Long-term benefits of early obstructive sleep apnea treatment in infants with Down syndrome

PURPOSE: The Respire-21 study found that early obstructive sleep apnea (OSA) diagnosis and treatment is associated with improved neurocognitive and behavioral outcomes in infants with Down syndrome (DS) followed from 6 to 36 months of age (screened group) versus a control group receiving standard care at 36 months of age (standard care group). This follow-up study assessed whether these benefits persisted at 60 months of age and whether early OSA treatment influenced language and communication outcomes. METHODS: Children from the initial study diagnosed with and treated for OSA underwent neurocognitive assessment at 60 months of age using the Griffiths Scales of Child Development, Third Edition (Griffiths III); the Vineland Adaptive Behavior Scales, Second Edition (VABS-II); and in-laboratory polysomnography. RESULTS: Twenty-four screened group and 13 standard care group children were included. The between-group difference in Griffiths III Global Quotient of Development favored the screened group but was not statistically significant (3.9 [standard error 2.8]; p = 0.130). The screened group scored significantly better on the Griffiths III Foundations of Learning (p = 0.014) and Personal-Social-Emotional (p = 0.019) domains, and on the VABS-II global composite score (p = 0.007), Daily Living Skills (p = 0.004), and Socialization (p = 0.005) domains. No significant benefit was observed for language or communication outcomes. CONCLUSION: Long-term neurocognitive benefits of early OSA screening and treatment were observed in infants with DS at 60 months of age, particularly for daily functioning and socialization. CLINICAL TRIAL REGISTRATION: Registered at ClinicalTrials.gov under registration number NCT03210675 (registration date: 2017-07-05). CURRENT KNOWLEDGE/STUDY RATIONALE: Obstructive sleep apnea (OSA) is very frequent in infants with Down syndrome (DS). Early diagnosis and treatment of OSA is associated with significant improvement of neurocognitive outcomes and behavior at 36 months of age compared to no systematic evaluation of OSA. STUDY IMPACT: This study showed perduring benefits of early OSA interventions (at 60 months of age) compared with children receiving diagnosis and treatment later, i.e., after 36 months of age. Guidelines should be adapted to favor early interventions for OSA if diagnosed.