Growth-related changes in the influence of obesity on signs suggesting sleep-disordered breathing and sleepiness in young individuals with Down syndrome.
In kids with Down syndrome, high BMI signals sleep-disordered-breathing risk only after age 13, but watch for daytime sleepiness in the 6-9 window.
01Research in Context
What this study did
The team tracked kids and teens with Down syndrome. They asked parents to fill out two short checklists about snoring, gasping, and daytime sleepiness.
They also measured each child's height and weight to get a BMI score. Then they looked to see if heavier kids had more sleep problems at different ages.
What they found
Extra weight predicted sleep-breathing trouble only after age 13. In the 6- to 9-year window, weight did not matter; instead, those young kids simply showed more daytime sleepiness.
The pattern gives two clear age flags: watch younger kids for naps and yawning, watch teens for snoring and long pauses in breathing.
How this fits with other research
Cornacchia et al. (2019) found that four out of five adults with Down syndrome already have obstructive sleep apnea. Takahashi et al. (2023) now show the risk window opens right after early adolescence, tightening the timeline for screening.
Mannion et al. (2024) widen the lens: every child in their survey had sleep problems, and kids with stomach pain showed more self-injury. Together the two surveys tell us to screen both breathing and pain, not just one or the other.
Older work by Doughty et al. (2010) first linked obesity to Down syndrome teens. The new paper keeps the obesity focus but adds the sleep angle, showing WHEN the link kicks in.
Why it matters
You now have a simple age rule. If the client is 6-9, track daytime sleepiness even when BMI is normal. If the client is 13 or older, treat rising BMI as a red flag for overnight sleep study. Add these two checkpoints to your intake form and you will catch sleep-disordered breathing before it hurts learning and behavior.
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02At a glance
03Original abstract
BACKGROUND: Sleep-disordered breathing (SDB) is highly prevalent in individuals with Down syndrome (DS), who cease growing earlier than individuals without DS. These characteristics may be associated with increased obesity and subsequent SDB signs, such as snoring and apnoea or excessive daytime sleepiness (EDS). Thus, we assessed the influence of growth on the association between obesity and SDB signs or EDS; we used questionnaires sent to young individuals with DS and their caregivers, in a cross-sectional study. METHODS: We sent out 2000 questionnaires to individuals with DS and their caregivers. The surveys included questions about SDB signs (witnessed snoring or apnoea), subjective sleeping time including witnessed midnight arousal, the Epworth sleepiness scale and witnessed napping as well as sex, age, body weight and body height. RESULTS: Of the 1222 questionnaires we received, 660 were from young individuals and were included in the analysis. SDB signs were highly prevalent (77.1%), and frequency of SDB signs increased with growth (P-trend: P = 0.02) in individuals with DS. Multivariate analyses showed that EDS (Epworth sleepiness scale > 10 points) was associated with body mass index Z-score (Z-BMI) in the 6-9 years age group (odds ratio [OR] 95% confidence interval [95% CI]: 1.69 [1.09-2.62], P = 0.02). Conversely, SDB signs were associated with Z-BMI in the 13-15 (OR [95% CI]: 1.99 [1.06-3.72], P = 0.03) and 16-18 years age groups (OR [95% CI]: 3.04 [1.22-7.59], P = 0.02). For the 19-21 years age group, SDB signs were associated with only male sex (OR [95% CI]: 7.28 [1.22-43.38], P = 0.03). CONCLUSIONS: This study showed that the association between Z-BMI and SDB or EDS was age dependent. In early school-age children with DS, high Z-BMI could not accurately predict the presence of SDB, but it was associated with EDS. In the pubescent period (i.e. 13-18 years), high Z-BMI was associated with SDB signs but not with EDS. Overall, obesity affected SDB signs and EDS differently based on age in young individuals with DS.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.13079