Down SyndromePhase 2DOSANCT06043440
Down Syndrome Obstructive Sleep Apnea
A Phase 2 study testing Oxygen in people with Down Syndrome and Obstructive Sleep Apnea, run by Brigham and Women's Hospital at 7 sites in United States.
Trial summary
The purpose of this study is to assess whether oxygen supplementation during sleep improves working memory and other clinical and patient-reported outcomes among children who have Down Syndrome (DS) with moderate to severe Obstructive Sleep Apnea (OSA). Read more about this study
- Who is it for?
- Ages 5 to 18 years
- Conditions the study is for
- Down Syndrome, Obstructive Sleep Apnea
- What is being tested?
- Oxygen
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 230 participants
- Where
- 7 sitesUnited States
- Study dates
- 24 Oct 2023to 30 Dec 2027
- Phase
- Phase 2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 5 to 18 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Ages 5.0 to 17.9 years at the time of screening
- Children with OSA and obstructive apnea hypopnea index (OAHI) ≥5/hour.
- Absence of clinically significant hypoxia defined as oxygen saturation <88% for 5 minutes or episodic desaturation to 60% as these levels would otherwise identify children eligible to routinely receive oxygen.
- 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
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- Reaching an optimum oxygen flow which is defined as the flow that achieves the lowest level of AHI with maximum CO2 level less than 65 mmHg observed for 5 consecutive minutes and or an increase in CO2 by less than 15 points above baseline. The above criteria are observed while the patient spends a minimal of 30 minutes in the supine position and at least one cycle of rapid eye movement (REM) sleep.
- Oxygen flow required does not exceed 3.0 LPM and does not exceed a FiO2 > 40 %.
- Willingness to comply with all study procedures and available for duration of study.
- At baseline the participant attempts to perform the neuropsychological tests
Who cannot join
- 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.
Show all 12Show fewer
- 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.
Trial locations and contacts
7 sites in 1 country. Contact the study team or a site near you to ask about taking part.
7 sites in 1 country
United States7 sites, 7 recruiting
- Recruiting
University of Michigan, Ann Arbor Hospital
Ann Arbor, Michigan, 48109
Emily Herreshoff, egalopin@med.umich.edu
Ronald Chervin, MD
- Recruiting
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
Suzanna Hicks, suzanna.hicks@cchmc.org
Raouf Amin, MD
- Recruiting
Rainbow Babies and Children's Hospital, Case Medical Center
Cleveland, Ohio, 44106
Alyssa Keller, Alyssa.Keller@Uhhospitals.org
Sally Ibrahim, MD
- Recruiting
Children's Hospital of Los Angeles
Los Angeles, California, 90027
Danny Del Cid-Linare, ddelcidlinares@chla.usc.edu
Sally Ward, MD
- Recruiting
East Virginia Medical Center
Norfolk, Virginia, 23507
Thomas Boswick, BoswicST@EVMS.edu
Cristina Baldassari, MD
- Recruiting
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
Ebereh Uwah, uwahe@chop.edu
Christopher Cielo, MD
- Recruiting
Seattle Children's Hospital
Seattle, Washington, 98105
Sharon McNamara, sharon.mcnamara@seattlechildrens.org
Maida Chen, MD
About this study
Official title: Randomized Control Trial of Oxygen Therapy in Children and Adolescents With Down Syndrome and Obstructive Sleep Apnea
The purpose of this study is to assess whether oxygen supplementation during sleep improves working memory and other clinical and patient-reported outcomes among children who have Down Syndrome (DS) with moderate to severe Obstructive Sleep Apnea (OSA).
Read the detailed description
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).
- Conditions
- Down Syndrome, Obstructive Sleep Apnea
- Being tested
- Oxygen
- Medical subject headings
- Down Syndrome, Sleep Apnea, Obstructive
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
OxygenDrug
Active nocturnal oxygen concentrator
| Study group | Role | What they receive |
|---|---|---|
| Oxygen plus supportive care (OXT) | Active comparator | Nocturnal oxygen therapy plus providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators. Receives: Drug: Oxygen |
| Supportive care (SC) | No intervention | Providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Behavior Rating Inventory of Executive Function 2 (BRIEF2) working memory score
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.
Measured: Baseline and 6 months
Differential Ability Scales - 2nd Edition (DAS-II) T-score.
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.
Measured: Baseline and 6 months
Secondary outcomes (40)
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Total raw score
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.
Measured: Baseline and 6 Months
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Verbal raw score
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.
Measured: Baseline and 6 Months
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Non Verbal raw score
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.
Measured: Baseline and 6 Months
Differential Ability Scales-2 (DAS-II) Recall of Digits Forward raw score
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.
Measured: Baseline and 6 Months
Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) adjusted total errors based on stages completed
Change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) adjusted total errors based on stages completed
Measured: Baseline and 6 Months
Cambridge Neuropsychological Test Automated Battery (CANTAB) Reaction Time (RTI)
Change from baseline in Cambridge Neuropsychological Test Automated Battery (CANTAB) Reaction Time (RTI)
Measured: Baseline and 6 Months
Developmental Neuropsychological Assessment 2nd Edition (NEPSY-II) verbal fluency test raw score
Change from baseline in Developmental Neuropsychological Assessment 2nd Edition (NEPSY-II) verbal fluency test raw score. Range-N/A
Measured: Baseline and 6 Months
Observer Memory Questionnaire - Parent Form (OMQ-PF) total T-score
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.
Measured: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for subscales (Inhibit, Self-Monitor, Shift, Emotional Control, Initiate)
Change from baseline in Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for subscales (Inhibit, Self-Monitor, Shift, Emotional Control, Initiate).
Measured: Baseline and 6 Months
Child Behavior Checklist (CBCL) T-scores for domains (Internalizing, Externalizing, Total Problems).
Change from baseline in Child Behavior Checklist (CBCL) T-scores for domains (Internalizing, Externalizing, Total Problems).
Measured: Baseline and 6 Months
Child Behavior Checklist (CBCL) T-scores for subscales (Attention Problems, Thought Problems, Rule-Breaking Behaviors, Aggressive Behaviors)
Change from baseline in Child Behavior Checklist (CBCL) T-scores for subscales (Attention Problems, Thought Problems, Rule-Breaking Behaviors, Aggressive Behaviors)
Measured: Baseline and 6 Months
KIDSCREEN-27 T-score
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
Measured: Baseline and 6 Months
Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance T-score
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.
Measured: Baseline and 6 Months
Patient-Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment T-score
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.
Measured: Baseline and 6 Months
Presence of right ventricular hypertension
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)
Measured: Baseline and 6 Months
Wechsler Intelligence Scale (WISC) for Children 5th edition (WISC-5) Cancellation raw score
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.
Measured: Baseline and 6 Months
Wechsler Preschool and Primary Scale of Intelligence 4th edition (WPPSI-4) Cancellation task raw score
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.
Measured: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Behavior Regulation Index (BRI) domain.
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.
Measured: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Emotional Recognition Index (ERI) domain.
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.
Measured: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Cognitive Regulation Index (CRI) domain.
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.
Measured: Baseline and 6 Months
7-day actigraphy measurement of sleep efficiency
Change from baseline in 7-day actigraphy measurement of sleep efficiency
Measured: Baseline and 6 Months
7-day actigraphy measurement of time wake after sleep onset
Change from baseline in 7-day actigraphy measurement of time wake after sleep onset
Measured: Baseline and 6 Months
7-day actigraphy measurement of sleep fragmentation
Change from baseline in 7-day actigraphy measurement of sleep fragmentation
Measured: Baseline and 6 Months
7-day actigraphy measurement of total sleep duration
Change from baseline in 7-day actigraphy measurement of total sleep duration
Measured: Baseline and 6 Months
Polysomnography (PSG) AHI parameter
Change from baseline in Polysomnography (PSG) AHI parameter. The score ranges from 0- >40. A higher score is a worse outcome.
Measured: Baseline and 6 Months
Polysomnography (PSG) percentage time of O2 <90 % parameter
Change from baseline in Polysomnography (PSG) percentage time of O2 <90 % parameter
Measured: Baseline and 6 Months
Polysomnography (PSG) sleep apnea associated hypoxic burden parameter
Change from baseline in Polysomnography (PSG) sleep apnea associated hypoxic burden, parameter
Measured: Baseline and 6 Months
Polysomnography (PSG) end-tidal CO2 level, parameter
Change from baseline in Polysomnography (PSG) end-tidal CO2 parameter.
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of sleep stages
Change from baseline in Polysomnography (PSG) -based measure of sleep stages. Range- N/A
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of EEG power bands
Change from baseline in Polysomnography (PSG) -based measure of EEG power bands
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle morphology
Change from baseline in Polysomnography (PSG) -based measure of spindle morphology
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle numbers
Change from baseline in Polysomnography (PSG) -based measure of spindle numbers
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle density
Change from baseline in Polysomnography (PSG) -based measure of spindle density
Measured: Baseline and 6 Months
Polysomnography (PSG) -based measure of slow wave oscillations
Change from baseline in Polysomnography (PSG) -based measure of slow wave oscillations
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral E and A wave (E:A ratio)
Change from baseline in left ventricular diastolic function as measured by Mitral E and A wave (E:A ratio)
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by E wave deceleration time
Change from baseline in left ventricular diastolic function as measured by E wave deceleration time
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral septal and lateral e' and a' (E/e')
Change from baseline in left ventricular diastolic function as measured by Mitral septal and lateral e' and a' (E/e')
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral lateral tissue Doppler isovolumic relaxation time
Change from baseline in left ventricular diastolic function as measured by Mitral lateral tissue Doppler isovolumic relaxation time
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by Pulmonary vein A wave reversal duration
Change from baseline in left ventricular diastolic function as measured by Pulmonary vein A wave reversal duration
Measured: Baseline and 6 Months
Left ventricular diastolic function as measured by Left atrial volume
Change from baseline in left ventricular diastolic function as measured by Left atrial volume
Measured: Baseline and 6 Months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Sep 2023
- Study start24 Oct 2023
- Primary completion30 Nov 2027 (estimated)
- Study completion30 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (58)Papers the sponsor has linked to this study.
- Other trials for Down SyndromeStudies of the same condition, open and under way.
- More trials run by Brigham and Women's HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Care provider, Investigator, Outcomes assessor
- Enrolment
- 230 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Brigham and Women's Hospital
- Sponsor type
- University, hospital or other
- Collaborators
- Children's Hospital Medical Center, Cincinnati, Children's Hospital of Philadelphia, Rainbow Babies and Children's Hospital, University of Michigan, Children's Hospital Los Angeles, Children's Hospital of The King's Daughters, Seattle Children's Hospital, University of Southern California, Boston Children's Hospital
- Responsible party
- Principal investigator, Susan Redline, Brigham and Women's Hospital
- Investigators
- Susan Redline, Principal investigator, Brigham and Women's HospitalRaouf Amin, Principal investigator, Children's Hospital Medical Center, Cincinnati
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06043440
- Sponsor's protocol ID
- 2023P000062
- Acronym
- DOSA
- Status last verified
- Sep 2026
- First submitted
- 17 Aug 2023
- Last updated
- 30 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
Publications
Das D, Medina B, Baktir MA, Mojabi FS, Fahimi A, Ponnusamy R, Salehi A. Increased incidence of intermittent hypoxemia in the Ts65Dn mouse model of Down syndrome. Neurosci Lett. 2015 Sep 14;604:91-6. doi: 10.1016/j.neulet.2015.07.040. Epub 2015 Aug 1.
PubMed 26240993Schloo BL, Vawter GF, Reid LM. Down syndrome: patterns of disturbed lung growth. Hum Pathol. 1991 Sep;22(9):919-23. doi: 10.1016/0046-8177(91)90183-p.
PubMed 1833304Bush D, Galambos C, Ivy DD, Abman SH, Wolter-Warmerdam K, Hickey F. Clinical Characteristics and Risk Factors for Developing Pulmonary Hypertension in Children with Down Syndrome. J Pediatr. 2018 Nov;202:212-219.e2. doi: 10.1016/j.jpeds.2018.06.031. Epub 2018 Jul 17.
PubMed 30025669Cooney TP, Wentworth PJ, Thurlbeck WM. Diminished radial count is found only postnatally in Down's syndrome. Pediatr Pulmonol. 1988;5(4):204-9. doi: 10.1002/ppul.1950050405.
PubMed 2976929Gonzalez OR, Gomez IG, Recalde AL, Landing BH. Postnatal development of the cystic lung lesion of Down syndrome: suggestion that the cause is reduced formation of peripheral air spaces. Pediatr Pathol. 1991 Jul-Aug;11(4):623-33. doi: 10.3109/15513819109064794.
PubMed 1835001O'Neill AC, Richter GT. Pharyngeal dysphagia in children with Down syndrome. Otolaryngol Head Neck Surg. 2013 Jul;149(1):146-50. doi: 10.1177/0194599813483445. Epub 2013 Mar 22.
PubMed 23525851Jackson A, Maybee J, Moran MK, Wolter-Warmerdam K, Hickey F. Clinical Characteristics of Dysphagia in Children with Down Syndrome. Dysphagia. 2016 Oct;31(5):663-71. doi: 10.1007/s00455-016-9725-7. Epub 2016 Jul 12.
PubMed 27405422Khoo MCK, Hu WH, Amin R. Effects of Ventilation-Perfusion Mismatch on Severity of Obstructive Sleep Apnea: A Modeling Study. Annu Int Conf IEEE Eng Med Biol Soc. 2020 Jul;2020:2792-2795. doi: 10.1109/EMBC44109.2020.9175297.
PubMed 33018586Alex RM, Panza GS, Hakim H, Badr MS, Edwards BA, Sands SA, Mateika JH. Exposure to mild intermittent hypoxia increases loop gain and the arousal threshold in participants with obstructive sleep apnoea. J Physiol. 2019 Jul;597(14):3697-3711. doi: 10.1113/JP277711. Epub 2019 May 9.
PubMed 31026056Vetrano DL, Carfi A, Brandi V, L'Angiocola PD, Di Tella S, Cipriani MC, Antocicco M, Zuccala G, Palmieri V, Silveri MC, Bernabei R, Onder G. Left ventricle diastolic function and cognitive performance in adults with Down syndrome. Int J Cardiol. 2016 Jan 15;203:816-8. doi: 10.1016/j.ijcard.2015.11.041. Epub 2015 Nov 6. No abstract available.
PubMed 26595792Mann DM, Esiri MM. The pattern of acquisition of plaques and tangles in the brains of patients under 50 years of age with Down's syndrome. J Neurol Sci. 1989 Feb;89(2-3):169-79. doi: 10.1016/0022-510x(89)90019-1.
PubMed 2522541Bauer J, Strauss S, Schreiter-Gasser U, Ganter U, Schlegel P, Witt I, Yolk B, Berger M. Interleukin-6 and alpha-2-macroglobulin indicate an acute-phase state in Alzheimer's disease cortices. FEBS Lett. 1991 Jul 8;285(1):111-4. doi: 10.1016/0014-5793(91)80737-n.
PubMed 1712317Di Domenico F, Tramutola A, Butterfield DA. Role of 4-hydroxy-2-nonenal (HNE) in the pathogenesis of alzheimer disease and other selected age-related neurodegenerative disorders. Free Radic Biol Med. 2017 Oct;111:253-261. doi: 10.1016/j.freeradbiomed.2016.10.490. Epub 2016 Oct 24.
PubMed 27789292Lyman M, Lloyd DG, Ji X, Vizcaychipi MP, Ma D. Neuroinflammation: the role and consequences. Neurosci Res. 2014 Feb;79:1-12. doi: 10.1016/j.neures.2013.10.004. Epub 2013 Oct 19.
PubMed 24144733Rueda N, Vidal V, Garcia-Cerro S, Narcis JO, Llorens-Martin M, Corrales A, Lantigua S, Iglesias M, Merino J, Merino R, Martinez-Cue C. Anti-IL17 treatment ameliorates Down syndrome phenotypes in mice. Brain Behav Immun. 2018 Oct;73:235-251. doi: 10.1016/j.bbi.2018.05.008. Epub 2018 May 31.
PubMed 29758264
Study at a glance
From the registry record, last updated by the sponsor on 30 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomized Control Trial of Oxygen Therapy in Children and Adolescents With Down Syndrome and Obstructive Sleep Apnea
- ClinicalTrials.gov ID
- NCT06043440
- Acronym / sponsor ID
- DOSA / 2023P000062
- Conditions
- Down Syndrome, Obstructive Sleep Apnea
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 230 participants (estimated)
- Lead sponsor
- Brigham and Women's HospitalUniversity, hospital or other
- Collaborators
- Children's Hospital Medical Center, Cincinnati, Children's Hospital of Philadelphia, Rainbow Babies and Children's Hospital, University of Michigan, Children's Hospital Los Angeles, Children's Hospital of The King's Daughters, Seattle Children's Hospital, University of Southern California, Boston Children's Hospital
- Study start
- 24 Oct 2023 (actual)
- Primary completion
- 30 Nov 2027 (estimated)
- Study completion
- 30 Dec 2027 (estimated)
- First posted
- 21 Sep 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to assess whether oxygen supplementation during sleep improves working memory and other clinical and patient-reported outcomes among children who have Down Syndrome (DS) with moderate to severe Obstructive Sleep Apnea (OSA).
Detailed description
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 design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Oxygen plus supportive care (OXT) | Active comparator | Drug: OxygenNocturnal oxygen therapy plus providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators. |
| Supportive care (SC) | No intervention | –Providing patient with healthy sleep habits materials, healthy diet materials and nasal dilators. |
Who may qualify
- Ages
- 5 to 18 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (10 listed)
- Ages 5.0 to 17.9 years at the time of screening
- Children with OSA and obstructive apnea hypopnea index (OAHI) ≥5/hour.
- Absence of clinically significant hypoxia defined as oxygen saturation <88% for 5 minutes or episodic desaturation to 60% as these levels would otherwise identify children eligible to routinely receive oxygen.
- Favorable response to oxygen therapy (allowing randomization) will be defined as follows:
- Willingness to comply with all study procedures and available for duration of study.
Key exclusion criteria (12 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| OxygenActive nocturnal oxygen concentrator | Drug | Oxygen plus supportive care (OXT) |
Primary outcome
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.
40 secondary outcomes
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Total raw score
Time frame: Baseline and 6 Months
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Verbal raw score
Time frame: Baseline and 6 Months
Stanford-Binet Intelligence Scales, 5th edition (SB-5) Working Memory Non Verbal raw score
Time frame: Baseline and 6 Months
Differential Ability Scales-2 (DAS-II) Recall of Digits Forward raw score
Time frame: Baseline and 6 Months
Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) adjusted total errors based on stages completed
Time frame: Baseline and 6 Months
Cambridge Neuropsychological Test Automated Battery (CANTAB) Reaction Time (RTI)
Time frame: Baseline and 6 Months
Developmental Neuropsychological Assessment 2nd Edition (NEPSY-II) verbal fluency test raw score
Time frame: Baseline and 6 Months
Observer Memory Questionnaire - Parent Form (OMQ-PF) total T-score
Time frame: Baseline and 6 Months
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
Child Behavior Checklist (CBCL) T-scores for domains (Internalizing, Externalizing, Total Problems).
Time frame: Baseline and 6 Months
Child Behavior Checklist (CBCL) T-scores for subscales (Attention Problems, Thought Problems, Rule-Breaking Behaviors, Aggressive Behaviors)
Time frame: Baseline and 6 Months
KIDSCREEN-27 T-score
Time frame: Baseline and 6 Months
Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance T-score
Time frame: Baseline and 6 Months
Patient-Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment T-score
Time frame: Baseline and 6 Months
Presence of right ventricular hypertension
Time frame: Baseline and 6 Months
Wechsler Intelligence Scale (WISC) for Children 5th edition (WISC-5) Cancellation raw score
Time frame: Baseline and 6 Months
Wechsler Preschool and Primary Scale of Intelligence 4th edition (WPPSI-4) Cancellation task raw score
Time frame: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Behavior Regulation Index (BRI) domain.
Time frame: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Emotional Recognition Index (ERI) domain.
Time frame: Baseline and 6 Months
Behavior Rating Inventory of Executive Function 2 (BRIEF2) T-scores for Cognitive Regulation Index (CRI) domain.
Time frame: Baseline and 6 Months
7-day actigraphy measurement of sleep efficiency
Time frame: Baseline and 6 Months
7-day actigraphy measurement of time wake after sleep onset
Time frame: Baseline and 6 Months
7-day actigraphy measurement of sleep fragmentation
Time frame: Baseline and 6 Months
7-day actigraphy measurement of total sleep duration
Time frame: Baseline and 6 Months
Polysomnography (PSG) AHI parameter
Time frame: Baseline and 6 Months
Polysomnography (PSG) percentage time of O2 <90 % parameter
Time frame: Baseline and 6 Months
Polysomnography (PSG) sleep apnea associated hypoxic burden parameter
Time frame: Baseline and 6 Months
Polysomnography (PSG) end-tidal CO2 level, parameter
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of sleep stages
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of EEG power bands
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle morphology
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle numbers
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of spindle density
Time frame: Baseline and 6 Months
Polysomnography (PSG) -based measure of slow wave oscillations
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral E and A wave (E:A ratio)
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by E wave deceleration time
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral septal and lateral e' and a' (E/e')
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by Mitral lateral tissue Doppler isovolumic relaxation time
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by Pulmonary vein A wave reversal duration
Time frame: Baseline and 6 Months
Left ventricular diastolic function as measured by Left atrial volume
Time frame: Baseline and 6 Months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Sep 2026.
- Background: PubMed 26240993Das D, Medina B, Baktir MA, Mojabi FS, Fahimi A, Ponnusamy R, Salehi A. Increased incidence of intermittent hypoxemia in the Ts65Dn mouse model of Down syndrome. Neurosci Lett. 2015 Sep 14;604:91-6. doi: 10.1016/j.neulet.2015.07.040. Epub 2015 Aug 1.
- Background: PubMed 1833304Schloo BL, Vawter GF, Reid LM. Down syndrome: patterns of disturbed lung growth. Hum Pathol. 1991 Sep;22(9):919-23. doi: 10.1016/0046-8177(91)90183-p.
- Background: PubMed 30025669Bush D, Galambos C, Ivy DD, Abman SH, Wolter-Warmerdam K, Hickey F. Clinical Characteristics and Risk Factors for Developing Pulmonary Hypertension in Children with Down Syndrome. J Pediatr. 2018 Nov;202:212-219.e2. doi: 10.1016/j.jpeds.2018.06.031. Epub 2018 Jul 17.
- Background: PubMed 2976929Cooney TP, Wentworth PJ, Thurlbeck WM. Diminished radial count is found only postnatally in Down's syndrome. Pediatr Pulmonol. 1988;5(4):204-9. doi: 10.1002/ppul.1950050405.
- Background: PubMed 1835001Gonzalez OR, Gomez IG, Recalde AL, Landing BH. Postnatal development of the cystic lung lesion of Down syndrome: suggestion that the cause is reduced formation of peripheral air spaces. Pediatr Pathol. 1991 Jul-Aug;11(4):623-33. doi: 10.3109/15513819109064794.
- Background: PubMed 23525851O'Neill AC, Richter GT. Pharyngeal dysphagia in children with Down syndrome. Otolaryngol Head Neck Surg. 2013 Jul;149(1):146-50. doi: 10.1177/0194599813483445. Epub 2013 Mar 22.
- Background: PubMed 27405422Jackson A, Maybee J, Moran MK, Wolter-Warmerdam K, Hickey F. Clinical Characteristics of Dysphagia in Children with Down Syndrome. Dysphagia. 2016 Oct;31(5):663-71. doi: 10.1007/s00455-016-9725-7. Epub 2016 Jul 12.
- Background: PubMed 33018586Khoo MCK, Hu WH, Amin R. Effects of Ventilation-Perfusion Mismatch on Severity of Obstructive Sleep Apnea: A Modeling Study. Annu Int Conf IEEE Eng Med Biol Soc. 2020 Jul;2020:2792-2795. doi: 10.1109/EMBC44109.2020.9175297.
- Background: PubMed 31026056Alex RM, Panza GS, Hakim H, Badr MS, Edwards BA, Sands SA, Mateika JH. Exposure to mild intermittent hypoxia increases loop gain and the arousal threshold in participants with obstructive sleep apnoea. J Physiol. 2019 Jul;597(14):3697-3711. doi: 10.1113/JP277711. Epub 2019 May 9.
- Background: PubMed 26595792Vetrano DL, Carfi A, Brandi V, L'Angiocola PD, Di Tella S, Cipriani MC, Antocicco M, Zuccala G, Palmieri V, Silveri MC, Bernabei R, Onder G. Left ventricle diastolic function and cognitive performance in adults with Down syndrome. Int J Cardiol. 2016 Jan 15;203:816-8. doi: 10.1016/j.ijcard.2015.11.041. Epub 2015 Nov 6. No abstract available.
- Background: PubMed 2522541Mann DM, Esiri MM. The pattern of acquisition of plaques and tangles in the brains of patients under 50 years of age with Down's syndrome. J Neurol Sci. 1989 Feb;89(2-3):169-79. doi: 10.1016/0022-510x(89)90019-1.
- Background: PubMed 1712317Bauer J, Strauss S, Schreiter-Gasser U, Ganter U, Schlegel P, Witt I, Yolk B, Berger M. Interleukin-6 and alpha-2-macroglobulin indicate an acute-phase state in Alzheimer's disease cortices. FEBS Lett. 1991 Jul 8;285(1):111-4. doi: 10.1016/0014-5793(91)80737-n.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Susan Redline principal investigator
Brigham and Women's Hospital
Raouf Amin principal investigator
Children's Hospital Medical Center, Cincinnati
7 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Oxygen in people with Down Syndrome and Obstructive Sleep Apnea, run by Brigham and Women's Hospital at 7 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 30 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 7 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Oltion Sina (8573407909, osina@bwh.harvard.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Behavior Rating Inventory of Executive Function 2 (BRIEF2) working memory score (time frame: Baseline and 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06043440, which also lists 58 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Sep 2026.