[Congressional Record (Bound Edition), Volume 152 (2006), Part 5]
[Extensions of Remarks]
[Page 6498]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        SLEEP APNEA TEST ADVISED

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                          HON. EDOLPHUS TOWNS

                            of massachusetts

                    in the house of representatives

                        Thursday, April 27, 2006

  Mr. TOWNS. Mr. Speaker, based on my concern regarding the severe 
impact of obstructive sleep apnea on young children and the need for 
baseline testing between ages three and four, I want to call my 
colleagues attention to an April 18, 2006 article in MedPage Today 
``Sleep Apnea Test Advised for Down's Children'' and ask that it be 
printed in the Congressional Record.

                           (By Judith Groch)

             Sleep Apnea Tests Advised for Down's Children

       Cincinnati, April 18--Because of high rates of obstructive 
     sleep apnea in young children with Down's syndrome, 
     researchers here have recommend baseline testing between ages 
     three and four.
       Overnight polysomnograms performed on 56 children, ages 3.5 
     to four, found that 57% of the children had abnormal results 
     and evidence of obstructive sleep apnea syndrome, according 
     to a study in the April issue of the Archives of 
     Otolaryngology-Head and Neck Surgery.
       When the researchers included an elevated arousal index, 
     which is associated with increased difficulty breathing, the 
     abnormal percentage rose to 80%, said Sally Shott, M.D., of 
     the University of Cincinnati here, and colleagues.
       Because of a lack of expertise in evaluating sleep 
     disturbances, the parents are often oblivious to the problem. 
     Sixty-nine percent of parents who filled out a questionnaire 
     about their child's sleep patterns reported no problems, 
     whereas 54% of the children had abnormal polysomnograms, Dr. 
     Shott said. Parents and children came from a tertiary-care 
     pediatric referral center.
       The polysomnograms were classified as abnormal if the 
     obstructive apnea index was greater than 1, if the carbon 
     dioxide level was greater than 45 mm Hg for more than two-
     thirds of the study or greater than 50 mm Hg for more than 
     10% of the study. Also included was unexpected hypoxemia 
     (oxygen saturation less than 92% during sleep or repeated 
     intermittent desaturations less than 90%), the researchers 
     said.
       For purpose of analysis, the results were categorized in 
     three groups, the researchers said. Group 1 (n=21) consisted 
     of abnormal results because of an elevated obstructive sleep 
     apnea index. These children also had hypercarbia, hypoxemia, 
     or any combination, with or without hypoventilation and an 
     elevated arousal index, according to the researchers.
       In this category, they said, hypercarbia and hypoxemia, in 
     addition to an abnormal obstructive apnea index, led to a 
     statistically high obstructive apnea index compared with the 
     index for children who did not have these add-on's (17.15, 
     4.63 vs. 2.91.86, respectively; 
     P=.02).
       In group 2 (n=11), results were reported as abnormal 
     because of hypoventilation with hypercarbia and/or hypoxemia, 
     with or without an elevated arousal index. The apnea 
     obstructive index was in the normal range. However, results 
     from other studies show an increased risk of hypertension and 
     abnormal cardiac rates as well as sleep fragmentation with 
     prolonged hypercarbia, the researchers commented.
       The third group (n= 24) included children with normal 
     polysomnograms, but further inspection found that 13 of these 
     children had an arousal index greater than 10 (mean index 
     15.6).
       Commenting on the significance of the arousal response, Dr. 
     Shott said that ordinarily an arousal is a protective reflex 
     that helps curtail the upper airway obstruction and 
     reestablish a patent airway.
       However, there is concern that an excessive number of 
     arousals may lead to fragmented sleep and sleep deprivation. 
     The increased arousal rate in Down's children may affect 
     daytime function, ability to learn, and resultant behavior, 
     often misattributed to a child's limited intellectual 
     abilities, she said.
       The parental questionnaire cast doubt on the parents' 
     ability to assess their child's sleep problems. In general, 
     these parents underestimate the severity of their child's 
     sleep disturbances, Dr. Shott said. Thirty-five parents 
     completed a questionnaire at the study's outset asking 
     whether their child snored, stopped breathing while sleeping, 
     and if there were snorts and gasps for air during sleep.
       Overall, 11 (31%) parents reported that their child had 
     sleep problems, but these parents were correct about a sleep 
     abnormality in only four cases. The other seven children, 
     believed by parents to have abnormalities, had normal 
     polysomnograms. Of the 24 parents who reported no sleep 
     problems, 13 children (54%) had abnormal tests, the 
     researchers reported.
       In a further analysis, for children in Groups 1 and 2 with 
     major sleep disorders, 13 parents (77%) said their child had 
     no sleep problems, and in group 3, in which the children were 
     normal, seven (39%) said their child had sleep problems.
       ``Our results point to the need for objective testing for 
     obstructive sleep disorders in children as young as three or 
     four years,'' Dr. Shott said. Because there is a high 
     incidence of sleep disorders in Down's syndrome children, 
     ``baseline studies, using full overnight polysomnograms, are 
     recommended even if parents report no sleep problems in their 
     child,'' she said.

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