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

Jasneek K Chawla^1,2, Anne Bernard³, Helen Heussler¹

¹Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD 4101, Australia.

|October 23, 2021

Insights

Sleep disorders are highly prevalent in children with Down syndrome, particularly non-respiratory issues. Obstructive Sleep Apnoea (OSA) remains common, yet sleep problems showed no correlation with behavior, function, or cognition in this study.

Area of Science:

Pediatric Sleep Medicine
Genetics and Developmental Disorders

Background:

Children with Down syndrome (DS) frequently experience sleep disturbances.
Understanding these sleep problems is crucial for improving overall health and development in this population.

Purpose of the Study:

To characterize sleep issues in children with DS attending a specialized sleep clinic.
To investigate the relationship between sleep problems, behavior, daily function, and cognitive abilities in children with DS.

Main Methods:

Data collected from 42 children with DS (aged 3-18) using validated questionnaires (sleep, behavior, function).
Cognitive assessment performed using the Stanford-Binet 5.
Sleep studies conducted as clinically indicated.

Main Results:

86% of participants had significant sleep disorders, with non-respiratory problems being common (e.g., difficulty falling asleep, restless sleep).
Obstructive Sleep Apnoea (OSA) was diagnosed in 61% of participants, even after prior ENT surgery.
No significant correlations were found between sleep measures and behavioral, functional, or cognitive parameters.

Conclusions:

Sleep disorders, especially non-respiratory ones, are very common in children with Down syndrome.
OSA prevalence remains high despite previous surgeries, indicating complex underlying factors.
The lack of association between sleep problems and daytime function/cognition may suggest limitations in assessment tools or study design, warranting further research.

Read full analysis

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.

Keywords:

Down syndrome outcomes paediatric sleep

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