Behavioural problems, functional ability and cognitive function in children with down syndrome and sleep problems

Abstract

Introduction: Large inter-individual differences are seen within the Down syndrome (DS) population and numerous factors are thought to play a role in how the DS phenotype expresses itself in each individual. Variation in sleep pattern and sleep disruption has been proposed to contribute to these inter-individual differences. The aim of this study is to describe the behavioural, functional and cognitive characteristics in children with DS and sleep problems attending a tertiary clinic pre and post management for their sleep problems. Materials and methods: A prospective longitudinal cohort study is underway at our centre involving children with DS aged 3-16yrs attending the paediatric sleep medicine clinic for evaluation and management of sleep problems. Participants and their families complete a series of assessments at baseline, 6 and 12 months post recruitment. These assessments include the Child Sleep Habits Questionnaire (CSHQ), Child Behaviour Checklist (CBCL), Life-Habits Questionnaire (Life-H) and Stanford Binet-5 (SB-5) Cognitive assessment (undertaken by a trained psychologist).Demographic, medical history and any sleep study data is also collected from the patients electronic medical record. The timing of any clinical management interventions, such as adenotonsillectomy, CPAP initiation, Melatonin prescription, are recorded through the longitudinal follow up in order to evaluate the impact of these treatments on the functional outcomes measured. Results: 42 children with Down syndrome participated in this study with a median age of median age of 6.91 years (IQ 5.07) and median BMI of 17.4kg/m2 (IQ 5.52). At recruitment, median CSHQ total score was 52.5 (16.0), in keeping with a high proportion of sleep problems in this referred population. Children scored highest in the bedtime and sleep behaviour sub-scores of the CHSQ. Median total Life-H score was 4.38 (1.69), with a slight decrease seen with age. Overall patients scored highest in the “Interpersonal Relationships” sub-score. 36% of participants had a CBCL score which fell in the clinical concern or borderline clinical concern range (>65 or >60 respectively). Children scored highest in the social, thought and attention problem sub-domains. Median SB-5 scores were between 50-60 for all subdomains, with non-verbal IQ scores higher than verbal IQ scores (52.5 vs 50.0). Children's scores generally fell in the lower than average range with the majority in the mild (55-69) or moderately impaired (40-54) ranges. At baseline, no significant correlation was seen between sleep measures and functional, behavioural or cognitive parameters. 6-month follow- up data analysis is currently in progress and will also be presented. Conclusions: This study provides one of the first descriptions of sleep, functional ability, behaviour and cognitive function in a referred sample of children with DS and sleep problems. The longitudinal follow-up underway in our study will hopefully increase our understanding of any potential relationship between sleep and functional outcomes and will evaluate the change in ability post sleep interventions. The importance of this is that sleep may be one of the few treatable factors that can impact the progressive phenotype in individuals with DS, leading to improvements in overall independent ability. Acknowledgements: Resmed/Sleep Health Foundation/ RACP Research Entry Scholarship 2017.L20042315372019-12-18 <br />