611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome

Introduction Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS. Methods A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded. Results 94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis. Conclusion Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs. Support (if any):

Obstructive sleep apnea syndrome: is it different in women?

Traditionally, obstructive sleep apnea syndrome (OSAS) was regarded by the medical community as a men’s disease. Current data shows indeed that the prevalence of OSAS is higher among men than women. However, in postmenopausal women the prevalence of OSAS is high. Differences between men and women in the prevalence of OSAS drop as age increases, mainly as a result of a marked increase in the prevalence and severity of respiratory sleep disorders in women after menopause. There are some differences regarding the clinical manifestations of OSAS in women and men. Also, it seems that women with moderate OSAS are more susceptible to cardiovascular consequences of OSAS compared with men, having a higher degree of endothelial dysfunction. Gender differences in the response to different therapeutic strategies for OSAS are still not known with certainty.

Respiratory sleep disorders in vehicle drivers

Aim: to determine the frequency of respiratory sleep disorders (RSD) in vehicle drivers, peculiarities of their clinical status and workability. Material and methods. The study included the main group of 106 vehicle drivers (VD) and control group of 104 of subjects of other professions. The following methods were used: fibrooptic endoscopy, standard questionnaire, pulsoxymetry, 24 hour blood pressure and ECG monitoring, psychophysiological testing of 86 VD with RSD, arterial hypertension with and without complications. Results. The clinical and instrumental signs of RSD were found in 65.1% VD of the main group and 47,1% of controls. Transitory ischemic attacks, cardiac arrhythmias and their combination occurred more frequently in VD (82.6, 59.2, and 52.2% respectively) than in controls (51.0, 44.8, and 32.6%). In most observations of VD, the smoking rate (98.1%), alcohol intake (95.3%), increased body mass (74.5%), obese (21,7%) dyslypoproteidemia (73.6%), left ventricular hypertrophy (54.7%) and arterial hypertension (57.5%) were significantly higher than in controls : S (76.9%), AI (75.0%), IBM (56.7%), O (18.3%), DLP (59.6%), LVH (41.3%), AH (39.4%). Chronic obstructive pulmonary diseases was diagnosed in 55.6% of VD and 51.9% of controls, diabetes mellitus in 34.9% and 20.2%, epidemiological forms of ischemic heart disease in 22.6% VD and 20.2% controls. Psychophysilogical testing of VD group revealed deterioration of professional qualities and functions of the drivers with respiratory sleep disorders. Conclusion. Significant frequency of RSD among VD (65.1%) in comparison with subjects of other professions (47.1%) was documented. RSD cause deterioration ofprofessional abilities of VD which increases the risk of traffic accidents.