Sleep Problems and Clinical Severity in Rett Syndrome

Rett syndrome is a neurodevelopmental disorder that primarily affects females and is often associated with sleep problems. To date, few studies have examined how sleep problems correspond to aspects of clinical severity in Rett syndrome. In this study, we examined how sleep architecture and sleep-disordered breathing correspond to psychometrically validated outcome measures that are being used in clinical trials. Thirteen participants (mean [M] = 5.96 years, standard deviation [SD] = 2.6), all with confirmed pathogenic variants in MECP2, were enrolled. Participants underwent polysomnography and formal clinical assessments. Six of thirteen participants had obstructive sleep apnea, which was worse during rapid eye movement (REM) sleep with associated hypoxemia and disruptions in sleep architecture. Decreased REM sleep time significantly correlated with higher overall clinical severity (r = -.57; P = .04), lower functional skills (r = -.56; P = .04), and lower social skills (r = -.57; P = .04) using the Revised Motor Behavioral Inventory. Results of t tests revealed that those with obstructive sleep apnea had significantly increased wake time. Those with obstructive sleep apnea also had more behavioral difficulties (higher anxiety, mood disturbance) as captured using the Rett Syndrome Behavior Questionnaire. Taken together, the results of this study show that reduced REM sleep is very common in Rett syndrome and is associated with more impairments in functional and social skills. Obstructive sleep apnea is also very common, and is associated with changes to sleep architecture, higher anxiety, and more mood disturbances. This suggests that providers should routinely screen for sleep problems and implement interventions that can positively impact the quality of life of individuals with Rett syndrome and their families.