Oxygen Therapy in Children and Adolescents With Down Syndrome and Obstructive Sleep Apnea (DOSA)
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT06043440 |
Recruitment Status :
Recruiting
First Posted : September 21, 2023
Last Update Posted : February 22, 2024
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Condition or disease | Intervention/treatment | Phase |
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Down Syndrome Obstructive Sleep Apnea | Drug: Oxygen | Phase 2 |
This will be a randomized, single-blind 6-month Phase-2 clinical trial that compares the impact of oxygen therapy during sleep on measures of cognition, behavior, quality of life, cardiac structure and function, and sleep in children with Down Syndrome(DS) with moderate to severe obstructive sleep apnea.
The proposed study will involve participation of children and their caregivers. Children will be recruited from each site's sleep clinics and laboratories, Down syndrome clinics and otolaryngology clinics. Community recruitment will be coordinated with local Down Syndrome Associations.
Children who agree to participate in the study will be screened for eligibility based on history, physical examination, and review of medical records including history of congenital heart disease and Pulmonary Hypertension (PHTN), and use of Continuous Positive Airway Pressure (CPAP). Children eligible for the study are those with persistent obstructive apnea after adenotonsillectomy or children with obstructive sleep apnea without adenotonsillar hypertrophy or in situations when parents refuse adenotonsillectomy.. The enrollment PSG eligibility will be determined by central scoring of either a research Polysomnography (PSG). In addition to an oxygen titration PSG, which determines responsiveness to oxygen, participants will be asked to wear a wrist actigraph and undergo neurocognitive testing, echocardiography, physical examination, anthropometry, and venipuncture. Caregivers will complete questionnaires to assess their child's emotional, physical, social, and school functioning, sleep quality; child's behavior and cognitive function, and will complete a sleep diary that is used concurrently with their child's use of a wrist actigraph. The latter includes caregiver completion of the "Behavior Rating Inventory of Executive Function" (BRIEF2), a co-primary outcome.
At 3 months, caregivers will complete the BRIEF2. At 6 months, all baseline studies and a PSG will be repeated.
At baseline, demographic data will be collected, including information on residential address (for use in geocoding).
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 230 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Triple (Care Provider, Investigator, Outcomes Assessor) |
Primary Purpose: | Treatment |
Official Title: | Randomized Control Trial of Oxygen Therapy in Children and Adolescents With Down Syndrome and Obstructive Sleep Apnea |
Actual Study Start Date : | October 24, 2023 |
Estimated Primary Completion Date : | August 31, 2027 |
Estimated Study Completion Date : | December 27, 2027 |
Arm | Intervention/treatment |
---|---|
Active Comparator: Oxygen plus supportive care (OXT)
Nocturnal oxygen therapy plus providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators.
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Drug: Oxygen
Active nocturnal oxygen concentrator |
No Intervention: Supportive care (SC)
Providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators.
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- Behavior Rating Inventory of Executive Function 2 (BRIEF2) working memory score [ Time Frame: Baseline and 6 months ]Change from baseline in the Behavior Rating Inventory of Executive Function 2 (BRIEF2) working memory score (BRIEF2wm). The score ranges from 35-90. A higher score is a worse outcome.
- Differential Ability Scales - 2nd Edition (DAS-II) T-score. [ Time Frame: Baseline and 6 months ]Change from baseline in the Differential Ability Scales - 2nd Edition (DAS-II) recognition of pictures (DAS2RoP) T-score. The score ranges from 10-90. A higher score is a better outcome.
- Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Total raw score [ Time Frame: Baseline and 6 Months ]Change from baseline of Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Total raw score. The score ranges from 0-64. A higher score is a better outcome.
- Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Verbal raw score [ Time Frame: Baseline and 6 Months ]Change from baseline of Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Verbal raw score. The score ranges from 0-30. A higher score is a better outcome.
- Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Non Verbal raw score [ Time Frame: Baseline and 6 Months ]Change from baseline of Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Non Verbal raw score. The score ranges from 0-34. A higher score is a better outcome.
- Differential Ability Scales-2 (DAS-II) Recall of Digits Forward raw score [ Time Frame: Baseline and 6 Months ]Change from baseline in Differential Ability Scales-2 (DAS-II) Recall of Digits Forward raw score. The score ranges from 0-38. A higher score is a better outcome.
- Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) adjusted total errors based on stages completed [ Time Frame: Baseline and 6 Months ]Change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) adjusted total errors based on stages completed
- Cambridge Neuropsychological Test Automated Battery (CANTAB) Reaction Time (RTI) [ Time Frame: Baseline and 6 Months ]Change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) Reaction Time (RTI)
- Developmental Neuropsychological Assessment 2nd Edition (NEPSY-II) verbal fluency test raw score [ Time Frame: Baseline and 6 Months ]Change from baseline in Developmental Neuropsychological Assessment 2nd Edition (NEPSY-II) verbal fluency test raw score. Range-N/A
- Observer Memory Questionnaire - Parent Form (OMQ-PF) total T-score [ Time Frame: Baseline and 6 Months ]Change from baseline in Observer Memory Questionnaire - Parent Form (OMQ-PF) total T-score. The score ranges from 0-135. A higher score is a better outcome.
- Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for subscales (Inhibit, Self-Monitor, Shift, Emotional Control, Initiate) [ Time Frame: Baseline and 6 Months ]Change from baseline in Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for subscales (Inhibit, Self-Monitor, Shift, Emotional Control, Initiate).
- Child Behavior Checklist (CBCL) T-scores for domains (Internalizing, Externalizing, Total Problems). [ Time Frame: Baseline and 6 Months ]Change from baseline in Child Behavior Checklist (CBCL) T-scores for domains (Internalizing, Externalizing, Total Problems).
- Child Behavior Checklist (CBCL) T-scores for subscales (Attention Problems, Thought Problems, Rule-Breaking Behaviors, Aggressive Behaviors) [ Time Frame: Baseline and 6 Months ]Change from baseline in Child Behavior Checklist (CBCL) T-scores for subscales (Attention Problems, Thought Problems, Rule-Breaking Behaviors, Aggressive Behaviors)
- KIDSCREEN-27 T-score [ Time Frame: Baseline and 6 Months ]Change from baseline in KIDSCREEN-27 T-score, including domains of: physical well-being; psychological well-being; autonomy and parent relations; social support and peers; school environment. Range-N/A
- Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance T-score [ Time Frame: Baseline and 6 Months ]Change from baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance T-score. The score ranges from 28.7-85.6. A higher score is a worse outcome.
- Patient-Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment T-score [ Time Frame: Baseline and 6 Months ]Change from baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment T-score. The score ranges from 37.9-86.6. A higher score is a worse outcome.
- Presence of right ventricular hypertension [ Time Frame: Baseline and 6 Months ]Presence of right ventricular hypertension as measured by tricuspid regurgitation continuous wave peak velocity (defined as a ratio of pulmonary artery pressure / systolic arterial pressure (PAP/SAP) >1/3); interventricular septal flattening as measured by eccentricity index (defined as systolic ratio of >1.25)
- Wechsler Intelligence Scale (WISC) for Children 5th edition (WISC-5) Cancellation raw score [ Time Frame: Baseline and 6 Months ]Change from baseline of Wechsler Intelligence Scale (WISC) for Children 5th edition (WISC-5) Cancellation raw score. The score ranges from 0-128. A higher score is a better outcome.
- Wechsler Preschool and Primary Scale of Intelligence 4th edition (WPPSI-4) Cancellation task raw score [ Time Frame: Baseline and 6 Months ]Change from baseline in Wechsler Preschool and Primary Scale of Intelligence 4th edition (WPPSI-4) Cancellation task raw score (if unable to complete Wechsler Intelligence Scale 5th edition Cancellation test). The score ranges from 0-96. A higher score is a better outcome.
- Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Behavior Regulation Index (BRI) domain. [ Time Frame: Baseline and 6 Months ]Change from baseline in Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Behavior Regulation Index (BRI) domain. The score ranges from 35-90. A higher score is a worse outcome.
- Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Emotional Recognition Index (ERI) domain. [ Time Frame: Baseline and 6 Months ]Change from baseline in Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Emotional Recognition Index (ERI) domain. The score ranges from 35-90. A higher score is a worse outcome.
- Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Cognitive Regulation Index (CRI) domain. [ Time Frame: Baseline and 6 Months ]Change from baseline in Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Cognitive Regulation Index (CRI) domain. The score ranges from 35-90. A higher score is a worse outcome.
- 7-day actigraphy measurement of sleep efficiency [ Time Frame: Baseline and 6 Months ]Change from baseline in 7-day actigraphy measurement of sleep efficiency
- 7-day actigraphy measurement of time wake after sleep onset [ Time Frame: Baseline and 6 Months ]Change from baseline in 7-day actigraphy measurement of time wake after sleep onset
- 7-day actigraphy measurement of sleep fragmentation [ Time Frame: Baseline and 6 Months ]Change from baseline in 7-day actigraphy measurement of sleep fragmentation
- 7-day actigraphy measurement of total sleep duration [ Time Frame: Baseline and 6 Months ]Change from baseline in 7-day actigraphy measurement of total sleep duration
- Polysomnography (PSG) AHI parameter [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) AHI parameter. The score ranges from 0- >40. A higher score is a worse outcome.
- Polysomnography (PSG) percentage time of O2 <90 % parameter [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) percentage time of O2 <90 % parameter
- Polysomnography (PSG) sleep apnea associated hypoxic burden parameter [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) sleep apnea associated hypoxic burden, parameter
- Polysomnography (PSG) end-tidal CO2 level, parameter [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) end-tidal CO2 parameter.
- Polysomnography (PSG) -based measure of sleep stages [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of sleep stages. Range- N/A
- Polysomnography (PSG) -based measure of EEG power bands [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of EEG power bands
- Polysomnography (PSG) -based measure of spindle morphology [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of spindle morphology
- Polysomnography (PSG) -based measure of spindle numbers [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of spindle numbers
- Polysomnography (PSG) -based measure of spindle density [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of spindle density
- Polysomnography (PSG) -based measure of slow wave oscillations [ Time Frame: Baseline and 6 Months ]Change from baseline in Polysomnography (PSG) -based measure of slow wave oscillations
- Left ventricular diastolic function as measured by Mitral E and A wave (E:A ratio) [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by Mitral E and A wave (E:A ratio)
- Left ventricular diastolic function as measured by E wave deceleration time [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by E wave deceleration time
- Left ventricular diastolic function as measured by Mitral septal and lateral e' and a' (E/e') [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by Mitral septal and lateral e' and a' (E/e')
- Left ventricular diastolic function as measured by Mitral lateral tissue Doppler isovolumic relaxation time [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by Mitral lateral tissue Doppler isovolumic relaxation time
- Left ventricular diastolic function as measured by Pulmonary vein A wave reversal duration [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by Pulmonary vein A wave reversal duration
- Left ventricular diastolic function as measured by Left atrial volume [ Time Frame: Baseline and 6 Months ]Change from baseline in left ventricular diastolic function as measured by Left atrial volume
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 5 Years to 215 Months (Child) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Ages 5.0 to 17.9 years at the time of screening
- Children with Obstructive Sleep Apnea (OSA) and obstructive apnea hypopnea index (OAHI) 5-40/hour. :
- Absence of clinically significant hypoxia defined as oxygen saturation <88% for 5 minutes or episodic desaturation to 60%.
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Favorable response to oxygen therapy (allowing randomization) will be defined as follows:
- Oxygen saturation nadir >92% and
- Decrease in obstructive index < 5 / hour or by > 50% from screening PSG
- Reaching an optimum oxygen flow, which is defined as the flow that achieves the lowest level of AHI without hypoventilation.
- Oxygen flow required does not exceed 3.0 liter/minute or Fraction of Inspired Oxygen (FiO2) >40%.
- Willingness to comply with all study procedures and be available for the duration of study.
- At baseline, the participant attempts to perform the neuropsychological tests
Exclusion Criteria:
- Current CPAP use with documented compliance(> 4 hrs/ night; > 70% of nights).
- Oxygen saturation < 90% at rest during wakefulness.
- Chronic daytime or nighttime use of supplemental oxygen.
- Smoker in the child's bedroom.
- Unrepaired congenital heart disease.
- Moderate to severe pulmonary hypertension requiring treatment with oxygen and or pulmonary vasodilator.
- Unable to participate in a PSG.
- Individuals who develop alveolar hypoventilation with oxygen as previously defined.
- Other severe chronic diseases determined by their provider as making them poor study candidates.
- Enrolled or planning to enroll in another study that may conflict with protocol requirements or confound results in this trial.
- Documented clinically significant untreated hypothyroidism
- Children with adenotonsillar hypertrophy who are candidates for adenotonsillectomy and parents agree to the surgery.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06043440
Contact: Oltion Sina | 8573407909 | osina@bwh.harvard.edu | |
Contact: Suzie Hicks | 5136364944 | suzanna.hicks@cchmc.org |
United States, California | |
Children's Hospital of Los Angeles | Recruiting |
Los Angeles, California, United States, 90027 | |
Contact: Danny Del Cid-Linare ddelcidlinares@chla.usc.edu | |
Principal Investigator: Sally Ward, MD | |
United States, Michigan | |
University of Michigan, Ann Arbor Hospital | Recruiting |
Ann Arbor, Michigan, United States, 48109 | |
Contact: Emily Herreshoff egalopin@med.umich.edu | |
Principal Investigator: Ronald Chervin, MD | |
United States, Ohio | |
Cincinnati Children's Hospital Medical Center | Recruiting |
Cincinnati, Ohio, United States, 45229 | |
Contact: Suzanna Hicks suzanna.hicks@cchmc.org | |
Principal Investigator: Raouf Amin, MD | |
Rainbow Babies and Children's Hospital, Case Medical Center | Recruiting |
Cleveland, Ohio, United States, 44106 | |
Contact: Alyssa Keller Alyssa.Keller@Uhhospitals.org | |
Principal Investigator: Sally Ibrahim, MD | |
United States, Pennsylvania | |
Children's Hospital of Philadelphia | Recruiting |
Philadelphia, Pennsylvania, United States, 19104 | |
Contact: Ebereh Uwah uwahe@chop.edu | |
Principal Investigator: Christopher Cielo, MD | |
United States, Virginia | |
East Virginia Medical Center | Recruiting |
Norfolk, Virginia, United States, 23507 | |
Contact: Thomas Boswick BoswicST@EVMS.edu | |
Principal Investigator: Cristina Baldassari, MD | |
United States, Washington | |
Seattle Children's Hospital | Recruiting |
Seattle, Washington, United States, 98105 | |
Contact: Sharon McNamara sharon.mcnamara@seattlechildrens.org | |
Principal Investigator: Maida Chen, MD |
Principal Investigator: | Susan Redline | Brigham and Women's Hospital | |
Principal Investigator: | Raouf Amin | Children's Hospital Medical Center, Cincinnati |
Responsible Party: | Susan Redline, Proffesor, Brigham and Women's Hospital |
ClinicalTrials.gov Identifier: | NCT06043440 |
Other Study ID Numbers: |
2023P000062 |
First Posted: | September 21, 2023 Key Record Dates |
Last Update Posted: | February 22, 2024 |
Last Verified: | February 2024 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | Yes |
Apnea Sleep Apnea Syndromes Sleep Apnea, Obstructive Down Syndrome Syndrome Disease Pathologic Processes Respiration Disorders Respiratory Tract Diseases Signs and Symptoms, Respiratory Sleep Disorders, Intrinsic |
Dyssomnias Sleep Wake Disorders Nervous System Diseases Intellectual Disability Neurobehavioral Manifestations Neurologic Manifestations Abnormalities, Multiple Congenital Abnormalities Chromosome Disorders Genetic Diseases, Inborn |