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.

COGNITIVE BEHAVIORAL THERAPY: A WAY TOWARDS SOUND SLEEP

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. Insomnia is a frequent sleep problem that interferes with daily activities. It may play a role in the development of co-morbid conditions such as arterial hypertension. Many types of research, however, imply that CBT is a superior therapy with a better long-term effect. In this descriptive analysis, we retrospect the literature concerning CBT and insomnia. To retrospect the literature focusing on CBT and Sleep Quality. We searched the databases like Google scholar, pub med and Cochrane, and Embase, web of science with keywords (Cognitive behavioral therapy, Sleep quality, insomnia, physical therapy, and physiotherapist). We reviewed 104 articles out of which 25 studies were enrolled. We reviewed abstracts of 102 articles from which we shortlisted 85 articles. 85 articles were analyzed and reviewed in detail out of which 30 are cited in the present review. We found sufficient literature supporting the use of CBT to modify sleep quality or to deal with insomnia. However, there is ambiguity about the execution of this therapy among the clinicians. The literature focusing on the exact execution of CBT is needed which will make the clinicians incorporate this treatment in their day-to-day practice and benefit the patients.

The Experiences and Determinants of Sleep Problems of Immigrant and Canadian-Born Older Adults—Analysis of Canadian Longitudinal Study on Aging Baseline Data

Background Although prevalent, limited knowledge is available on the experience of sleep problems (i.e., disturbance in sleep latency and in sleep maintenance) and their determinants in immigrant older adults. Purpose To compare immigrant and Canadian-born older adults’ experiences of: 1) sleep problems, 2) determinants of sleep problems, categorized into precipitating and perpetuating factors, and 3) determinants most significantly contributing to each sleep problem. Methods Baseline data obtained by the comprehensive cohort of the Canadian Longitudinal Study on Aging were analyzed. Participants 55+ years of age and with complete data on their country of birth comprised the sample, with 18,245 Canadian-born and 4,257 immigrant older adults. Single or multiple items were used to assess the precipitating (chronic condition, sleep disorders, pain, depressive symptoms, psychological distress, education, marital and socio-economic status) and perpetuating (smoking, alcohol consumption, physical activity) factors. Chi-square test and independent sample t-test were used in the comparison and multiple regression was applied to determine the most significant determinant of each sleep problem in each group of older adults. Results Despite differences in a few determinants of sleep problems, the set of factors contributing to disturbance in sleep latency and maintenance was comparable for Canadian-born and immigrant older adults, and included: having a sleep disorder and high level of depressive symptoms and psychological distress. Conclusion The findings highlight the importance of public health campaigns to increase older adults’ awareness of sleep problems, the factors that may contribute to disturbance in sleep, and strategies to prevent and/or manage sleep problems.

Prevalence of different sleep problems in patients with respiratory diseases presented to a respiratory outdoor clinic: A Descriptive analysis

Introduction: A patient with compromised respiratory system due to some diseases, may have disturbed sleep to a great extent. It has been proved in various community based epidemiologic studies. Though most of such studies available had concentrated on single respiratory disease like COPD or Asthma in the community. But such studies are hardly available for patients attending a respiratory clinic, where all respiratory ailments were evaluated with concurrent sleep problems. The present study is one such. Methods: Total 163 patients were screened and among them 100 were selected as the study group. The patients were enquired with a standard questionnaire provided to them. In addition, they were given seperate questionnaire as STOP BANG, Insomnia Severity Index Score, RLS questionnaire . Those persons with STOP BANG > 5, were also advised for a Polysomnography (PSG) , if not already done. Descriptive statistical analysis has been carried out in the present study. Results: The present study is a cross-sectional depiction of relationships between various respiratory diseases and sleep problems. As per this study, most patients were asthmatic and commonest sleep problem was OSA. A subgroup analysis was done to determine the significance of difference of various parameters between the three groups of asthmatic patients, patients having COPD and the 'Other' group. Discussion: Subjective sleep problems were significantly more in Asthma group than COPD group (p<0.0362). The mean STOP BANG was more in COPD group than the Asthma group (p<0.0301). Though OSA was the commonest sleep problem between the three groups, but the prevalence was not statistically significant between them. More patients in the COPD group had insomnia, but it was not statistically significantly more than in Asthma group. Sleeping pill use was significantly more in COPD group than the Asthma group (p<0.0039). Conclusion: Sleep problems are common in patients with respiratory diseases and OSA is the most common problem according to the present study. Asthma patients had more subjective sleep problems. Sleeping pill use is more common in COPD patients instead of having less subjective sleep complaints than asthma patients.

AB0139 RHEUMATOID ARTHRITIS AND SLEEP QUALITY

Background:Consequences of rheumatoid arthritis (RA) are many and varied: physical, psycho-affective and financial.Objectives:The objective of our study is to evaluate the impact of RA on sleep quality.Methods:We conducted a cross-sectional study including 49 RA patients. An evaluation of sleep quality using the MOS-Sleep Scale was performed.Results:The mean age of patients was 54.1 years, with a female predominance (89.8%). The mean duration of RA was 11.43 ± 7.32 years with a mean time to diagnosis of 2.35 years. Rheumatoid factor was positive in 77.6% of cases. A atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. All patients were on symptomatic treatment, 57.1% of whom were on corticosteroid therapy. 83.67% of patients were on cs-DMARDs and 14.2% were on biologics. At inclusion, sleep was optimal in 63.2% of cases and the mean Sleep Problem Index was 26.19 ± 22.77.The index of sleep problems was higher in older subjects and in those with long diagnostic delays. The presence of co-morbidities and atlanto-axial dislocation and/or coxitis was associated with impaired sleep quality. Also, VAS pain and EGP were associated with an increase in the sleep problem index. In the multivariate study, EGP, the presence of co-morbidities and atlanto-axial dislocation and/or coxitis were the independent factors affecting sleep quality.Conclusion:The impact of RA on the patient’s quality of life and especially the quality of sleep is confirmed by several studies in the literature. A global management of the patient is necessary in order to adapt well to his disease.Disclosure of Interests:None declared

The association of sleep problem, dietary habits and physical activity with weight status of adolescents in Nepal

Background Overweight/obesity among adolescents is an emerging public health issue worldwide. However, the evidence on the determinants of body weight status and lifestyle behaviors among Nepalese adolescents is limited. This study aims to explore the sleep characteristics, dietary habits, and physical activity and its association with body mass index (BMI) among Nepalese adolescents. Methods A cross-sectional study was conducted between July and November 2019 among 627 randomly selected adolescents from eight schools located in Kathmandu Metropolitan City, Nepal. A self-administrated structure questionnaire was used to collect the data. Anthropometric measurements (adolescent’s BMI), sleep characteristics, dietary habits, and physical activity were assessed using validated tools. Multinomial logistic regression analyses assessed the association between covariates and BMI categories. The statistical significance was considered at p-value < 0.05 and 95% confidence intervals (CIs). Results The overall prevalence of underweight and overweight/obesity among adolescents was 9.1% (95% CI: 7.1–11.6) and 23.7% (95% CI: 20.6–27.7) respectively. In multinomial logistic regression, adolescents who reported sleep problem compared to those with no such problem (Relative risk ratio (RRR) = 13.37, 95% CI: 7.14–25.05), adolescents who had obstructive sleep apnea (OSA) symptoms (RRR = 3.21, 95% CI:1.31–7.86), who consumed soft drink ≥1 time/day in past 1 months (RRR = 5.44, 95% CI: 2.93–10.10), consumed high-fat dietary ≥2 times/day (RRR = 2.17, 95% CI: 1.18–3.99), and had a habit of junk food consumptions (RRR = 5.71, 95% CI:2.55–12.82), adolescents who had 5–6 h/day sedentary behavior (RRR = 3.21, 95% CI: 1.14–9.09), adolescents from Terai/Madhesi castes (RRR = 2.81, 95% CI: 1.19–6.64) and adolescents whose father was employed (RRR = 2.04, 95% CI: 1.04–3.98) were at increased risk of being overweight/obesity. In contrast, adolescents aged 14–16 years had 71% lower (RRR = 0.29, 95% CI: 0.16–0.52), and adolescents who consumed less than five food groups had 45% lower (RRR = 0.55, 95% CI: 0.31–0.97) risk of being overweight/obesity compared to 12–14 years age groups and consumed more than five food groups respectively. Conclusions The findings of this study warrant immediate interventions to improve the lifestyle to reduce overweight/obesity among Nepalese adolescents. Creating a conducive environment, both at school and home is essential to encourage adolescents for the adoption of healthy lifestyle behaviors.