Down Syndrome (Trisomy 21), Obstructive Sleep Apnea
Conditions
Keywords
Sleep apnea, Down syndrome, Oro-myo-functional development, Sleep, Non-nutritive sucking, Pacifier
Brief summary
Obstructive Sleep Apnea (OSA) is characterised by repetitive collapse of the upper airway during sleep, inducing breathing disturbances that can result in oxygen desaturation and frequent arousals. In children, OSA can have long-term consequences on the development and on the cardiovascular system. Down Syndrome (DS) is a genetic disorder associated with intellectual disability and many comorbidities. The prevalence of OSA is particularly high in patients with DS, from infancy. In a recent study, OSA was diagnosed in 97% infants and early diagnosis and intervention from the age of 6 months was associated with better neurocognitive outcome at 3 years old. Therefore, there is a need to develop new strategies to prevent OSA early in infancy. OSA can be linked to some orofacial abnormalities presented by patients with DS. Indeed, orofacial functions and structures ca play a crucial role in OSA. For example, nose breathing allows the tongue to act as a stimulator of the transverse maxillary growth during childhood, allowing the upper airway to develop properly. The primary objective of the present study is to evaluate the effects of a pacifier used by infants with Down Syndrome (from the age of 1 months) on the severity of OSA at the age of 6 months, by comparing a group of infants with the pacifier vs a group of infants without the pacifier. The main hypothesis is that infants who used the pacifier from 1 month- to 6 month-old will have lower OSA severity (estimated by the obstructive apnea hypopnea index on polysomnography (PSG)).
Interventions
DEVICECURAPROX pacifier use
The CURAPROX pacifier is a biofunctional pacifier developed to promote nasal breathing and a healthy oro-facial development, available for sale to the general public. It will be given to infants when they are 1 month old, until the last visit at 6 months.
OTHERPacifier diary
A diary will be filled in by the caregivers for 2 consecutive days each month until the visit at the hospital (at 6 months). Parents will be reminded to fill in the dairy by a phone call.
DIAGNOSTIC_TESTPolysomnography (PSG) to explore OSA
Patients will undergo full-night PSG (including electrocardiogram to monitor heart rate and the JAWAC system to record mandibular movements) at the age of 6 months in the sleep unit of Hôpital Femme-Mère-Enfant (Bron, France) to explore OSA, included in the routine care of children with DS. OSA diagnosis will be made based on the obstructive apnea-hypopnea index (OAHI) resulting from the PSG. OSA will be diagnosed when OAHI ≥1.5/hour.
Non-nutritive sucking performance will be recorded through an experimental method using a classical pacifier, equipped with pressure sensors. Recording will last about 10 minutes. Variables related to sucking performance (maximum amplitude, frequency of sucking bursts, etc.) will be recorded. It will be recorded on the day of inclusion (1 month old) and on the day of polysomnography (6 months old).
Orofacial myofunctional evaluation will be conducted by a physiotherapist according to the OMES-E (Orofacial Myofunctional Evaluation with Scores for Nursing Infants) during the hospitalization for polysomnography (at 6 months old).
BEHAVIORALNeurocognitive evaluation
The Bayley Scale (4th edition) will be administered by a neuropsychologist. Global score will be calculated along with its four subscores (cognitive, language, motor).
The Sleep Disturbance Scale for Children is a short questionnaire answered by parents about their child's sleep disorders. Total score and scores for each sleep disorder will be calculated, according to the classical procedures during hospitalization for polysomnography in the sleep unit.
OTHERSleep Hygien Scale for Children
The Sleep Hygiene Scale for Children is a short questionnaire answered by parents about their child's sleep habits. Total score and scores for each sleep disorder will be calculated, according to the classical procedures during hospitalization for polysomnography in the sleep unit.
OTHERPedsQL-Infants
The PedsQL-Infants questionnaire is designed to evaluate quality of life in infants. It will be given to parents during their child's hospitalization for polysomnography (at 6 months old).
Sponsors
Hospices Civils de Lyon
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
23 Days to 38 Days
Healthy volunteers
No
Inclusion criteria
* Group 1 (infants with CURAPROX pacifier) * Age 1 month (±1 week) * Children diagnosed with free and homogeneous trisomy 21 * For whom a consultation is planned at \~1 month in the department of genetics * Affiliated to a social security scheme * With informed consent of the 2 legal representatives * Group 2 (infants without CURAPROX pacifier) * Infants included in the OMF21 study (sponsored by HCL, n°ID-RCB 2025-A01900-49, approved by ethical committee Nord-Ouest IV on October 9th 2025) * With informed consent of the 2 legal representatives for re-use of the data
Exclusion criteria
* Group 1 (infants with CURAPROX pacifier) * Diagnosed with mosaic trisomy 21 * Born preterm (gestation age at birth \<37 weeks) * Known allergy to silicone * Currently participating to an interventional study protocol implying an ongoing exclusion period from other studies * Group 2 (infants without CURAPROX pacifier) - Use of the CURAPROX pacifier for ≥1 month
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Obstructive apnea hypnopnea index | Month 6 | OAHI (/h) will be measured by PSG. Night PSG will take place during a 24h-stay at the hospital when infants are 6 months old. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pulse wave amplitude drop (PWAD) | Month 6 | PWAD (/h) will be measured by PSG. Night PSG will take place during a 24h-stay at the hospital when infants are 6 months old. |
| Hypoxic burden | Month 6 | Hypoxic burden (% min /h) will be measured during a 24h-stay at the hospital when infants are 6 months old. |
| Mandibular movements index | Month 6 | Mandibular movements index (/h) will be measured using the JAWAC system during the PSG of a 24h-stay at the hospital when infants are 6 months old. |
| OSA severity class | Month 6 | Determined based on the value of OAHI on PSG at 6 months: * No OSA : IAHO \<1,5/h * Light OSA : IAHO ≥1,5/h * Moderate OSA : IAHO \[5 ;10/h\[ * Severe OSA : IAHO ≥10/ Night PSG will be recorded during the 24h-hospital stay at 6 month old. |
| Frequency of sucking bursts (/min) | Month 6 | Sucking performance will be measured by non-nutritive sucking recording. Non-nutritive sucking recording will take place at 1 month (during a consultation in the department of genetics) and at 6 months (during the 24h-stay at the hospital for polysomnography). |
| Amplitude of sucking bursts (mB) | Month 6 | Sucking performance will be measured by non-nutritive sucking recording. Non-nutritive sucking recording will take place at 1 month (during a consultation in the department of genetics) and at 6 months (during the 24h-stay at the hospital for polysomnography). |
| Total sleep time (TST) | Month 6 | TST (min) will be measured during a 24h-stay at the hospital when infants are 6 months old. |
| Wake after sleep onset (WASO) | Month 6 | WASO (min) will be measured during a 24h-stay at the hospital when infants are 6 months old. |
| Sleep fragmentation | Month 6 | Arousal index (/h) will be measured during a 24h-stay at the hospital when infants are 6 months old. |
| Sleep architecture | Month 6 | Percentage of sleep stages (%) will be measured during a 24h-stay at the hospital when infants are 6 months old |
| Oro-facial myo-functional characteristics | Month 6 | 12 subscores and total score on the OMES-E (Orofacial Myofunctional Evaluation with Scores - Expanded protocol ; score) Clinical examination of oro-facial myo-functional characteristics will take place during the 24h-stay at the hospital for polysomnography (age: 6 months). Total score ranges from 0 to 100. Higher score means better outcome. |
| Subjective parental evaluation of sleep disorders on the Sleep Disturbance Scale for Children (SDSC) | Month 6 | SDSC: 1 total score and subscores (insomnia, sleep disordered breathing, non-restorative sleep) Total score ranges from 22 to 110. Higher scores mean worse outcomes. |
| Subjective parental evaluation of sleep hygiene on the Sleep Hygiene Scale for Children (SHSC) | Month 6 | SHSC: 1 total result ("sleep hygiene issue": yes/no) and three scores (attachment parenting, translational coping, screen exposure). Positive scores are worse than negative scores. SHSC will be filled-in by parents during the hospital-stay of their child for polysomnography (age: 6 months) |
| Neuropsychological evaluation | Month 6 | Neurosychological evaluation will be conducted by an experienced neuropsychologist using the Bayley Scales of Infant and Toddler Development (4th edition). Total score and subscores (posture, hand-eye coordination, language, sociability) will be collected. Neurosychological evaluation will be conducted on the morning following polysomnography, during the 24h-hospital stay of the child (age: 6 months). Scores range from 0 to 160. Higher scores mean better outcomes. |
| Heart rate variability (HRV) | Month 6 | Time-domain HRV indices: RR, HR, NN50, pNN50, SDNN, RMSSD Frequency-domain HRV indices: Ptot, VLF, LF, HF, LFnu, HFnu, LF/HF ratio. HRV measures will be compared between the sample of children with DS and a control group of healthy children from the AuBE cohort (cohort from a previous study). HRV indices will be calculated for the electrocardiogram signal recorded during the PSG (age: 6 months). |
| Quality of life on the PedsQL | Month 6 | Results of the PedsQL consist in 1 total score + 5 subscores (physical functioning, physical symptoms, emotional functioning, social functioning, cognitive functioning). The PedsQL questionnaire will be filled-in by parents during the hospital-stay of their child for polysomnography (age: 6 months). Total score ranges from 0 to 144. Higher score means worse outcomes. |
Countries
France
Contacts
CONTACTPatricia FRANCO, PU-PH
CONTACTAurore GUYON, PhD
PRINCIPAL_INVESTIGATORPatricia FRANCO, PU-PH
Hospices Civils de Lyon
Outcome results
None listed