The Respire−21 study found that early obstructive sleep apnea (OSA) diagnosis and treatment is associated with improved neurocognitive and behavioral outcomes in infants with Down syndrome (DS) followed from 6 to 36 months of age (screened group) versus a control group receiving standard care at 36 months of age (standard care group). This follow-up study assessed whether these benefits persisted at 60 months of age and whether early OSA treatment influenced language and communication outcomes. Children from the initial study diagnosed with and treated for OSA underwent neurocognitive assessment at 60 months of age using the Griffiths Scales of Child Development, Third Edition (Griffiths III); the Vineland Adaptive Behavior Scales, Second Edition (VABS-II); and in-laboratory polysomnography. Twenty-four screened group and 13 standard care group children were included. The between-group difference in Griffiths III Global Quotient of Development favored the screened group but was not statistically significant (3.9 [standard error 2.8]; p = 0.130). The screened group scored significantly better on the Griffiths III Foundations of Learning (p = 0.014) and Personal–Social–Emotional (p = 0.019) domains, and on the VABS-II global composite score (p = 0.007), Daily Living Skills (p = 0.004), and Socialization (p = 0.005) domains. No significant benefit was observed for language or communication outcomes. Long-term neurocognitive benefits of early OSA screening and treatment were observed in infants with DS at 60 months of age, particularly for daily functioning and socialization. Registered at ClinicalTrials.gov under registration number NCT03210675 (registration date: 2017-07-05). Obstructive sleep apnea (OSA) is very frequent in infants with Down syndrome (DS). Early diagnosis and treatment of OSA is associated with significant improvement of neurocognitive outcomes and behavior at 36 months of age compared to no systematic evaluation of OSA. This study showed perduring benefits of early OSA interventions (at 60 months of age) compared with children receiving diagnosis and treatment later, i.e., after 36 months of age. Guidelines should be adapted to favor early interventions for OSA if diagnosed.
Insomnia is a highly prevalent, chronic disorder that is a modifiable novel risk factor for cardiovascular disease. However, there are fewer physiological data available suggesting that insomnia may be related to early cardiac disease and atherosclerotic progression among young adults (ages 21–44 years). In this case–control study, we investigated the association between insomnia and subclinical cardiovascular disease risk markers in a sample of young adults with ICSD-3-diagnosed insomnia compared to healthy good sleepers. Among a sample of 43 community-based, healthy young adults (18 individuals with insomnia disorder, 25 good sleeping controls; Mage = 28.7 years, range 21–42), we compared indices of cardiac function with 2D echocardiography, endothelial dysfunction with flow-mediated endothelial dilation, and arterial stiffness with carotid-femoral pulse wave velocity, adjusted for body mass index. The insomnia group had worse left ventricular global longitudinal strain in comparison to the good sleeping controls (insomnia M(SD) − 22.8 (2.2), good sleeping controls − 24.3 (1.5), F[1, 39] = 7.42, p = 0.01, ηp2 = 0.16, estimated marginal mean difference = 1.47
Children with obstructive sleep apnea (OSA) requiring positive airway pressure (PAP) therapy are commonly treated with fixed-pressure continuous positive airway pressure (CPAP). Auto-adjusting positive airway pressure (APAP) is widely used in adults with OSA and may have potential roles in pediatric PAP initiation, ongoing treatment, and pressure optimization; however, the pediatric evidence base remains under-investigated. This scoping review maps the peer-reviewed literature on APAP use in children with OSA and describes how APAP effectiveness has been evaluated. We conducted this review using Joanna Briggs Institute methodology and reported findings in accordance with PRISMA-ScR. MEDLINE, Embase, CINAHL, and Scopus were searched in June 2025, with forward and backward citation searching of included articles and selected reviews. Two reviewers independently screened studies and charted data using a standardized extraction form. Eleven studies were included (total APAP-exposed participants n = 373). Evidence was predominantly observational (10/11 studies; 7 retrospective and 3 prospective), with one randomized trial. APAP was often initiated empirically, frequently prior to titration PSG. Outcomes most commonly focused on adherence/use (8/11 studies), while physiologic sleep indices, pressure-metric concordance, and safety were each assessed in 4/11 studies; patient-centered clinical outcomes were rarely evaluated. Reporting of APAP device specifications and initiation supports was inconsistent. The pediatric APAP peer-reviewed literature remains small and predominantly observational. More rigorous pediatric research, including pragmatic comparative designs with standardized reporting of device details, initiation protocols, and outcomes, is needed to clarify which children may be suitable for APAP therapy and when titration PSG remains necessary.
