Behavioural and emotional disturbances associated with sleep-disordered breathing symptomatology in children with Down's syndrome.
In kids with Down syndrome, more snoring and shorter sleep each predict worse behavior—screen and refer for sleep evaluation when behavior spikes.
01Research in Context
What this study did
The team asked parents of the kids with Down syndrome about sleep and behavior.
Parents filled out two checklists: one for snoring, choking, and night-wakings, and one for tantrums, hyperactivity, and anxiety.
The kids were 4 to 15 years old and lived at home.
What they found
More snoring, choking, and night-wakings meant worse behavior scores.
Kids who slept fewer hours also showed more tantrums and restlessness.
The link stayed strong even after the team counted age and sex.
How this fits with other research
Cotton et al. (2006) first showed that sleep problems are common in Down syndrome. The new study adds the key detail: the worse the breathing symptoms, the worse the daytime behavior.
Carter Leno et al. (2021) found the same sleep-behavior link in autism kids. Together, the papers say the pattern holds across different developmental disabilities.
Kurokawa et al. (2021) showed GI pain and sensory issues also raise behavior scores. This means sleep is one of several hidden drivers you should check when behavior spikes.
Why it matters
If a child with Down syndrome suddenly melts down more, ask about snoring, choking, and night-wakings. A quick parent checklist can flag who needs a sleep study. Fixing sleep may cut problem behavior faster than adding another behavior plan.
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02At a glance
03Original abstract
BACKGROUND: Down's syndrome (DS) predisposes to sleep-disordered breathing (SDB). In children with DS, behavioural and emotional disturbances secondary to SDB are often assumed to result from cognitive impairment alone. Our aim was to explore the relationship of behavioural and emotional disturbances with SDB in a population of children with DS. METHODS: A modified sleep questionnaire, Epworth Sleepiness Scale (ESS), Paediatric ESS and the short form of the developmental behaviour checklist (DBC-P24) were sent to 261 carers of children aged 4 to 15 years with DS in 2012. RESULTS: Of 120 participants, 25% had probable SDB. In children with probable SDB compared to those without nocturnal symptoms, the total behaviour problem score (TBPS) was significantly higher (20.3 ± 8.6/48 vs. 12 ± 7.5/48; P = 0.002) as was the PaedESS (7.7 ± 5.6/24 vs. 2.8 ± 3.5/24; P = 0.002). For every increase in frequency of choking attacks, snoring and night awakenings, the TBPS increased by 1.37, 1.28 and 1.75 points, respectively, indicating worsening behaviour. The TBPS was found to decrease by 1.31 points for every hour more of self-reported sleep duration (r = -0.25, P = 0.017). CONCLUSIONS: SDB symptoms and shorter self-reported sleep duration are highly prevalent among children with DS and are independently associated with worsening behaviour using the TBPS.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12765