Sleep, Function, Behaviour and Cognition in a Cohort of Children with Down Syndrome

Objective: To describe the sleep problems experienced by children with Down syndrome attending a tertiary sleep clinic and relationship with behaviour, function and cognition. Methods: Data were collected from children with Down syndrome aged 3–18 years old. Carers completed the Abbreviated Child Sleep Habits Questionnaire, Child Behaviour Checklist and Life-Habits Questionnaire at enrolment. Cognitive assessment (Stanford-Binet 5) was undertaken by a trained psychologist. Children received management for their sleep problem as clinically indicated. Results: Forty-two subjects with a median age of 6.8 years (Interquartile Range-IQR 4.5, 9.8) were enrolled. A total of 92% were referred with snoring or symptoms of Obstructive Sleep Apnoea (OSA), with 79% of those referred having had previous ENT surgery. Thus, 85% of all participants underwent a sleep study and 61% were diagnosed with OSA (OAHI ≥ 1/h). Based on questionnaires, 86% of respondents indicated that their child had a significant sleep disorder and non-respiratory sleep problems were common. Non-respiratory problems included: trouble going to sleep independently (45%), restless sleep (76%), night-time waking (24%) and bedtime resistance (22%). No significant correlations were found between sleep measures (behavioural and medical sleep problems) and the behavioural, functional or cognitive parameters. Conclusion: Sleep disorders were very common, especially non-respiratory sleep problems. OSA was common despite previous surgery. No association was found between sleep-related problems (snoring, sleep-study-confirmed OSA or non-respiratory sleep problem) and parent-reported behavioural problems, functional impairments or intellectual performance. This may reflect limitations of the measures used in this study, that in this population ongoing problems with daytime function are not sleep related or that a cross-sectional assessment does not adequately take into account the impacts of past disease/treatments. Further research is required to further evaluate the tools used to evaluate sleep disorders, the impact of those disorder on children with Down syndrome and interventions which improve both sleep and daytime function.

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The impact of sleep problems on functional and cognitive outcomes in children with Down syndrome: a review of the literature

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8630 ◽

2020 ◽

Vol 16 (10) ◽

pp. 1785-1795 ◽

Cited By ~ 1

Author(s):

Jasneek K. Chawla ◽

Scott Burgess ◽

Helen Heussler

Keyword(s):

Down Syndrome ◽

Sleep Problems ◽

Cognitive Outcomes ◽

Review Of The Literature ◽

Children With Down Syndrome ◽

The Impact

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Impact of methylphenıdate and atomoxetıne on sleep ın chıldren wıth ADHD

The Journal of Medical Research ◽

10.31254/jmr.2020.6509 ◽

2020 ◽

Vol 6 (5) ◽

pp. 216-218

Author(s):

Elif Gokce ERSOY SIMSEK ◽

◽

Saniye Tulin FIDAN ◽

Keyword(s):

Sleep Disorders ◽

Sleep Problem ◽

Sleep Problems ◽

Inpatient Service ◽

Sleep Habits ◽

Time Duration ◽

Children With Adhd ◽

Falling Asleep ◽

Child Psychiatric ◽

Significant Difference

Aim: Our purpose in this study is to determine the effects of methylphenidate and atomoxetine on the sleep of children with attention-deficit/hyperactivity disorder (ADHD). Methods: Eighty-one children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which 42 subjects received extended release methylphenidate, and 39 subjects received atomoxetine only one dose in the morning daily at least for 6 months. Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL) and Child Sleep Habits Survey (CSHS) were applied to all children. Results: There was a sleep problem in 81% (n = 34) of the patients using methylphenidate and 89.7% (n=35) of the group using atomoxetine. When we evaluated according to the CSHS cut-off score, whether having a sleep problem or sleep problems, and there was no statistically significant difference between the two groups (p> 0.05). We are not able to find significant difference between two groups in terms of bedtime resistance, sleep duration, sleep anxiety, night awakenings, parasomnia, sleep-breathing problems, and daytime sleepiness subtest and total sleep scores (p> 0.05). There was a significant difference in sub-test of the falling asleep duration. It was found that the methylphenidate group had a longer falling asleep time duration(p <0.05). Discussion: Sleep-related complaints in children diagnosed with ADHD are not uncommon in clinical practice. It is known that 25-55% of children with ADHD often report various sleep problems and in addition, more sleep problems are reported by their parents. In our study, when the total scores of CSHS filled by the family were evaluated, this rate was found to be 85%. There was no difference in the frequency of sleep problems between the group using methylphenidate and the group using atomoxetine. In our study, there was significant difference between the group using methylphenidate and the group using atomoxetine in terms of delay in falling asleep. In many studies based on both objective and subjective measurements, psychostimulant drugs have been reported to be associated with difficulty falling asleep and prolonged sleep latency. Sleep disorders are common in ADHD. It is important that child and adolescents with ADHD must be evaluated the sleep habits before medical treatment to identify the etiology of sleep disorders.

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611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome

SLEEP ◽

10.1093/sleep/zsab072.609 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A240-A240

Author(s):

Nisha Patel ◽

Timothy Morgenthaler ◽

Julie Baughn

Keyword(s):

Down Syndrome ◽

Sleep Disorders ◽

Screening Tools ◽

Treatment Needs ◽

Cross Sectional Survey ◽

Periodic Limb Movement Disorder ◽

Cross Sectional ◽

Children With Down Syndrome ◽

Obstructive Sleep ◽

Respiratory Sleep Disorders

Abstract Introduction Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS. Methods A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded. Results 94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis. Conclusion Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs. Support (if any):

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The impact of developmental behavioral pediatrics in a population of children with Down syndrome

Journal of Pediatric Nursing ◽

10.1016/j.pedn.2020.10.019 ◽

2021 ◽

Vol 57 ◽

pp. 38-42

Author(s):

Daphna Shaw ◽

Sari Bar ◽

Jane Dimmitt Champion

Keyword(s):

Down Syndrome ◽

Children With Down Syndrome ◽

Behavioral Pediatrics ◽

The Impact

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Sleep problems and temperament in young children with Down syndrome and typically developing controls

Journal of Intellectual Disability Research ◽

10.1111/jir.12321 ◽

2016 ◽

Vol 61 (3) ◽

pp. 221-232 ◽

Cited By ~ 12

Author(s):

A. F. Lukowski ◽

H. M. Milojevich

Keyword(s):

Down Syndrome ◽

Young Children ◽

Sleep Problems ◽

Typically Developing ◽

Children With Down Syndrome

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Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315064 ◽

2018 ◽

Vol 104 (3) ◽

pp. 275-279 ◽

Cited By ~ 4

Author(s):

Magnus von Lukowicz ◽

Nina Herzog ◽

Sebastian Ruthardt ◽

Mirja Quante ◽

Gabriele Iven ◽

...

Keyword(s):

Down Syndrome ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Marginal Effect ◽

Sleep Study ◽

Desaturation Index ◽

Intensive Training ◽

Children With Down Syndrome ◽

Training Camp ◽

Obstructive Sleep

BackgroundObstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS.Patients and methodsForty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir).ResultsEighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05).ConclusionThe 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.

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A Good Night’s Sleep: Learning About Sleep From Autistic Adolescents’ Personal Accounts

Frontiers in Psychology ◽

10.3389/fpsyg.2020.583868 ◽

2020 ◽

Vol 11 ◽

Author(s):

Georgia Pavlopoulou

Keyword(s):

Sleep Problems ◽

Sleep Hygiene ◽

Physical Activities ◽

Photo Elicitation ◽

Personal Factors ◽

Sleep Habits ◽

Night Time ◽

Sleep Study ◽

Autistic People ◽

Personal Accounts

BackgroundSleep is a strong predictor of quality of life and has been related to cognitive and behavioral functioning. However, research has shown that most autistic people experience sleep problems throughout their life. The most common sleep problems include sleep onset delay, frequent night-time wakings and shorter total sleep time. Despite the importance of sleep on many domains, it is still unclear from first-hand accounts what helps autistic people to sleep. The purpose of this study is to explore together with autistic adolescents their sleep-related practices before bedtime and during the day which contribute to a good night’s sleep.MethodsFifty-four autistic adolescents collaborated with an academic researcher in a novel adapted photo-elicitation methodology, rooted in a Lifeworld framework. The adolescents were invited to collect and analyze their data. The data were also presented in a community knowledge exchange event.ResultsSeveral self-reported practices that facilitate better nocturnal sleep were identified. Those were organized into two thematics: Evening/bedtime factors and Day time factors. These included practices such as personalized sensory and relaxation tools before bed and during night-time, engaging in a range of physical activities during daytime and accommodating personal time to engage with highly preferred and intense focus activities and hobbies. It also included spending time in predictable and fun ways with family members before bedtime.ConclusionThis is the first time that a study uses a novel methodological approach based on personal accounts elicited by photos rooted in a Lifeworld framework to describe personal sleep-related practices before bedtime and during the day to identify a “good night of sleep” in autistic adolescents. The outcomes from the current study showed that sleep facilitating factors are in a direct contrast to the sleep hygiene recommendations. Therefore, it is thus important for the sleep practitioners and healthcare providers to move beyond providing standardized sleep hygiene interventions. A Lifeworld led care model that pays attention to personal experiences, promotes sense of agency, evaluates both autism-specific strengths and struggles could and should complement biomedical approaches.Lay SummaryThis is the first study to examine autistic adolescents’ self-reported sleep habits and factors which facilitate autistic adolescents’ sleep by employing adapted photo-elicitation interviews. This study is innovative in at least three ways. First, it examines the factors that may facilitate a good night’s sleep through personal accounts of autistic adolescents. Second, this is the first sleep study to adopt a collaborative, flexible approach to understanding positive sleep factors in the lives of autistic adolescents. This study employed a personalized approach into collecting, categorizing, coding, and analyzing qualitative data allowing autistic adolescents and the researcher to work together across key stages of data collection and data analysis. Third, we adopted a theoretical framework that allows us to consider autistic adolescents in both agency and vulnerability positions when it comes to their sleep difficulties. Our results highlight that sleep should be treated individually and in relation to the environmental and personal factors that affect each autistic person. Hence, researchers and professionals may benefit from working collaboratively with autistic adolescents with the aim to identify individual strengths and adopt a positive narrative around sleep. Furthermore, it is important to further examine both the daytime and evening factors that may affect bedtime and the quality and quantity of sleep as well as the role of intense focused interests and physical activities that cultivate positive feelings and help autistic people to relax before bedtime.

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