# Obstructive Sleep Apnea-Hypopnea Syndrome in Children With Down Syndrome Treated at a Tertiary Care Hospital in Northeastern Colombia

## TL;DR

Children with Down Syndrome in Colombia have a lower rate of diagnosed sleep apnea, likely due to limited access to diagnostic tests.

## Contribution

The study identifies socioeconomic factors as key barriers to diagnosing OSAHS in children with Down Syndrome in Colombia.

## Key findings

- Only 15.3% of children with Down Syndrome were diagnosed with OSAHS in a Colombian hospital.
- Access to polysomnography, not clinical features, determines OSAHS diagnosis rates in this population.
- Urban residence correlates with higher OSAHS diagnosis due to better access to diagnostic tools.

## Abstract

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is frequent in children with Down Syndrome (DS), associated with anatomical characteristics such as midfacial hypoplasia, macroglossia, and hypotonia. It represents a frequent cause of morbidity and mortality among children with DS. Early identification of OSAHS in the DS population is essential, as untreated sleep breathing disorders are linked to severe complications, including pulmonary hypertension. Consequently, guidelines, such as the Health Supervision for Children with Down Syndrome from the American Academy of Pediatrics, recommend polysomnography (PSG) for all children with DS before age 4. This case-control study examined the profile of OSAHS in 124 patients with DS under 13 years of age who were treated at a tertiary care institution in northeastern Colombia from 2012 to 2023. Of the 124 patients, 19 (15.3%) were diagnosed with OSAHS. The only significant association identified was with place of residence, related to the fact that individuals (not patients) living in the city or its metropolitan area have greater access to PSG. Our observed frequency is lower than previously reported in the literature, indicating possible systematic underdiagnosis. Socioeconomic status and access to diagnostic evaluation, rather than clinical characteristics, appear to be the primary determinants for receiving a diagnosis. Expanding access to PSG, particularly in rural and low-income regions, and prioritizing universal screening in clinical protocols over symptom-based referral are essential steps.