To Örebro University

Background: Obstructive sleep apnoea (OSA) is overrepresented in patients with Down syndrome (DS). We aimed to compare patient characteristics and outcomes of CPAP treatment for OSA between persons with DS and people without DS from the general population.

Methods: Population-based, longitudinal study on patients initiating CPAP therapy between July 2010 and March 2018 in Sweden, with crosslinked data from the National Patient Registry and the Prescribed Drug Registry. Each DS patient was sex- and age matched with 5 controls. Hospitalization free survival was analyzed with Cox´s proportional hazard regression, and association between having DS and adherence to CPAP treatment with logistic and linear regression.

Results: DS patients initiating CPAP (n=64) had higher apnoea-hypopnea index (AHI) (51.7±30.3 vs 36.8±29.1, p<0.001), Epworth sleepiness scale (ESS) score (13.7±5.9 vs 11.0±4.9, p=0.001), rate of surgery of tonsils and/or adenoids (21.9% vs 8.2%, p=0.001), more thyroid replacement hormones therapy (45.3% vs 7.8%, p<0.001), but lower use of cardiovascular drugs (7.8% vs 22.3%, p=0.003) compared to controls. Outcomes were similar between groups in terms of nocturnal CPAP usage time (5.6±2.4 vs 5.5±2.0 hours, p=0.77), adherence ≥4 hours/night (62% vs 65%, p=0.93), improved ESS score (-5.4±6.8 vs -5.0±2.0, p=0.84). Patients with DS were more often hospitalized during the study period (34.4% vs 17.9%, p=0.003).

Conclusion: When starting CPAP for OSA, patients with DS have more severe sleep apnea and had more often undergone tonsil/adenoid surgery but have similar adherence to CPAP therapy and effect on daytime sleepiness as patients without DS.