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Relationship between sleep, sleep apnea, and neuropsychological function in children with Down syndrome
Lee J Brooks1, Molly N Olsen, Ann Mary Bacevice
1Division of Pulmonary Medicine, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA, brooksl@email.chop.edu.
Insights
Sleep disordered breathing (SDB) is common in children with Down syndrome but not a primary cause of cognitive deficits. However, improving sleep quality, particularly slow-wave sleep, and treating SDB can enhance attention and cognitive function.
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- Down syndrome is associated with cognitive impairments.
- Sleep disordered breathing (SDB) is prevalent in children with Down syndrome.
- The impact of SDB on neuropsychological deficits in this population requires further investigation.
Purpose of the Study:
- To investigate the relationship between sleep, SDB, and neuropsychological deficits in children with Down syndrome.
- To determine if treating SDB improves cognitive function in these patients.
Main Methods:
- A cohort study involving 25 children with Down syndrome.
- Utilized polysomnography (PSG) and Multiple Sleep Latency Testing (MSLT).
- Administered comprehensive neuropsychological tests before and after SDB treatment.
Main Results:
- No direct link found between SDB and baseline neuropsychological deficits.
- Total sleep time and slow-wave sleep correlated with cognitive ability, comprehension, achievement, and adaptive behavior.
- Successful SDB treatment led to improvements in attention and adaptive behaviors.
Conclusions:
- SDB is not the primary driver of cognitive deficits in Down syndrome.
- Sleep quantity and quality, especially slow-wave sleep, are crucial for cognitive function.
- Treatment of SDB shows potential to improve attention in children with Down syndrome.
Purpose:
To determine whether sleep and sleep disordered breathing (SDB) contribute to the neuropsychological deficits of patients with Down syndrome, and whether treatment of SDB results in improvement in cognitive function.
Methods:
In this cohort study, 25 children with Down syndrome underwent overnight polysomnography (PSG), Multiple Sleep Latency Testing (MSLT), and a battery of neuropsychological tests. Patients with SDB underwent a follow up PSG after treatment. All patients repeated the neuropsychological tests 13 months later.
Results:
At baseline, there was no relationship between SDB and performance on the neuropsychological tests. However, total sleep time and sleep latency were related to tests of cognitive ability (p < 0.05) and comprehension (p < 0.01). The amount of time in slow-wave sleep correlated with tests of achievement (p < 0.01), and adaptive behavior (p < 0.01). Ten patients had SDB confirmed on PSG. Five of these patients were treated successfully with adenotonsillectomy and/or continuous positive airway pressure. The five who did not tolerate treatment were deficient in tests of adaptive behavior (Vineland p < 0.05) visual-motor integration (Beery p < 0.01) and achievement (Woodcock-Johnson p < 0.05) compared to those successfully treated. After treatment the patients improved in ratings of attention (Conners p < 0.05).
Conclusions:
Although SDB is common in children with Down syndrome, it is not a major contributor to their cognitive deficits. Cognitive function is related to the amount of sleep and particularly slow wave sleep. Successful treatment of SDB may improve their attention.
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