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Published on: December 6, 2016
Association of Sleep Apnea With Development and Behavior in Down Syndrome: A Prospective Clinical and
Vaishakh Anand1, Garima Shukla2, Neerja Gupta1
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Children with Down syndrome and sleep apnea experience more behavioral issues and developmental delays. Increased severity of obstructive sleep apnea (OSA) correlates with poorer outcomes in these children.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Developmental Pediatrics
Background:
- Sleep-disordered breathing (SDB) is common in children with Down syndrome.
- Limited research exists on SDB's impact on development and behavior in this population.
- This study investigates the link between sleep apnea severity and neurodevelopmental outcomes in Down syndrome.
Purpose of the Study:
- To assess the relationship between obstructive sleep apnea (OSA) severity and developmental quotient (DQ) in children with Down syndrome.
- To examine the association between OSA severity and behavioral abnormalities using the Child Behavior Checklist (CBCL).
- To determine if OSA is an independent predictor of developmental and behavioral outcomes in this cohort.
Main Methods:
- A prospective, cross-sectional study involving 53 children with Down syndrome (ages 3-11.8 years).
- Overnight polysomnography was used to diagnose and quantify sleep-disordered breathing, measured by the Apnea-Hypopnea Index (AHI).
- Behavioral assessments utilized the CBCL, and developmental status was evaluated using the Developmental Profile 3 (DQ). Spearman rank correlation and multiple linear regression were employed for analysis.
Main Results:
- A high prevalence of obstructive sleep apnea (OSA) was observed, with 96% of participants diagnosed.
- Significant positive correlations were found between AHI and CBCL scores across age groups, indicating more behavioral issues with increased OSA severity.
- A significant negative correlation was found between AHI and DQ, suggesting poorer development with more severe OSA.
Conclusions:
- Obstructive sleep apnea (OSA) significantly impacts development and behavior in children with Down syndrome, mirroring findings in typically developing children.
- Increasing OSA severity is independently associated with more pronounced behavioral abnormalities, including attention deficit and hyperactivity.
- Poorer developmental scores are also linked to increased OSA severity in children with Down syndrome, highlighting the need for sleep screening.
Background:
The prevalence of sleep-disordered breathing is high in children with Down syndrome. Although the association between sleep-disordered breathing and developmental delay and behavioral abnormalities are proven among typically developing children, there are few such studies of children with Down syndrome. This study assesses the relationship between the severity of sleep apnea and development and behavioral abnormalities in individuals with Down syndrome.
Methods:
In a cross-sectional prospective study, 53 children with Down syndrome were assessed for sleep-disordered breathing by overnight polysomnography. Behavior was assessed using Child Behavior Checklist (CBCL) and developmental quotient (DQ) using Developmental Profile 3. The association between various domains of behavior and development with the Apnea-Hypopnea Index (AHI) was assessed using Spearman rank correlation. Multiple linear regression assessed the independent effects of various factors on development and behavior.
Results:
Of 53 subjects (three to 11.8 years), 51 (96%) were found to have obstructive sleep apnea (OSA). In both three to five year and six to 12 year age groups, there was a statistically significant positive correlation between the CBCL scores and the AHI (rho = 0.77 and 0.83, respectively). There was a statistically significant negative correlation between the DQ and the AHI (rho = -0.62). In multiple linear regression, AHI was the only independent variable that was associated with CBCL and DQ.
Conclusions:
This study provides robust evidence that OSA can negatively influence the development and behavior in children with Down syndrome as in typically developing children. Moreover, with increasing severity of OSA, children with Down syndrome have more behavioral abnormalities, especially attention deficit and hyperactivity, and also have poorer development scores.
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