Sleep Concerns in Children with Down Syndrome
Sleep, behavior and mental health are all intimately related and can influence each other. The relationship between sleep and behavior is complex and causality runs in both directions. Children with Down syndrome (DS) who have high levels of activity or anxiety may display difficult behavior with bedtime routines. Such children are more likely to have insomnia and problems initiating and/or maintaining consistently restful or restorative sleep. In turn, poor quality sleep can exacerbate existing problems with attention, learning and daytime behavior control. Even in those children without pre-existing behavior concerns, the onset of new medical conditions may result in poor sleep and daytime behavior concerns. Working to promote consistently good sleep habits (sleep hygiene) is an important and practical goal.
Are there physical reasons why children with Down syndrome are more likely to have sleep disordered breathing?
Yes, there are many reasons why children with DS may have sleep disordered breathing or sleep apnea.
Several factors contribute to sleep apnea in children with Down syndrome
- Narrowing and collapse of the upper airway resulting in obstructed breathing with respiratory pauses or apnea, during sleep.
- A small oral cavity with a relatively enlarged tongue and low tone of airway muscles are common to most children with DS.
- Apnea may become worse due to enlarged tonsils or adenoids, nasal or sinus congestion, poorly controlled asthma or gastroesophogeal reflux.
- Having more than a single airway factor with or without overweight increases the severity of OSA.
- Symptoms of obstructive sleep apnea (OSA) often include snoring, restless sleep, unusual sleep position, excessive mouth breathing, daytime tiredness, or behavioral changes such as irritability, inattention, and poor impulse control.
- Even children who have undergone previous tonsil or adenoid removal may have persistent OSA.
How common are sleep disturbances in children with Down syndrome?
There is a 50-100% incidence of OSA in children with DS, with almost 60% of children having an abnormal sleep studies by age 3-4 years. The incidence of OSA increases as children grow older. In one study >95% of children with DS between 1-19 years, who snored had OSA. Unfortunately, the ability to predict OSA in children based on parent observation is not always reliable, except in severe cases. A sleep study or polysomnogram (PSG) remains the gold standard test from which to evaluate sleep disorders and OSA. The American Academy of Pediatrics Health Supervision for children with Down Syndrome (2011) now recommends PSG by age 4-5 years for all children with DS
Are there neurological factors that can cause sleep disturbances in Down Syndrome?
Some children may have an underlying predisposition for limb movements or restless sleep with frequent arousals or awakenings resulting in fragmentation of sleep even in the absence of OSA. These phenomena likely reflect problems with neurochemical signaling during the orchestration of sleep-phase cycling throughout the night. Frequent sleep arousals often results in a lack of restorative sleep for the child, and/or frequent awakening of the parents and other family members.
Can sleep apnea or other sleep disorders be improved in children with Down syndrome?
Yes, addressing any underlying medical or health-related concerns is paramount to achieving quality sleep