A prospective, randomised, controlled trial of CPAP in adults with Down syndrome

Introduction: Adults with Down syndrome (DS) are predisposed to sleep apnoea (SA), but efficacy and acceptability of CPAP in this group has never been formally assessed. Aim: To assess CPAP effectiveness in adults with DS+SA in the UK. Methods: Symptomatic adults with DS exhibiting ≥10 apnoeas/hypopnoeas per hour in bed (AH/hr) during a level 2 home sleep study were invited to participate. Participants were randomised to CPAP or lifestyle advice, with review at 1, 3, 6 and 12m. Participants in the lifestyle arm were offered CPAP at 1m. Standard measurements including cognitive function tests were undertaken (Edgin, J.O. et al, J Neurodevelop Disord 2010; 2:149–164). Results: Twenty-eight adults with DS (19 male) were enrolled: age 28±9yr; BMI 31.5±7.9kg/m2; neck circumference 41.5±4.9cm; AH/hr 39.6±32.2; Epworth Sleepiness Score (ESS) 11±6/24. There were no significant differences between groups at baseline. At 1m, no significant differences were noted between groups; the CPAP group showed a trend towards improvement on Disruptive (p=0.007) and Depressive (p=0.080) subscales of the Developmental Behaviour Checklist for Adults (DBC-A). At 12m, 3 participants had withdrawn. Those remaining were on CPAP. Patient ESS (p=0.001), carer ESS (p=0.029) and DBC-A Disruptive (p<0.0001), Anxiety/antisocial (p=0.024) and Depressive (p=0.008) subscales were significantly reduced versus baseline. KBIT-2 verbal (P=0.001) and nonverbal (p=0.011) raw scores and RAND-36 total score (p=0.022) improved. Conclusion: In this first randomised, controlled study of CPAP in adults with DS+SA, CPAP use led to significant improvements in sleepiness, health status, cognitive function and behavioural/emotional outcomes at 12m