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Children with DS are prone to develop obstructive sleep apnea syndrome because of chronic upper airway obstruction. Untreated OSA results in serious morbidities including pulmonary hypertension (PHT. The aim of our study is to identify the sleep abnormalities in Pediatric patients with DS that are referred to Pediatric pulmonary and general Pediatric clinic from the period Ist Jan-30 Dec 2011 for respiratory symptoms and regular check up. A Prospective Sleep study (Polysomnography) was carried out in the sleep laboratory. Demographic, clinical, diagnostic, morbidity, mortality data, sleep studies abnormalities, and type of medical or surgical interventions were reported. A total of 23 patients confirmed Down syndrome Clinically and by Chromosomal studies. 15 male (65%), 8 female (35%). The most presenting symptoms were: snoring 19 (82%), Shortness of Breath 16 (70%), cough 16 (70%), stopping breathing 16 (70%), increase body movements in 18 (78%), Rhinorrhea in 14 (61%), Sweating 13 (56%), Mouth breathing in 16 (70%), frequent Upper respiratory Tract Infection in 17 (73%), Difficulty in Swallowing in 5 (22%), Difficulty in hearing in 4 (17%), Excessive sleeping during the day in 6 (26%), Enuresis in 5 (22%), Aggressive behaviors in 9 (39%), Asthma in 14 (60%), Recurrent Chest Infection in 13 (57%), Home O2 requirement in 4 (17%), Hypothyroidism in 6 (26%), Gastroesophageal reflux (GER) in 4 (17%). Sleep Study was done in all 23 patients. 19 patients (83%) showed sleep related disorder breathing ( SRDB). Abnormal mean Apnea hypopnea index (AHI) of 12.3 (Normal <1.5 %) in 19 patients (83%), mean obstructive apnea index (OAI) of 4.7 in 11 patients (48%), abnormal hypopnea index of 5.6 (N= <1), abnormal periodic leg movements of mean 5.9 in 6 patients (26%). 16 of 23 patients (70%) have Congenital heart disease (CHD). The most common lesions were: ASD in 13 (56%), VSD in 5 (22%), Common A-V Canal in 3 (13%), PDA in 8 (35%). .PHT was detected by Cardiac Cath in 10 patients (43%) with mean PAP 54.6 mmHg ± 4.5. Persistent PHT at follow up was detected in 8 (35%) of patients with mean PAP of 40± 13.5 mmHg. Vasodilator was used in 7 (33%). Sleep related disorder breathing ( SRDB) is common in patients with Down syndrome (DS) and has been under estimated by many physicians for a long time. Such patients should be screened for sleep abnormalities specially with significant respiratory or sleep disturbance symptoms. Medical or surgical options should be offered to such patients without delay to prevent complications.
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Author(s): Hanaa Hasan Banjar Mohammad Jamil Hoda Kattan Jecintha Jancy Soha AlZabin Hanan AlHarbi Abdelmuniem AlDalee
Down syndrome, Sleep abnormalities, Pulmonary hypertension