Obesity, diabetes and their metabolic correlates in middle-aged adults with Down syndrome

Adults with Down syndrome and obstructive sleep apnea treated with hypoglossal nerve stimulation

STUDY OBJECTIVES

We aimed to examine the feasibility, adherence to therapy, and efficacy of hypoglossal nerve stimulation in adults with Down syndrome and obstructive sleep apnea.

METHODS

Adults patients with Down syndrome who met criteria for hypoglossal nerve stimulation were prospectively enrolled. Objective adherence was extracted from a cloud-based compliance database. Preoperative sleep studies were compared to follow-up testing performed no sooner than 3 months after device activation.

RESULTS

Eleven adults with Down syndrome underwent implantation of hypoglossal nerve stimulation between May 2021 and July 2024. Median age was 27 years (interquartile range 26, 33), body mass index 28.5 kg/m2 (26.5, 32.4), 27% were female, and patients had severe obstructive sleep apnea (apnea-hypopnea index 40 events/h, 28.4, 42.9). All patients were successfully implanted on an outpatient basis with no postoperative complications or readmissions and activated on schedule at 1 month after surgery. Adherence data show nightly usage longer than 4 hours was 100% and 96% of nights and a median of 9.2 and 8.5 hours/night in the first 30 and 90 days, respectively. Seven patients have undergone follow-up testing and the median entire-night apnea-hypopnea index was reduced by 76%. All patients experienced a > 50% decrease in apnea-hypopnea index and to less than 15 events/h. Median time spent below 88% improved from 2.0% (0.3, 5.0) to 0.2% (0, 0.6), and oxygenation nadir improved from 79.0% (75.5, 85) to 88.0% (86.5, 91).

CONCLUSIONS

In this small initial cohort, hypoglossal nerve stimulation appears to be a safe, well-tolerated, and efficacious treatment option for adults with Down syndrome with moderate-to-severe obstructive sleep apnea and positive airway pressure therapy intolerance.

CITATION

Huyett P, Santoro SL, Oreskovic NM, Skotko BG. Adults with Down syndrome and obstructive sleep apnea treated with hypoglossal nerve stimulation. J Clin Sleep Med. 2025;21(4):619-625.

Metabolic dysfunction-associated liver disease and biliary lithiasis in children with Down Syndrome: a retrospective study

OBJECTIVE

To investigate the presence of metabolic dysfunction-associated fatty liver disease (MAFLD) and gallbladder abnormalities in a sample of people with Down syndrome in Brazil.

METHODS

This is a retrospective study using medical charts involving Down syndrome patients, diagnosed by karyotype, aged over 5 years, who underwent abdominal ultrasound and were monitored by the same professional in a clinic in Curitiba, Brazil. Data spanned January 1995 to September 2023; all cases with no use of alcohol or hepatotoxic medications.

RESULTS

A total of 124 patients were evaluated, 64 (51.6%) being females. Ages varied between 5 and 30 years (average of 13.2±5.7 years). Body mass index ranged from 14.08 to 44.98 kg/m2, with 27 (21.7%) patients being overweight and 42 (33.8%) obese. The frequency of increased total cholesterol and triglyceride concentrations was significantly higher in children. No age or sex differences were seen in low- and high-density lipoprotein cholesterol. Alanine transferase (ALT) and aspartate transferase (AST) levels were within normal ranges and showed no differences concerning sex or age. Four patients (3.2%) had diagnosis of MAFLD. The prevalence of gallstone varied widely in terms of the number and size of stones among patients, affecting 11 (8.9%) of them, with no significant difference in age or sex.

CONCLUSIONS

MAFLD was found in 3.2% of the individuals, while gallstone disease was identified in 8.9% of the cases studied. Moreover, we noted a significant presence of risk factors associated with MAFLD, with dyslipidemia being the predominant factor.

Adherence to adult clinical practice guidelines for Down syndrome

Adults with Down syndrome (DS) have unique health care needs with evidence-based care guidelines to address these. Yet, the 2020 adult guidelines were unstudied; we aimed to assess adherence to these guidelines. We reviewed clinical and demographic data from medical charts of 327 adults with DS who were seen in the MGH DSP. We calculated adherence to care guidelines and analyzed correlations between both demographic traits and clinical results. Mean adherence rate to each of the nine adult guidelines was 67.3%. Adherence rates that were below our mean adherence rate included colonoscopy (42.9%), iron (41.9%), audiology specialist (35.8%), and audiogram (35.2%). We found four significant correlations: assigned females at birth had a significantly higher body mass index (BMI) than assigned males at birth (p < 0.001), Hispanic patients had a significantly higher BMI than other patients (p = 0.015), Hispanic patients had a significantly higher rate of diabetes than other patients (p = 0.036), and Black patients had a significantly lower rate of hypothyroidism than other patients (p = 0.004). We assessed the adherence rates to adult DS guidelines and highlighted disparities in healthcare for patients with DS to inform clinicians on how to improve care for patients with DS.

Body composition parameters and sarcopenia in adults with Down syndrome: a case-control study

BACKGROUND

Individuals with Down syndrome (DS) experience premature aging. Whether accelerated aging involves changes in body composition parameters and is associated with early development of sarcopenia is unclear.

AIMS

To compare parameters of body composition and the prevalence of sarcopenia between adults with DS and the general population.

METHODS

Body composition was assessed by whole-body dual-energy X-ray absorptiometry (DXA). Fat mass (FMI) and skeletal mass indices (SMI) were calculated as the ratio between total body fat mass and appendicular lean mass and the square of height, respectively. Fat mass distribution was assessed by the android/gynoid fat ratio (A/G). Sarcopenia was defined according to the criteria and cut-points recommended by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Data on age- and sex-matched non-DS controls were retrieved from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) population.

RESULTS

Sixty-four DS adults (mean age 37.2 ± 12.0 years, 20.3% women) were enrolled and compared with age- and sex-matched NHANES participants (n = 256), in a 1:4 ratio. FMI (7.96 ± 3.18 kg/m2 vs. 8.92 ± 4.83 kg/m2, p = 0.135), SMI (7.38 ± 1.01 kg/m2 vs. 7.46 ± 2.77 kg/m2, p = 0.825) and A/G (0.98 ± 0.17 vs. 1.01 ± 0.22, p = 0.115) were not significantly different between DS and control participants. When the sample was stratified by sex, women with DS had a higher FMI compared with their NHANES controls (10.16 ± 4.35 kg/m2 vs. 8.11 ± 4.29 kg/m2, p < 0.001), while men with DS had lower A/G ratio (1.04 ± 0.16 vs. 1.11 ± 0.22, p = 0.002). Sarcopenia was more frequent in individuals with DS than in controls (35.6% vs. 19.9%, p = 0.007). This association was stronger in men 40 years and older.

CONCLUSIONS

Adults with DS have a higher prevalence of sarcopenia compared with the general population. This finding suggests that DS is associated with early muscle aging and calls for the design of interventions targeting the skeletal muscle to prevent or treat sarcopenia.