0879 Definition of Real-World Responsiveness to PAP using Home Monitoring in Children with Down Syndrome
Angela Guerrero Pena, Oscar Rodriguez, Iman R. Sami-Zakhari, Jenny Pan Lew, Miriam Weiss, Maria Ortiz Vergara, N. Gustavo · SLEEP · 2025
Abstract Background: Evidence indicates that obstructive sleep apnea (OSA) is not only more prevalent but also more severe in children with Down Syndrome (DS). Multiple anatomical factors contribute to this susceptibility, including craniofacial abnormalities, obesity, and hypotonia. However, how these factors influence responsiveness to positive airway therapy (PAP) in children with DS remains unclear. The goal of this study was to examine real-world responses using PAP home monitoring in children with DS diagnosed with OSA. Methods: The study included PAP therapy data for 195 children, comprising 28 individuals with DS. Subjects ranged in age from 1 month to 18 years and had PSG-confirmed OSA. We collected demographic information, clinical variables, and PSG parameters for all participants. Individual responses to PAP therapy were assessed by comparing the apnea-hypopnea index (AHI) from the initial polysomnography with the mean AHI obtained from PAP device downloads. Multivariate models (linear regression) were employed to identify predictors of a positive PAP response. Results: We observed excellent responses to PAP therapy in children with DS, with a median AHI reduction of 79%. This was not statistically different from the non-DS group, which had a median AHI reduction of 73% (p = 0.27). A greater proportion of children in the DS group (82%) achieved an AHI reduction of ≥ 75%, compared to 67% in the non-DS group (p = 0.12). The required PAP pressure was comparable between both groups (DS: 7.32 cm/H₂O vs. non-DS: 7.34 cm/H₂O, p = 0.97). Multivariate linear regression analysis showed that AHI reductions on PAP were independent of DS status after adjusting for age and biological sex but were more pronounced in those with obesity or severe OSA. Conclusions: Real-world monitoring of PAP at home can effectively evaluate individual responsiveness in children with DS. Overall, PAP therapy proves to be highly effective in children with DS, particularly among those who are obese or have severe OSA.