Can Early OSA Treatment Improve Outcomes in Infants With Down Syndrome?

The early diagnosis and treatment of obstructive sleep apnea (OSA) in infants with Down syndrome (DS) results in improved neurocognitive outcomes and behavior, according to study findings published in the Lancet.

OSA is common among infants and children with DS and may affect neurocognition and behavior; however, there is lack of evidence on the benefit of early detection and treatment of OSA to improve these outcomes.

Researchers conducted a prospective nonrandomized controlled study (RESPIRE21; ClinicalTrials.gov Identifier: NCT03210675) to determine the effect of early screening and treatment on neurocognitive and behavioral development at 36 months in infants with DS.

Participants with genetically-confirmed DS who received polysomnography (PSG) in room air every 6 months between the ages of 6 and 36 months were compared with a control group of infants with DS who received standard care and a single round of PSG in room air at 36 months.

Treatment for OSA was a combination of upper airway surgery and drug-induced sleep endoscopy, and noninvasive positive airway pressure (CPAP), if needed.

Primary study endpoint was the total score on the Griffiths Scales of Child Development, Third Edition (Griffiths III). Secondary endpoints included scores on the Behaviour Rating Inventory of Executive Function–Preschool (BRIEF-P), the Child Behaviour Checklist-Preschool (CBCL-P), and the Vineland Adaptive Behaviour Scales, Second Edition (VABS-II).

Study visits were conducted at an outpatient clinic in Paris at 6, 12, 24, and 36 months. The researchers collected data using a standard questionnaire that included questions about medical history, medication use, and additional therapies, such as speech therapy.

Between 2017 and 2019, a total of 80 infants with DS were enrolled, of whom 74 (34 in the screened group and 40 in the standard-care group) were eligible in the study. Mean age of participants in both groups was 36 months; the majority were boys.

Statistically significant differences were noted in median Griffiths III Global Quotient of Development (GQD) scores at 36 months in the screened vs standard-care group (55.4 vs 50.7; difference, 4.1; 95% CI, 1.3-7.6; P =.009). The between-group difference for Personal Social Emotional QD was also significant (59.1 vs 55.6, respectively; difference, 4.3; 95% CI, 1.2-7.7; P =.046).

Significant differences were noted in the VABS-II Global Composite Score (GCS) in the screened vs standard-care group (57.0 vs 43.5; difference, 13.0; 95% CI, 8.0-19.0; P <.0001). In addition, the researchers noted a statistically significant association between Griffiths III GQD and VABS-II GCS (P =.72 and P <.0001, respectively).

PSG data at 36 months indicated that apnea hypopnea index (AHI) was higher in the standard-care vs screened group (4.0 [1.5-9.0] vs 1.0 [1.0-3.0] events/hour; P =.006). Researchers observed that moderate and severe OSA, as well, were more common in the standard-care vs screened group (18.9% vs 3.7% and 27.0% and 7.4%, respectively).

Limitations of the analysis was lack of randomization and blinding, which could have resulted in biases, and limited generalizability of results to the overall population.

“The results underline the importance of early diagnosis, within the first months of life, and intervention for OSA within this critical window of cognitive development,” the researchers concluded.