Evaluation of behavioural outcomes in children with down syndrome and co-existing sleep problems

Abstract

Introduction: It is now well recognized that poor sleep has a negative impact on behaviour and cognition in typically developing children (TD). Children with Down syndrome (DS) have an increased risk of sleep disorders compared to typically developing (TD) children. For example, the prevalence of OSA is estimated at 45-79% in children with DS compared to 1-5% in the general paediatric population. Small cross-sectional studies have found difference in IQ, cognitive function and accomplishment of daily activities in children with DS and comorbid OSA compared to those without OSA. To our knowledge no studies have evaluated the impact of co-existing sleep problems on behaviour in children with DS. Materials and methods: As part of a larger prospective longitudinal cohort study we examined the behavioural profiles of children with DS aged 3-16yrs attending a tertiary sleep clinic for assessment and management of a sleep complaint. Parents of participants completed the abbreviated Child Sleep Habit's Questionnaire (CSHQ) to provide a measure of sleep difficulties and the Child Behaviour Checklist (CBCL) for behavioural evaluation. This was undertaken at baseline with a plan to repeat at 6 and 12 months and following any specific sleep intervention (e.g. adenotonsillectomy, CPAP commencement). Results: Preliminary data is available for 15 of the 30 currently recruited patients (Male =9). Mean age of patients was 7.75 yr (3.16-16.36 yr) and BMI 19.72 kg/m2 (15.70-26.90 kg/m2). CSHQ was indicative of a sleep problem (defined as score>41/110) in all patients with a mean score of 56 (42-72). Mean total CBCL scale rawscorewas 41.5 (20-72) with mean raw score for internalizing problems of 7.1 (2-11) and externalizing problems 11 (1-33) respectively. Children scored highest in the subscales of “attention problems”, “aggressive behaviour” and “other problems” Conclusions: Our preliminary results suggest that children with DS and co-existing sleep problems score high for problem behaviours assessed through the CBCL parent questionnaire. Van Gameren-Oosterom et al. have published data on a population based sample of eight-year-old children with DS and found a mean CBCL score of 30.08 ±18.06 in this group. They also showed a higher score for externalizing problems (mean 8.73 ± 6.84) than internalizing problems (4.71 ± 4.55) and showed peak scores in the “attention problems” and “aggressive behaviour” subscales. Although our population is not directly comparable due to a wider age range, our total mean score is 10 points higher, with our subscales showing similar trends. We hypothesise that children with Down syndrome and sleep difficulties will have more behavioural challenges than both their typically developing peers of the same developmental age and their Downs syndrome peers.L6207881022018-02-27 <br />