(1035) Sleep Position and Upper Airway Dynamics in Children with Down Syndrome

Introduction: Children with Down syndrome (DS) may be uniquely predisposed to positional obstructive sleep apnea (OSA) because of their distinct physical characteristics. Determining if body position can affect OSA severity and understanding the anatomic mechanisms underlying this phenomenon in children with DS has significant implications for possible treatment options. The objective of this study is to examine sleep endoscopy (DISE) findings in the supine and lateral body positions in children with DS.

Methods: In this prospective study, DS children over 2 years of age were enrolled if they had a complete polysomnogram and were scheduled to undergo DISE between March 2022 and May 2024. DISE was performed in both the lateral and supine position. Endoscopic examinations were reviewed by 2 independent raters using the Chan-Parikh scoring system. Associations between total obstructive score and apnea-hypopnea index (AHI) and body mass index (BMI) were assessed using Spearman’s rank correlation coefficients. Differences in obstructive scores between supine and lateral positions for each rater were evaluated using Wilcoxon signed-rank tests.

Results: Of the 21 subjects enrolled, 16 (76%) were male, 18 (90%) were Hispanic, with an average age of 9.9 years. No statistically significant correlations were identified between total obstructive score and BMI across any scoring approach (averaged, rater 1, or rater 2) or body position. Similarly, no significant associations were found between obstructive score and AHI; however, a positive correlation was observed for rater 1 in the lateral position (p = 0.03). Both raters reported significantly higher obstructive scores at nearly every anatomical level and overall, in the supine vs lateral position.

Conclusions: Children with DS have improved obstruction in the lateral position likely due to diminished gravitational effects on their large tongue and airway. These results confirm that positional therapy for management of OSA may be a useful adjunct for DS children who are intolerant of CPAP.