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Use of Sleep Evaluations and Treatments in Children with Down Syndrome
Anna J Esbensen1, Dean W Beebe, Kelly C Byars
1Divisions of *Developmental and Behavioral Pediatrics; †Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Less than half of children with Down syndrome (DS) receive sleep evaluations, despite high rates of sleep problems. Treatment is consistent with diagnosis, but age and gender influence intervention delivery, highlighting the need for targeted screening and care.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Rare Diseases
Background:
- Sleep disturbances are prevalent in children with Down syndrome (DS).
- Understanding current sleep evaluation and intervention practices is crucial for optimizing care.
Purpose of the Study:
- To characterize practice patterns for sleep evaluation and intervention in children with DS.
- To identify factors associated with sleep study completion and treatment delivery.
Main Methods:
- Retrospective cohort study of 954 children with DS (aged 5-21) using electronic health records (2009-2013).
- Identified sleep problems (obstructive sleep apnea, behavioral disturbances) via ICD-9 codes.
- Assessed outcomes including polysomnography (PSG) and interventions (CPAP, ENT surgery, medication, behavioral therapy).
Main Results:
- 47.7% of children with DS underwent PSG; 39.1% had diagnosed sleep problems.
- 81.2% of diagnosed children received appropriate sleep interventions.
- Age, gender, and race were associated with PSG completion and certain interventions; BMI was linked to obstructive sleep apnea.
Conclusions:
- Less than half of children with DS with sleep issues undergo PSG, indicating a potential gap in evaluation.
- While treatments align with diagnoses, age and gender influence intervention rates, suggesting disparities.
- Emphasizes the need for systematic screening and targeted sleep interventions for children with DS.
Objective:
To characterize practice patterns regarding sleep evaluation and intervention among children with Down syndrome (DS).
Method:
Data were obtained from electronic health records from 2009 to 2013 for a retrospective cohort of 954 children with DS, aged 5 to 21 years during the time sampled. International Classification of Diseases, Ninth Revision, diagnoses were used to identify children with obstructive sleep apnea and/or behavioral sleep disturbances. Primary outcomes were confirmed by participation in an overnight diagnostic polysomnography (PSG) and/or documented provision of specified sleep interventions including positive airway pressure, otolaryngology (ENT) surgery, sleep medication, and behavioral sleep therapy.
Results:
Overall, 47.7% of children with DS had undergone PSG, 39.1% had diagnosed sleep problems, and of those diagnosed with sleep problems, 81.2% had received sleep intervention. Consistent with best practice clinical care, sleep treatments matched the diagnosed sleep problems. Age, gender, and race, but not body mass index (BMI), were associated with PSG completion rate and occurrence rates for ENT surgery and sleep medication usage. BMI was associated with obstructive sleep apnea.
Conclusion:
Despite high rates of reported sleep problems in children with DS, less than half underwent PSG. Children diagnosed with sleep problems received treatment consistent with their sleep diagnosis. However, age and gender were associated with differential rates of treatment delivery that was incongruous with prevalence rates for diagnosed sleep problems. These findings underscore the importance of screening for sleep problems in children with DS, and referring for and providing appropriate targeted sleep interventions.
