Magnetic resonance imaging of the upper airway in children with Down syndrome

• Published in: American journal of respiratory and critical care medicine Vol. 163; no. 3; pp. 731 - 736
• Main Authors: UONG, Elizabeth C, MCDONOUGH, Joseph M, TAYAG-KIER, Catherine E, HUAQING ZHAO, HASELGROVE, John, MAHBOUBI, Soroush, SCHWAB, Richard J, PACK, Allan I, ARENS, Raanan
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01-03-2001
• Subjects: Biological and medical sciences; Child; Child, Preschool; Down Syndrome - complications; Down Syndrome - pathology; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Medical sciences; Nasopharynx - pathology; Non tumoral diseases; Oropharynx - pathology; Otorhinolaryngology. Stomatology; Sleep Apnea, Obstructive - etiology; Surveys and Questionnaires; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Chromosomal aberration; Human; Upper respiratory tract; Respiratory disease; Aneuploidy; Exploration; Down syndrome; Congenital disease; Nuclear magnetic resonance imaging; Symptomatology; Medical imagery; ENT disease; Child
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.163.3.2004231

As compared with control subjects, children with Down syndrome have different size and shape relationships among tissues composing the upper airway, which may predispose them to obstructive sleep apnea (OSA). We hypothesized that Down syndrome children without OSA have similar subclinical differences. We used magnetic resonance imaging to study the upper airway in 11 Down syndrome children without OSA (age, 3.2 +/- 1.4 yr) and in 14 control subjects (age, 3.3 +/- 1.1 yr). Sequential T1- and T2-weighted spin-echo axial and sagittal images were obtained. We found a smaller airway volume in subjects with Down syndrome (1.4 +/- 0.4 versus 2.3 +/- 0.8 cm(3) in controls, p < 0.005). Subjects with Down syndrome had a smaller mid- and lower face skeleton. They had a shorter mental spine-clivus distance (5.7 +/- 0.6 versus 6.2 +/- 0.4 cm, p < 0.05), hard palate length (3.2 +/- 0.4 versus 3.7 +/- 0.2 cm, p < 0.005), and mandible volume (11.5 +/- 3.7 versus 16.9 +/- 2.9 cm3, p < 0.0005). Adenoid and tonsil volume was significantly smaller in the subjects with Down syndrome. However, the tongue, soft-palate, pterygoid, and parapharyngeal fat pads were similar to those of control subjects. This study shows that Down syndrome children without OSA do not have increased adenoid or tonsillar volume; reduced upper airway size is caused by soft tissue crowding within a smaller mid- and lower face skeleton.