. Report of Case: 14-year-old African American child with history of DS presented with the concern of loud snoring, apneic pauses, fragmented sleep and daytime somnolence. Physical exam revealed oropharyngeal crowding, tonsillar hypertrophy 3+. Polysomnogram (PSG) demonstrated severe OSA with AHI of 22.4, oxygen nadir of 60% and transcutaneous CO2 elevation and was not able to tolerate positive airway pressure (PAP) trial. Tonsillectomy and adenoidectomy was performed but patient's sleep did not improve. Repeat PSG revealed residual AHI of 24.5 and oxygen nadir of 71%. Patient vehemently declined PAP use. Other interventions such as mandibular device and hypoglossal nerve simulator were discussed extensively but due to age could not qualify. After multiple multidisciplinary conferences, it was decided to try simpler strategy of elevating the head of the bed (HOB). Final PSG with HOB elevated 30 to 40 degrees, revealed significant improvement in OSA with AHI of 3.3 oxygen nadir of 87%, without any TCO2 elevation. Thus, OSA resolved and sleep quality significantly improved by elevating HOB at home, using a hospital bed. Conclusion: While routine OSA screening/evaluation of DS patients is recommended, it is often overlooked due to challenges of PAP therapy application and tolerance. Thus, it is imperative to consider simple yet innovative solutions and interventions including positional therapy, oral and PAP devices, and various surgical procedures to find the best fit in terms of tolerance and efficacy.