Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Sleep Med. 2021 May;81:463-465. doi: 10.1016/j.sleep.2021.03.018. Epub 2021 Mar 26.
To assess sleep positions in children with both Down syndrome (DS) and obstructive sleep apnea (OSA) and determine if there is a preferred sleep position by severity of apnea.
A single-center retrospective review of patients with both DS and OSA was performed. Caregivers reported sleep position utilized greater than 50% of observed sleep time. Accuracy of this report was confirmed through review of hypnograms from polysomnography studies.
Eighty-two patients met inclusion criteria. Median body mass index (BMI) was 26.6 and 56% of patients had a prior tonsillectomy and/or adenoidectomy. The mean obstructive AHI (OAHI) was 25.33 with 90.4% having severe OSA, 9.6% having moderate OSA, and no patients having mild OSA. Reported sleep positions were skewed towards lateral/decubitus (82.9%) compared to prone (11.0%) and supine (6.1%). This was consistent with hypnogram data where 71% of total sleep time in lateral/decubitus positions compared to prone (13%) and supine (6%). The median changes in sleep position per patient was 5 (IQR: 3-6). Lower BMI (p < 0.001, 95% CI: 0.32-1.13) and tonsillectomy (p < 0.001, 95% CI: 7.7-18.19) were associated with lower OAHI. Sleep position was not associated with age (p = 0.19), sex (p = 0.66), race (p = 0.10), ethnicity (p = 0.68) nor history of tonsillectomy (p = 0.34). Preferred sleep position was not correlated with OAHI (p = 0.78, r = 0.03) or OSA severity (p = 0.72, r = 0.03).
This study highlights the possibility that children with DS may have preferential sleep positions that cater to optimized airflow in the context of OSA although further prospective study is needed.
评估唐氏综合征（DS）合并阻塞性睡眠呼吸暂停（OSA）患儿的睡眠体位，并确定根据呼吸暂停严重程度是否存在首选睡眠体位。
对患有 DS 和 OSA 的患者进行单中心回顾性研究。看护人报告了观察到的睡眠时间中超过 50%的睡眠时间所采用的睡眠体位。通过对多导睡眠图研究中的催眠图进行回顾，确认了该报告的准确性。
82 名患者符合纳入标准。中位体重指数（BMI）为 26.6，56%的患者行过扁桃体切除术和/或腺样体切除术。平均阻塞性呼吸暂停低通气指数（OAHI）为 25.33，90.4%的患者有严重的 OSA，9.6%的患者有中度 OSA，没有患者有轻度 OSA。报告的睡眠体位偏向于侧卧/仰卧位（82.9%），而俯卧位（11.0%）和仰卧位（6.1%）则较少。这与催眠图数据一致，其中侧卧/仰卧位的总睡眠时间为 71%，而俯卧位为 13%，仰卧位为 6%。每位患者睡眠体位的中位数变化为 5（IQR：3-6）。较低的 BMI（p<0.001，95%CI：0.32-1.13）和扁桃体切除术（p<0.001，95%CI：7.7-18.19）与较低的 OAHI 相关。睡眠体位与年龄（p=0.19）、性别（p=0.66）、种族（p=0.10）、民族（p=0.68）或扁桃体切除术史（p=0.34）无关。首选的睡眠体位与 OAHI 无关（p=0.78，r=0.03）或 OSA 严重程度无关（p=0.72，r=0.03）。
本研究强调了唐氏综合征患儿可能存在偏好的睡眠体位，以适应 OSA 情况下优化的气流，尽管还需要进一步的前瞻性研究。
