Accuracy of Parental Perception of Nighttime Breathing in Children with Down Syndrome. (February 2018)

• Record Type: Journal Article
• Authors: Friedman, Norman R.; Ruiz, Amanda G.; Gao, Dexiang; Ingram, David G.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 158:Number 2(2018)
• Page Start: 364
• Page End: 367
• Publication Date: 2018-02
• Subjects: Down syndrome -- tonsillectomy -- obstructive sleep apnea -- child -- polysomnography -- history -- symptoms; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599817726286
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: In 2011, the American Academy of Pediatrics published a guideline for children with Down syndrome (DS), recommending a polysomnogram (PSG) by age 4 years regardless of symptoms. Their rationale was based on 2 publications with small cohorts, where at least 50% of the children had no obstructive sleep apnea (OSA) symptoms but their PSG results were abnormal. The American Academy of Otolaryngology—Head and Neck Surgery Foundation published a clinical practice guideline recommending PSG prior to adenotonsillectomy for these children. This study aimed to assess parents' accuracy of their children's breathing patterns as compared with PSGs in a larger cohort of children with DS. Study Design: Case series with chart review. Setting: Tertiary care academic pediatric hospital. Subjects and Methods: Sleep intake forms assessing frequency of parent-observed apnea, snoring, and restless sleep were analyzed. None of the children had a previous tonsillectomy. Two groups were analyzed according to symptoms: infrequent (<3 nights per week on all questions answered) and frequent (≥6 nights per week on at least 1 question). OSA severity was categorized as follows: normal, <2 events per hour; mild, 2 to 4.9; moderate, 5 to 9.9; and severe, ≥10. Results: A total of 113 children met inclusion criteria: 34% (n = 38) had infrequent symptoms, and 66% (n = 75) had frequent symptoms. Parents were unable to predict the presence or absence of OSA by nighttime symptoms ( P = .60). The risk of OSA for children with frequent symptoms versus those with infrequent symptoms was 1.04 (95% CI, 0.89-1.3). Conclusion: Parents of DS children are unable to predict the presence or absence of OSA by nighttime symptoms, nor are they able to determine its severity.