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

Abstract

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.

Follow‐up of children with Down syndrome and sleep disordered breathing and the effects of treatment on actigraphically recorded sleep, quality of life, behaviour, and daytime functioning

“…We identified that daytime sleepiness as assessed by the ESS‐CHAD, behaviour as assessed by the CBCL, or daily functioning skills as assessed by the ABAS‐II did not change in either group at follow‐up. Our findings are supported by a previous study that also reported no association between sleep problems (snoring, sleep study confirmed OSA, or non‐respiratory sleep problems) and parent reported behavioural problems assessed by the CBCL, functional impairments assessed by the Life Habits Questionnaire or intellectual performance assessed by the Stanford‐Binet Intelligence Scales in children with DS (Chawla et al, 2021). Additionally, actigraphic sleep parameters assessing sleep duration and quality have been found to be not related to cognitive task performance in children with DS, whereas they were in typically developing children (Ashworth et al, 2015).…”

“…We also assessed aspects of daytime behaviour and functioning with parental questionnaires. We identified that daytime sleepiness as Scales in children with DS (Chawla et al, 2021). Additionally, actigraphic sleep parameters assessing sleep duration and quality have been found to be not related to cognitive task performance in children with DS, whereas they were in typically developing children (Ashworth et al, 2015).…”

Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review

“…Other significant associations were also reported in the accomplishment of responsibilities, relationships, community life, school, mealtimes, fitness and personal care (Churchill et al, 2015). However, Chawla, Bernard, et al (2021) found no relationship between sleep and cognition, functional ability or behaviour. Suggesting that these problems are not solely driven by sleep issues, with confounding variables such as physical problems and pain potentially affecting both sleep and behaviour (Chow et al, 2020; Esbensen et al, 2021).…”

Sleep and behavioral problems in preschool-age children with Down syndrome

“…In spite of the crucial role of sleep in pediatric age, especially for population with DS, very few studies specifically investigated the distribution of sleep difficulties and their behavioral correlates in preschool-age children with DS. On the other hand, the studies that investigated sleep problems in preschoolers with DS included wide age ranges ( Levanon et al, 1999 ; Carter et al, 2009 ; Nisbet et al, 2014 ; Bassell et al, 2015 ; Anand et al, 2021 ; Chawla et al, 2021 ; Fucà et al, 2021 ; Kose et al, 2021 ). Moreover, studies focusing on preschoolers with DS were conducted on small sample sizes ( Edgin et al, 2015 ; Joyce and Dimitriou, 2017 ; D’Souza et al, 2020 ; Lukowski et al, 2020 ; Arias-Trejo et al, 2021 ).…”