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O'Sullivan R, Bissell S, Agar G, Spiller J, Surtees A, Heald M, Clarkson E, Khan A, Oliver C, Bagshaw AP, Richards C. Exploring an objective measure of overactivity in children with rare genetic syndromes. J Neurodev Disord 2024; 16:18. [PMID: 38637764 PMCID: PMC11025271 DOI: 10.1186/s11689-024-09535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates. METHODS A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes. RESULTS M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex. DISCUSSION These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.
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Affiliation(s)
- Rory O'Sullivan
- School of Psychology, University of Birmingham, Birmingham, UK.
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Georgie Agar
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Jayne Spiller
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Andrew Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Mary Heald
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK
| | | | - Aamina Khan
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | | | - Andrew P Bagshaw
- School of Psychology, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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Browne EG, King JR, Surtees ADR. Sleep in people with and without intellectual disabilities: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:1-22. [PMID: 37857569 DOI: 10.1111/jir.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sleep problems are regularly reported in people with intellectual disabilities. Recent years have seen a substantial increase in studies comparing sleep in people with intellectual disabilities to control participants, with an increase in the use of validated, objective measures. Emerging patterns of differences in sleep time and sleep quality warrant pooled investigation. METHODS A systematic search was conducted across three databases (Ovid Embase, PsycInfo and Medline) and returned all papers comparing sleep in people with intellectual disabilities to a control group, published since the last meta-analysis on the topic. A quality framework was employed to rate the risk of bias across studies. Separate meta-analyses of sleep duration and sleep quality were conducted. Subgrouping compared findings for those studies with participants with genetic syndromes or neurodevelopmental conditions and those with heterogeneous intellectual disability. RESULTS Thirteen new papers were identified and combined with those from the previous meta-analysis to provide 34 papers in total. Quality of studies was generally rated highly, though sampling provided risk of bias and adaptive functioning was rarely measured. People with intellectual disability associated with genetic syndromes or neurodevelopmental conditions sleep for shorter time periods (standardised mean difference = .26) and experience worse sleep quality (standardised mean difference = .68) than their peers. People with intellectual disability of heterogeneous origin show no difference in sleep time but have poorer sleep quality. There was some evidence that age moderated these effects. CONCLUSIONS People with intellectual disability have poorer sleep than those without. Subtle patterns suggest that aetiology of intellectual disability moderates the topography of these difficulties, with further work needed to differentiate common and distinct mechanisms across groups.
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Affiliation(s)
- E G Browne
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J R King
- School of Psychology, University of Birmingham, Birmingham, UK
| | - A D R Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
- Division of Mental Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Alam MK, Alsharari AHL, Shayeb MAL, Elfadil S, Cervino G, Minervini G. Prevalence of bruxism in down syndrome patients: A systematic review and meta-analysis. J Oral Rehabil 2023; 50:1498-1507. [PMID: 37507203 DOI: 10.1111/joor.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Bruxism is a parafunctional activity characterised by grinding or clenching of teeth and is a common oral health concern in individuals with down syndrome (DS). Understanding the prevalence of bruxism in this population is crucial for developing effective management strategies. This systematic review and meta-analysis is aimed to investigate the prevalence of bruxism among individuals with DS and explore its association with other oral health issues. METHODS A comprehensive search was conducted across multiple electronic databases to identify relevant studies. Cross-sectional and observational studies were included. Data on bruxism prevalence and associated factors were extracted, and a meta-analysis was performed using both fixed-effects (FE) and random-effects (RE) models of MedCalc software. Heterogeneity among studies was assessed using I2 statistics. New Castle-Ottawa Scale was used to evaluate methodological quality of the included studies. RESULTS Eight studies met the pre-defined inclusion criteria and were included in the analysis. Seven studies used a questionnaire to assess bruxism. The pooled proportion estimate for occurrence of DS across the included studies was found to be 0.33 (95% CI: 0.22-0.45) as per the RE model and 0.35 (95% CI: 0.31-0.450) as per FE model in the quantitative analysis. All studies exhibited good methodological quality. CONCLUSION This systematic review and meta-analysis provide evidence of a significant prevalence of bruxism among individuals with DS. The findings highlight the association of bruxism with other oral health issues and specific chromosomal abnormalities. Comprehensive oral health assessments, including diagnostic procedures like Polysomnography, are essential for addressing the unique oral health needs of individuals with DS. Further studies are recommended with a valid tool for the diagnosis. Early interventions and management strategies need to be tailored to this population, considering the multifaceted nature of oral health concerns in individuals with DS.
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Affiliation(s)
- Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
- Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | | | - Maher A L Shayeb
- Clinical Science Department, Center of Medical and Bioallied Health Sciences Research, Ajman University, Ajman, UAE
| | - Sittana Elfadil
- Department of Clinical Sciences, Prosthodontics, College of Dentistry, Center of Medical and Bio-Allied Health Sciences Research. Ajman University, Ajman, UAE
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, School of Dentistry, University of Messina, Messina, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania, Naples, Italy
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O'Sullivan R, Bissell S, Hamilton A, Bagshaw A, Richards C. Concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions: A systematic review and meta-analysis. Sleep Med Rev 2023; 71:101814. [PMID: 37422998 DOI: 10.1016/j.smrv.2023.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
The purpose of this systematic review and meta-analysis is to delineate the concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions (NDCs). A systematic literature search identified 31 studies that compare objective and subjective estimates of sleep parameters in autism, ADHD or rare genetic syndromes associated with intellectual disability. The meta-analyses revealed smaller mean differences and larger correlations indicative of greater concordance for parameters associated with sleep scheduling compared to parameters associated with sleep duration and night awakenings. Relative to objective measures, subjective measures produced: 1) greater estimates of total sleep time, sleep efficiency and time in bed; and 2) lower estimates of wake after sleep onset and number of night awakenings. Subgroup analyses also revealed differences in concordance between measurement comparison types (e.g., stronger correlations between actigraphy and sleep diaries, compared to actigraphy and questionnaires) and NDC diagnostic groups. The results predominantly replicate concordance trends observed in typically-developing samples, although some NDC-specific patterns of concordance were identified. This indicates that objective and subjective sleep measures retain broadly similar properties across populations, although researchers and clinicians should be cautious of the impact of NDC-related characteristics on sleep parameter estimates. These findings should inform sleep assessment design and the interpretation of sleep parameter estimates in NDCs, increasing the rigour of sleep parameter description across research and clinical settings.
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Affiliation(s)
- Rory O'Sullivan
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Anna Hamilton
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Andrew Bagshaw
- School of Psychology, University of Birmingham, UK; Centre for Human Brain Health, University of Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
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Caldwell AR, Kim Y, Alshahwan N, Vellody K, Bendixen RM, Renz K, Duong T, Dodd J, Terhorst L, Must A. Parental perception of facilitators and barriers to health among young children with down syndrome: a qualitative study. Front Pediatr 2023; 11:1155850. [PMID: 37497298 PMCID: PMC10366365 DOI: 10.3389/fped.2023.1155850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Background Despite high rates of obesity and weight-related conditions observed in children with Down syndrome, little is known about how to prevent these conditions. Purpose The purpose of this study was to identify parent-perceived facilitators and barriers to health for toddlers (12-36 months old) with Down syndrome. Materials and methods We conducted in-depth, semi-structured interviews with the mothers of 25 toddlers with Down syndrome. All interviews were conducted using Zoom Video Technology, audio recorded and transcribed before being coded in NVivo software using a structured protocol. Thematic analysis was used to identify themes in perceived facilitators and barriers to health at the level of the child, family, and community. Data were triangulated using reflective journaling, video review of child meals, and member-checking techniques. Results We identified unique themes for facilitators (on the move and sound sleep) and barriers (co-occurring conditions and eating behaviors) at the level of the child. At the level of the family and community, overarching themes that were viewed as either a facilitator or barrier, depending on the context, were identified (role models matter, time is critical, the importance of place, and social support). Conclusion These themes can help clinicians and researchers tailor their health promotion interventions to meet the unique needs of children with Down syndrome by using strength-based approaches and providing families with the tools to overcome barriers.
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Affiliation(s)
- Angela R. Caldwell
- Pediatric Health Promotion Laboratory, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yeook Kim
- Families and Autism Research Lab, Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Nada Alshahwan
- Pediatric Health Promotion Laboratory, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kishore Vellody
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Roxanna M. Bendixen
- Department of Rehabilitation Sciences, College of Health Professions, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kayley Renz
- Pediatric Health Promotion Laboratory, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tiffany Duong
- Pediatric Health Promotion Laboratory, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Judith Dodd
- Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lauren Terhorst
- Pediatric Health Promotion Laboratory, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
- SHRS Data Center, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aviva Must
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
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Hayton J, Azhari A, Esposito G, Iles R, Chadiarakos M, Gabrieli G, Dimitriou D, Mangar S. Short Report: Lack of Diurnal Variation in Salivary Cortisol Is Linked to Sleep Disturbances and Heightened Anxiety in Adolescents with Williams Syndrome. Behav Sci (Basel) 2023; 13:bs13030220. [PMID: 36975245 PMCID: PMC10045386 DOI: 10.3390/bs13030220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Objective: The aim of the current study was to examine the potential relationship between sleep patterns, cortisol levels, and anxiety profiles in adolescents with Williams Syndrome (WS) compared to typically developing adolescents. Method: Thirteen adolescents with WS and thirteen TD adolescents (age range 12–18 years) were recruited. Participants were provided with a “testing kit”, containing instructions for collecting data through a sleep diary, MotionWare actigraphy, the Childhood Sleep Habits Questionnaire (CSHQ), and the Spence Children’s Anxiety Scale, and a salivary cortisol collection kit. Results: Adolescents in the WS group did not show diurnal variation in salivary cortisol. Significantly higher scores were reported for two CSHQ subsections, night wakings and parasomnias, in the WS group. Regarding the actigraphy, only significantly longer sleep latency was observed in the WS group. In comparison to the TD group, the WS group had significantly higher anxiety. As expected, the TD group showed typical diurnal variation in cortisol, whereas the WS group showed a flattened cortisol profile throughout the day. Conclusions: From the developmental perspective, this study provides new data supporting the conclusion that sleep problems are not transient but continue to persist into adolescence in WS. Future studies ought to consider examining the role of cortisol and its interplay with anxiety levels and sleep problems across the lifespan in individuals with WS.
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Affiliation(s)
- Jessica Hayton
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
| | - Atiqah Azhari
- Psychology Programme, School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Gianluca Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Ray Iles
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Michaella Chadiarakos
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
| | - Giulio Gabrieli
- Neuroscience and Behaviour Laboratory, Italian Institute of Technology, 00161 Roma, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
- Correspondence: (D.D.); (S.M.)
| | - Stephen Mangar
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
- Correspondence: (D.D.); (S.M.)
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Sleep in Children With Neurodevelopmental Disabilities During COVID-19: An Integrative Review. J Pediatr Health Care 2023; 37:153-166. [PMID: 36334949 PMCID: PMC9550660 DOI: 10.1016/j.pedhc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Sleep issues occur at higher rates in children with neurodevelopmental disorders than in the typical population. Little is known about the impact of COVID-19 on sleep issues in this population METHOD: This integrative review aimed to characterize studies during the COVID-19 pandemic (2020-2022) addressing the prevalence and management of sleep issues in children and youth with neurodevelopmental disorders.Comprehensive database searches were used to identify articles, and 31 studies were considered suitable for this review. RESULTS Most studies reported worsening sleep disturbances during COVID-19 restrictions. All studies were conducted when clinics were closed; only two studies addressed treatment options such as music therapy and sleep hygiene education and found improvement in sleep issues. DISCUSSION Future research needs to concentrate on developing interventions to assist families remotely and empower families with a toolkit of preparedness in times of crisis.
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Lushington K, Biggs S, Martin J, Kennedy D. Short report: Sleep talking and mental health in children with developmental problems and typically developing children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 124:104214. [PMID: 35290948 DOI: 10.1016/j.ridd.2022.104214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/26/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sleep talking although often considered benign is associated with poor mental health. However, it remains to be tested whether this association may be better explained by the presence of co-morbid sleep problems and the presence in survey samples of children with development disorders who tend to report a higher frequency of both sleep problems and poor mental health. AIM The aim of the present study was to examine the association between sleep talking and mental health after controlling for comorbid sleep problems in typically developing children and children with developmental problems. METHODS Parents of typically developing children (n = 1609) and children with either intellectual or developmental delay (n = 128) aged 5-10 years completed an omnibus survey which was administered through participating South Australian primary schools assessing mental health (Strengths and Difficulties Questionnaire) and sleep problems (Paediatric Sleep Survey Instrument). RESULTS After controlling for co-morbid sleep problems, regression analyses revealed that sleep talking in typically developing children was an independent but weak predictor of worse emotional symptoms, conduct problems and peer relationship problems. By contrast, only a single significant association was observed in children with developmental problems. Paradoxically, sleep talking was associated with better prosocial behaviour. CONCLUSION It is suggested that in typically developing children with a history of sleep talking, mental health merits evaluation at clinical interview while in both typically developing children and children with developmental problems, co-morbid sleep problems merit evaluation.
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Affiliation(s)
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
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Lovos A, Bottrill K, Sakhon S, Nyhuis C, Egleson E, Luongo A, Murphy M, Thurman AJ, Abbeduto L, Lee NR, Hughes K, Edgin J. Circadian Sleep-Activity Rhythm across Ages in Down Syndrome. Brain Sci 2021; 11:brainsci11111403. [PMID: 34827402 PMCID: PMC8615672 DOI: 10.3390/brainsci11111403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
Across all ages, individuals with Down syndrome (DS) experience high rates of sleep problems as well as cognitive impairments. This study sought to investigate whether circadian rhythm disruption was also experienced by people with DS and whether this kind of sleep disorder may be correlated with cognitive performance. A cross-sectional study of 101 participants (58 with DS, 43 with typical development) included individuals in middle childhood (6–10 years old), adolescence (11–18 years old), and young adulthood (19–26 years old). Sleep and markers of circadian timing and robustness were calculated using actigraphy. Cognitive and behavioral data were gathered via a novel touchscreen battery (A-MAPTM, Arizona Memory Assessment for Preschoolers and Special Populations) and parent questionnaire. Results indicated that children and adolescents with DS slept the same amount as peers with typical development, but significant group differences were seen in phase timing. The circadian robustness markers, interdaily stability and intradaily variability of sleep-wake rhythms, were healthiest for children regardless of diagnostic group and worst for adults with DS. Amplitude of the 24-h activity profile was elevated for all individuals with DS. In analyses of the correlations between sleep quality, rhythms, and cognition in people with DS, interdaily stability was positively correlated with reaction time and negatively correlated with verbal and scene recall, a finding that indicates increased stability may paradoxically correlate with poorer cognitive outcomes. Further, we found no relations with sleep efficiency previously found in preschool and adult samples. Therefore, the current findings suggest that a thorough examination of sleep disorders in DS must take into account age as well as circadian robustness to better understand sleep-cognitive correlations in this group.
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Affiliation(s)
- Annalysa Lovos
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
- Correspondence:
| | - Kenneth Bottrill
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Stella Sakhon
- Statistics Department, Los Angeles Valley College, Van Nuys, Los Angeles, CA 91401, USA;
| | - Casandra Nyhuis
- College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Elizabeth Egleson
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Alison Luongo
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Melanie Murphy
- Department of Physiology and Buiphysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA;
| | | | - Jamie Edgin
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
- Sonoran University Center for Excellence in Developmental Disabilities (UCEDD), University of Arizona, Farmington, CT 06032, USA
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Sleep, Function, Behaviour and Cognition in a Cohort of Children with Down Syndrome. Brain Sci 2021; 11:brainsci11101317. [PMID: 34679382 PMCID: PMC8534090 DOI: 10.3390/brainsci11101317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: To describe the sleep problems experienced by children with Down syndrome attending a tertiary sleep clinic and relationship with behaviour, function and cognition. Methods: Data were collected from children with Down syndrome aged 3–18 years old. Carers completed the Abbreviated Child Sleep Habits Questionnaire, Child Behaviour Checklist and Life-Habits Questionnaire at enrolment. Cognitive assessment (Stanford-Binet 5) was undertaken by a trained psychologist. Children received management for their sleep problem as clinically indicated. Results: Forty-two subjects with a median age of 6.8 years (Interquartile Range-IQR 4.5, 9.8) were enrolled. A total of 92% were referred with snoring or symptoms of Obstructive Sleep Apnoea (OSA), with 79% of those referred having had previous ENT surgery. Thus, 85% of all participants underwent a sleep study and 61% were diagnosed with OSA (OAHI ≥ 1/h). Based on questionnaires, 86% of respondents indicated that their child had a significant sleep disorder and non-respiratory sleep problems were common. Non-respiratory problems included: trouble going to sleep independently (45%), restless sleep (76%), night-time waking (24%) and bedtime resistance (22%). No significant correlations were found between sleep measures (behavioural and medical sleep problems) and the behavioural, functional or cognitive parameters. Conclusion: Sleep disorders were very common, especially non-respiratory sleep problems. OSA was common despite previous surgery. No association was found between sleep-related problems (snoring, sleep-study-confirmed OSA or non-respiratory sleep problem) and parent-reported behavioural problems, functional impairments or intellectual performance. This may reflect limitations of the measures used in this study, that in this population ongoing problems with daytime function are not sleep related or that a cross-sectional assessment does not adequately take into account the impacts of past disease/treatments. Further research is required to further evaluate the tools used to evaluate sleep disorders, the impact of those disorder on children with Down syndrome and interventions which improve both sleep and daytime function.
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Lai YYL, Downs JA, Wong K, Zafar S, Walsh LJ, Leonard HM. Oral parafunction and bruxism in Rett syndrome and associated factors: An observational study. Oral Dis 2021; 29:220-231. [PMID: 34033206 DOI: 10.1111/odi.13924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To explore patterns of parafunction, and bruxism, and its relationships with genotype and snoring in individuals with Rett syndrome (RTT). METHODS Retrospective observational data of those with confirmed MECP2 mutations in the InterRett database (n = 216) were used to investigate experience of parafunctional habits, and bruxism and their relationships with genotype and snoring using multivariable linear regression. RESULTS The prevalence of parafunction was 98.2%. Bruxism was reported (66.2%) with the patterns mostly both diurnal and nocturnal (44.1%) and exclusively diurnal (42.7%). Compared to individuals with C-terminal deletion, individuals with p.Arg106Trp mutations were less likely to have bruxism reported (aOR = 0.15; 95% CI 0.02-0.98, p = 0.05) and those with p.Arg168* mutation were more likely to have frequent bruxism than none or occasional bruxism reported (aROR 3.4; 95% CI 1.1-10.7 p = 0.04). The relative odds of having nocturnal bruxism constantly, compared to none/occasionally, were higher among those 'always' snoring (aROR 6.24; 95% CI 2.1-18.2, p = 0.001) than those with no snoring. CONCLUSIONS There appeared to be genotypic association with bruxism in p.Arg168* and p.Arg106Trp mutations and association between nocturnal bruxism and frequent snoring in an international sample of individuals with RTT. Clinical significance of the high prevalence of bruxism should be highlighted in relation to difficulty communicating pain and increased dental treatment need in RTT.
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Affiliation(s)
- Yvonne Yee Lok Lai
- The University of Queensland School of Dentistry, UQ Oral Health Centre, Herston, QLD, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Jenny Anne Downs
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Sobia Zafar
- The University of Queensland School of Dentistry, UQ Oral Health Centre, Herston, QLD, Australia
| | - Laurence James Walsh
- The University of Queensland School of Dentistry, UQ Oral Health Centre, Herston, QLD, Australia
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12
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Evans MA, Buysse DJ, Marsland AL, Wright AGC, Foust J, Carroll LW, Kohli N, Mehra R, Jasper A, Srinivasan S, Hall MH. Meta-analysis of age and actigraphy assessed sleep characteristics across the lifespan. Sleep 2021; 44:6211192. [PMID: 33823052 DOI: 10.1093/sleep/zsab088] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES Sleep quantity and continuity vary across the lifespan. Actigraphy is a reliable and widely-used behavioral measure of sleep in research and personal health monitoring. This meta-analysis provides a novel examination of whether age (in years) is associated with actigraphy-assessed sleep across the lifespan. METHODS A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using "actigraphy" and "sleep" terms provided 7,079 titles/abstracts; studies of individuals with known psychiatric or medical comorbidities were excluded. Ninety-one articles (N = 23,365) provided data for six meta-analyses examining sleep duration (k = 89), sleep efficiency (k = 58), bedtime (k = 19) and waketime (k = 9) for individuals ages 6-21, and bedtime (k = 7) and waketime (k = 7) for individuals ages 22 and older. RESULTS At older ages, sleep duration was shorter (r = -0.12) and sleep efficiency was lower (r = -0.05). Older age was associated with later bedtime (r = 0.37) and wake-up time (r = 0.24) from ages 6-21, whereas older age was associated with earlier bedtime (r = -0.66) and wake-up time (r = -0.59) for ages 22 and above. The strength of these associations was modified by study continent, but not by any other moderator. CONCLUSIONS Age was negatively associated with actigraphy-assessed sleep duration and efficiency, but the effects were small in magnitude. On the other hand, large associations were observed between age and sleep timing, despite a smaller literature and the absence of analyzable data for ages 30-60. Changes in sleep timing, rather than changes in sleep duration or continuity, may better characterize the effects of age on human sleep.
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Affiliation(s)
- Marissa A Evans
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jill Foust
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lucas W Carroll
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Naina Kohli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rishabh Mehra
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Jasper
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Swathi Srinivasan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Lights Out: Examining Sleep in Children with Vision Impairment. Brain Sci 2021; 11:brainsci11040421. [PMID: 33810398 PMCID: PMC8066760 DOI: 10.3390/brainsci11040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Sleep is crucial for development across cognitive, physical, and social-emotional domains. Sleep quality and quantity impact domains of daytime functioning, attainment, and global development. Previous work has explored sleep profiles in typically developing children and children with developmental disorders such as Down syndrome and Williams Syndrome, yet there is a complete absence of published work regarding the sleep profiles of children with vision impairment aged 4–11 years. This is the first known study that examines the sleep profiles in children with vision impairment (n = 58) in comparison to 58 typically developing children (aged 4–11 years) in the UK. Sleep was measured using the Childhood Sleep Habits Questionnaire (CSHQ; parental report), actigraphy and sleep diaries. Results showed group differences in subjective CSHQ scores but not objective actigraphy measures. Surprisingly, the findings revealed disordered sleep (namely, poor sleep quantity) in both groups. Discordance between CSHQ and actigraphy measures could represent heightened awareness of sleeping problems in parents/caregivers of children with vision impairment. The implications of this study extend beyond group comparison, examining disordered sleep in ‘typically developing’ children, exploring the potential role of light perception and the importance of sleep quality and quantity in both groups.
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Dimitriou D, Halstead EJ. Sleep-related learning in Williams Syndrome and Down's Syndrome. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:261-283. [PMID: 33641796 DOI: 10.1016/bs.acdb.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This chapter addresses sleep research challenges for the study of neurodevelopmental disorders drawing upon two disorders such as Down Syndrome and Williams syndrome. General sleep problems are outlined here, however particular consideration is given to the syndrome-specific issues or challenges that may be crucial to advancing our understanding of sleep-related cognitive and behavioral issues.
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Affiliation(s)
- Dagmara Dimitriou
- Sleep Research and Education Laboratory, UCL Institute of Education, London, United Kingdom.
| | - Elizabeth J Halstead
- Sleep Research and Education Laboratory, UCL Institute of Education, London, United Kingdom
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15
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Luongo A, Lukowski A, Protho T, Van Vorce H, Pisani L, Edgin J. Sleep's role in memory consolidation: What can we learn from atypical development? ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:229-260. [PMID: 33641795 DOI: 10.1016/bs.acdb.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.
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Affiliation(s)
- A Luongo
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - A Lukowski
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, United States
| | - T Protho
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - H Van Vorce
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - L Pisani
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - J Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States; University of Arizona Sonoran UCEDD, Tucson, AZ, United States.
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16
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Luconi E, Togni L, Mascitti M, Tesei A, Nori A, Barlattani A, Procaccini M, Santarelli A. Bruxism in Children and Adolescents with Down Syndrome: A Comprehensive Review. ACTA ACUST UNITED AC 2021; 57:medicina57030224. [PMID: 33804484 PMCID: PMC7999026 DOI: 10.3390/medicina57030224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022]
Abstract
The role of bruxism in children and adolescents with Down syndrome, the most often diagnosed congenital syndrome, is still unclear. Therefore, this study aims to conduct a narrative review of the literature about bruxism in children and adolescents with Down syndrome to identify the prevalence, risk factors, and possible treatments of this disorder. Although an accurate estimate of its prevalence could not be inferred, it appears that bruxism is more prevalent in Down syndrome individuals rather than in the general pediatric population. No gender difference was observed, but a reduction in its prevalence was described with increasing age (around 12 years). The variability in the diagnostic techniques contributed to the heterogeneity of the literature data. Clinicopathological features of Down syndrome, such as muscle spasticity, oral breathing, and a predisposition to obstructive sleep apnea, may suggest a higher prevalence of bruxism in this patient group. Finally, given the paucity of studies on the management of bruxism in this population, it was not possible to outline a standard protocol for the non-invasive treatment of cases in which an observational approach is not sufficient.
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Affiliation(s)
- Elisa Luconi
- Department of Surgical and Special Odontostomatology, Umberto I General Hospital, 60126 Ancona, Italy; (E.L.); (A.T.); (A.N.)
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.T.); (M.P.); (A.S.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.T.); (M.P.); (A.S.)
- Correspondence: ; Tel.: +39-071-2206226
| | - Andrea Tesei
- Department of Surgical and Special Odontostomatology, Umberto I General Hospital, 60126 Ancona, Italy; (E.L.); (A.T.); (A.N.)
| | - Alessandra Nori
- Department of Surgical and Special Odontostomatology, Umberto I General Hospital, 60126 Ancona, Italy; (E.L.); (A.T.); (A.N.)
| | - Alberta Barlattani
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Maurizio Procaccini
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.T.); (M.P.); (A.S.)
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (L.T.); (M.P.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, 60124 Ancona, Italy
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17
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Chawla JK, Howard A, Burgess S, Heussler H. Sleep problems in Australian children with Down syndrome: the need for greater awareness. Sleep Med 2021; 78:81-87. [PMID: 33412456 DOI: 10.1016/j.sleep.2020.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children with Down Syndrome (DS) have a high prevalence of obstructive sleep apnoea (OSA). Non-respiratory sleep disorders also occur commonly but are less well recognised. This cross-sectional study evaluates the prevalence of sleep difficulties in a community sample of Australian children with DS (DScomm), using the Children's Sleep Habits Questionnaire (CSHQ), and compares them to children referred to the sleep clinic (DSref). To our knowledge this is the first study to have reported prevalence of sleep problems in Australian children with DS and to compare a community and referred group of children with DS directly. METHODS The CSHQ was completed by parents of children with DS recruited from the community (DScomm) via survey distributed by Down syndrome Queensland and Australia. A second group was recruited through the tertiary sleep clinic at our institution (DSref) and completed the same questionnaire on enrolment. Data from these groups was compared. RESULTS There were 76 participants in the DScomm group (57% male; median age 9.7yrs) and 42 participants in the DSref group (50% male; median age 6.97yrs). The overall prevalence of sleep disturbances was 90.9% in the DScomm group, and 85.7% in the DSref group (p = 0.54). There was a statistically significant difference in the mean total CSHQ score, with the DScomm having the higher score (p = 0.023). CONCLUSIONS This study reports a high prevalence of sleep problems in both a community and referred group of Australian children with DS and suggests that there are many children with DS with sleep problems, particularly non-respiratory difficulties, who are potentially not receiving adequate treatment.
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Affiliation(s)
- Jasneek K Chawla
- Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia.
| | - Aidan Howard
- School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - Scott Burgess
- Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia
| | - Helen Heussler
- Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia; Department of Children Development, Queensland Children's Hospital, Queensland, Australia
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18
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Halstead EJ, Joyce A, Sullivan E, Tywyn C, Davies K, Jones A, Dimitriou D. Sleep Disturbances and Patterns in Children With Neurodevelopmental Conditions. Front Pediatr 2021; 9:637770. [PMID: 33738270 PMCID: PMC7961155 DOI: 10.3389/fped.2021.637770] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Children with neurodevelopmental conditions (NDC) often experience sleep problems which are long-lasting and more complex than typically developing children. These sleep problems impact their families and there is little guidance for management specifically for sleep for families of children with neurodevelopmental conditions. The present study aims to use parental report to evaluate sleep disturbances and sleep patterns in a large sample of children with NDC. We aim to identify associations with age, diagnosis, and medication groups. Methods: Data on 601 children aged between 2 and 17 years was analyzed from a UK non-profit service for sleep for families of children with NDC. Parents/carers completed the children's sleep habit questionnaire, a 7 day sleep diary, and information on child age, diagnosis, and medication. Parents also reported previous sleep management techniques they had tried. Results: Overall, we found differences between age, diagnosis, and medication use groups for sleep disturbances and sleep diary parameters in these populations. Sensory conditions were associated with high night time waking duration. Parents reported their child's short sleep duration was the most common problem for them. Conclusions: Key areas for further research are outlined including the long term considerations for parental presence at bedtime for sleep anxiety, melatonin use and efficacy, and consideration for interventions to reduce daytime fatigue in children aged 7-11 years old.
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Affiliation(s)
- Elizabeth J Halstead
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Anna Joyce
- Faculty of Humanities, Arts and Social Sciences, School of Psychotherapy & Psychology, Regent's University London, London, United Kingdom
| | - Emma Sullivan
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Carwyn Tywyn
- Cerebra, For Brain Injured Children and Young People, Carmarthen, United Kingdom
| | - Kyle Davies
- Cerebra, For Brain Injured Children and Young People, Carmarthen, United Kingdom
| | - Alexandra Jones
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
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19
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Greiner de Magalhães C, O'Brien LM, Mervis CB. Sleep characteristics and problems of 2-year-olds with Williams syndrome: relations with language and behavior. J Neurodev Disord 2020; 12:32. [PMID: 33218304 PMCID: PMC7679988 DOI: 10.1186/s11689-020-09336-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Sleep problems have been shown to have a negative impact on language development and behavior for both typically developing children and children with a range of neurodevelopmental disorders. The relation of sleep characteristics and problems to language and behavior for children with Williams syndrome (WS) is unclear. The goal of this study was to address these relations for 2-year-olds with WS. Associations of nonverbal reasoning ability, nighttime sleep duration, and excessive daytime sleepiness with language ability and behavior problems were considered. Method Ninety-six 2-year-olds with genetically confirmed classic-length WS deletions participated. Parents completed the Pediatric Sleep Questionnaire, which includes a Sleep-Related Breathing Disorder (SRBD) scale with a subscale measuring excessive daytime sleepiness, to assess sleep characteristics and problems. Parents also completed the Child Behavior Checklist (CBCL) and the MacArthur-Bates Communicative Development Inventory: Words and Sentences to assess behavior problems and expressive vocabulary, respectively. Children completed the Mullen Scales of Early Learning to measure nonverbal reasoning and language abilities. Results Parents indicated that children slept an average of 10.36 h per night (SD = 1.09, range 7.3–13.3), not differing significantly from the mean reported by Bell and Zimmerman (2010) for typically developing toddlers (p = .787). Sixteen percent of participants screened positive for SRBD and 30% for excessive daytime sleepiness. Children who screened positive for SRBD had significantly more behavior problems on all CBCL scales than children who screened negative. Children with excessive daytime sleepiness had significantly more attention/hyperactivity, stress, and externalizing problems than those who did not have daytime sleepiness. Individual differences in parent-reported nighttime sleep duration and directly measured nonverbal reasoning abilities accounted for unique variance in expressive language, receptive language, and internalizing problems. Individual differences in parent-reported daytime sleepiness accounted for unique variance in externalizing problems. Conclusions The relations of nighttime sleep duration, positive screens for SRBD, and excessive daytime sleepiness to language and behavior in toddlers with WS parallel prior findings for typically developing toddlers. These results highlight the importance of screening young children with WS for sleep problems. Studies investigating the efficacy of behavioral strategies for improving sleep in children with WS are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-020-09336-z.
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Affiliation(s)
- Caroline Greiner de Magalhães
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40204, USA
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, USA
| | - Carolyn B Mervis
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40204, USA.
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20
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Mughal R, Hill CM, Joyce A, Dimitriou D. Sleep and Cognition in Children with Fetal Alcohol Spectrum Disorders (FASD) and Children with Autism Spectrum Disorders (ASD). Brain Sci 2020; 10:brainsci10110863. [PMID: 33207724 PMCID: PMC7697116 DOI: 10.3390/brainsci10110863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/30/2022] Open
Abstract
Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage affecting cortical and subcortical connectivity occurs as a result of prenatal alcohol exposure in children with FASD, whilst it is believed an abundance of short-range connectivity explains the phenotypic manifestations of childhood ASD. These underlying neural structural and connectivity differences manifest as cognitive patterns, with some shared and some unique characteristics between FASD and ASD. This is the first study to examine sleep and its association with cognition in individuals with FASD, and to compare sleep in individuals with FASD and ASD. We assessed children aged 6–12 years with a diagnosis of FASD (n = 29), ASD (n = 21), and Typically Developing (TD) children (n = 46) using actigraphy (CamNTech Actiwatch 8), digit span tests of working memory (Weschler Intelligence Scale), tests of nonverbal mental age (MA; Ravens Standard Progressive Matrices), receptive vocabulary (British Picture Vocabulary Scale), and a choice reaction time (CRT) task. Children with FASD and ASD presented with significantly shorter total sleep duration, lower sleep efficiency, and more nocturnal wakings than their TD peers. Sleep was significantly associated with scores on the cognitive tests in all three groups. Our findings support the growing body of work asserting that sleep is significant to cognitive functioning in these neurodevelopmental conditions; however, more research is needed to determine cause and effect.
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Affiliation(s)
- Rabya Mughal
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London WC1H 0AA, UK;
- Correspondence:
| | - Catherine M. Hill
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | - Anna Joyce
- School of Psychotherapy & Psychology, Regent’s University London, London NW1 4NS, UK;
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London WC1H 0AA, UK;
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21
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Baltzan M, Yao C, Rizzo D, Postuma R. Dream enactment behavior: review for the clinician. J Clin Sleep Med 2020; 16:1949-1969. [PMID: 32741444 PMCID: PMC8034224 DOI: 10.5664/jcsm.8734] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
NONE Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
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Affiliation(s)
- Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L’île de Montréal, Montréal, Canada
- Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L’île de Montréal, Montréal, Canada
- Institut de Médecine du Sommeil, Montréal, Canada
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | - Dorrie Rizzo
- Faculty of Medicine, Department of Family Medicine, McGill University, Montréal, Canada
- Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux de l’ouest de l’île, Montréal, Canada
| | - Ron Postuma
- Research Institute of McGill University Health Centre, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
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Gwilliam K, Joyce A, Dimitriou D. Early manifestation of sleep problems in toddlers with Williams Syndrome using a mixed method longitudinal approach. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103658. [PMID: 32505082 DOI: 10.1016/j.ridd.2020.103658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Children with neurodevelopmental disorders commonly experience sleep problems. Williams Syndrome (WS), a rare genetic disorder characterised by a complex, uneven cognitive profile, is no exception. Compared with children with typical development (TD), school-aged children with WS experience significant sleep disruption: shorter sleep duration, more night wakings, greater bedtime resistance and excessive daytime tiredness. In children with TD, sleep problems impede optimal daytime functioning. In WS, this could compound existing difficulties. Few studies have examined sleep in very young children with WS and little is known about the early emergence of sleep problems in this population. To date, studies have been based on parent-report and no studies have objectively assessed sleep patterns using longitudinal approach in toddlers with WS. Thus, the current study sought to objectively explore sleep patterns in toddlers with WS. Parents of 38 children (13 WS, 25 TD) completed the Brief Infant Screening Questionnaire and the Medical and Demographics Questionnaire and sleep patterns were assessed using actigraphy. Data were collected longitudinally at ages 18, 24 and 30 months. Significant sleep disturbances were present in WS from 18 months old. Sleep duration, as measured by actigraphy, was significantly shorter in WS at all ages and, furthermore, parents of children with WS reported more night wakings, longer settling times and high levels of parental involvement. Crucially, whereas actigraphy showed developmental improvements in sleep quality in TD, no longitudinal changes were found in WS. Findings could be instrumental in working towards instigating appropriate, timely sleep management in this group, thus improving outcomes for children and their families.
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Affiliation(s)
- Kate Gwilliam
- Lifespan Learning and Sleep Laboratory, UCL-Institute of Education, London, UK.
| | - Anna Joyce
- School of Psychotherapy & Psychology, Regent's University London, London, UK
| | - Dagmara Dimitriou
- Lifespan Learning and Sleep Laboratory, UCL-Institute of Education, London, UK.
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23
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Kamara D, Beauchaine TP. A Review of Sleep Disturbances among Infants and Children with Neurodevelopmental Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020; 7:278-294. [PMID: 33344102 PMCID: PMC7747783 DOI: 10.1007/s40489-019-00193-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Sleep problems are common among children with neurodevelopmental disorders (NDDs). We review sleep disturbance in three major NDDs: autism spectrum disorder, Down syndrome, and fetal alcohol spectrum disorder (FASD). We review associations with functional impairment, discuss how patterns of sleep disturbance inform understanding of etiology, and theorize about mechanisms of impairment. Sleep disturbance is a transdiagnostic feature of NDDs. Caregivers report high rates of sleep problems, including difficulty falling or staying asleep. Polysomnography data reveal differences in sleep architecture and increased rates of sleep disorders. Sleep disturbance is associated with functional impairment and stress among families. Further research is needed to elucidate mechanisms of impairment and develop more effective interventions. Despite significant sleep disturbance in FASD, limited research is available.
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Affiliation(s)
- Dana Kamara
- The Ohio State University, Department of Psychology, 1835 Neil Ave., Columbus, OH 43210
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24
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Joyce A, Elphick H, Farquhar M, Gringras P, Evans H, Bucks RS, Kreppner J, Kingshott R, Martin J, Reynolds J, Rush C, Gavlak J, Hill CM. Obstructive Sleep Apnoea Contributes to Executive Function Impairment in Young Children with Down Syndrome. Behav Sleep Med 2020; 18:611-621. [PMID: 31311334 DOI: 10.1080/15402002.2019.1641501] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE/BACKGROUND Children with Down syndrome (DS) commonly experience difficulties with executive function (EF). They are also vulnerable to obstructive sleep apnoea (OSA). OSA is associated with EF deficits in typically developing children. A recent study reported an association between OSA and cognitive deficits in 38 school-aged children with DS. We experimentally investigated EF behaviours in young children with DS, and their association with OSA. PARTICIPANTS AND METHODS Children with DS were recruited to take part in a larger study of OSA (N = 202). Parents of 80 children (50 male) aged 36 to 71 months (M = 56.90, SD = 10.19 months) completed the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P). Of these 80 children, 69 were also successfully studied overnight with domiciliary cardiorespiratory polygraphy to diagnose OSA. RESULTS Obstructive apnoea/hypopnoea index was in the normal range (0-1.49/h) for 28 children but indicated OSA (≥1.5/h) in 41 children. Consistent with previous research, we found a large effect for children experiencing particular weaknesses in working memory, planning and organising, whilst emotional control was a relative strength. OSA was associated with poorer working memory (β = .23, R2 = .05, p = .025), emotional control (β = .20, R2 = .04, p = .047) and shifting (β = .24, R2 = .06, p = .023). CONCLUSIONS Findings suggest that known EF difficulties in DS are already evident at this young age. Children with DS already have limited cognitive reserve and can ill afford additional EF deficit associated with OSA. OSA is amenable to treatment and should be actively treated in these children to promote optimal cognitive development.
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Affiliation(s)
- Anna Joyce
- Centre for Innovative Research Across the Lifecourse, Coventry University , Coventry, UK
| | - Heather Elphick
- Department of Paediatric Respiratory Medicine, Sheffield Children's NHS Foundation Trust , Sheffield, UK
| | - Michael Farquhar
- Evelina London Children's Hospital, Guys & St Thomas's NHS Trust , London, UK
| | - Paul Gringras
- Evelina London Children's Hospital, Guys & St Thomas's NHS Trust , London, UK
| | - Hazel Evans
- Southampton Children's Hospital, Southampton University NHS Trust , Southampton, UK
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia , Perth, Australia
| | - Jana Kreppner
- School of Psychology, University of Southampton , Southampton, UK
| | - Ruth Kingshott
- Department of Paediatric Respiratory Medicine, Sheffield Children's NHS Foundation Trust , Sheffield, UK
| | - Jane Martin
- Southampton Biomedical Research Unit, Southampton General Hospital , Southampton, UK
| | - Janine Reynolds
- Department of Paediatric Respiratory Medicine, Sheffield Children's NHS Foundation Trust , Sheffield, UK
| | - Carla Rush
- Evelina London Children's Hospital, Guys & St Thomas's NHS Trust , London, UK
| | - Johanna Gavlak
- Southampton Children's Hospital, Southampton University NHS Trust , Southampton, UK
| | - Catherine M Hill
- Southampton Children's Hospital, Southampton University NHS Trust , Southampton, UK.,School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton, UK
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25
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Arias-Trejo N, Angulo-Chavira AQ, Demara B, Figueroa C, Edgin J. The influence of sleep on language production modalities in preschool children with Down syndrome. J Sleep Res 2020; 30:e13120. [PMID: 32537892 DOI: 10.1111/jsr.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
Evidence suggests that sleep may relate to oral language production in children with Down syndrome. However, these children are capable of using complex referential gestures as a compensation strategy for problems with oral production, and those with a greater productive oral vocabulary have less gestural vocabulary. The goal of this study was to explore whether sleep quality relates to oral and gestural production modalities in children with Down syndrome. We evaluated 36 preschool children with and without Down syndrome, paired by chronological age and gender, with similar sociodemographic backgrounds, using actigraphy to measure sleep behaviour and the Communicative Development Inventory for Down syndrome to measure vocabulary. Children with Down syndrome with better sleep efficiency showed more oral production but less gestural production. These results highlight the importance of sleep quality to language learning in children with Down syndrome.
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Affiliation(s)
- Natalia Arias-Trejo
- Laboratorio de Psicolingüística, Facultad de Psicología, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | | | - Bianca Demara
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
| | - Carlos Figueroa
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
| | - Jamie Edgin
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
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26
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Ridley E, Riby DM, Leekam SR. A cross-syndrome approach to the social phenotype of neurodevelopmental disorders: Focusing on social vulnerability and social interaction style. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103604. [PMID: 32142968 DOI: 10.1016/j.ridd.2020.103604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Following Annette Karmiloff-Smith's approach to cognitive research, this study applied a cross-syndrome approach to the social phenotype, focusing on social vulnerability (SV) and the factors that contribute to it. AIMS To (i) identify syndrome-specific differences in SV across four neurodevelopmental disorder (NDD) groups, (ii) determine the contribution of intellectual disability (ID), age or gender to SV, and (iii) explore its relationship with social interaction style (SIS). METHODS AND PROCEDURES 262 parents of children: Autism (n = 29), Williams syndrome (n = 29), Attention deficit hyperactivity disorder (n = 36), Fragile X syndrome (n = 18), and Neurotypical (n = 150) reported on their child's SV, quality of SIS and other factors (ID, age, gender). OUTCOMES AND RESULTS Heightened SV was not syndrome-specific. Instead it was found equally across NDD groups (and not in the neurotypical group), and independently of ID, age and gender. Different atypical SISs were also distributed across NDD groups and each were significantly related to SV, independent of the factors above and beyond neurodevelopmental diagnosis. CONCLUSIONS AND IMPLICATIONS The findings emphasise that social phenotypes are best understood as distributed across diagnostic boundaries and offer opportunities to further test the role of varied atypical SISs in the development of heightened SV.
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Affiliation(s)
- Ellen Ridley
- Centre for Developmental Disorders, Department of Psychology, Durham University, Science Site, South Road, Durham, UK.
| | - Deborah M Riby
- Centre for Developmental Disorders, Department of Psychology, Durham University, Science Site, South Road, Durham, UK
| | - Susan R Leekam
- Wales Autism Research Centre, Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, UK
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27
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Lee NR, Perez M, Hamner T, Adeyemi E, Clasen LS. A preliminary examination of brain morphometry in youth with Down syndrome with and without parent-reported sleep difficulties. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 99:103575. [PMID: 32106035 PMCID: PMC7483358 DOI: 10.1016/j.ridd.2020.103575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 12/23/2019] [Accepted: 01/10/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Down syndrome is associated with poor sleep but little is known about its neural correlates. AIMS The current research compared brain morphometry in youth with Down syndrome with parent-reported sleep problems (DS-S) to peers with Down syndrome (DS) and typical development (TD) without parent-reported sleep problems matched on age (M = 15.15) and sex ratio (62 % female). METHODS AND PROCEDURES Magnetic resonance imaging was completed on a 3 T scanner. Participants were stratified into groups based on parent-report: DS-S (n = 17), DS (n = 9), TD (n = 22). Brain morphometry, processed with the FreeSurfer Image Analysis Suite, was compared across groups. In addition, the co-occurrence of medical conditions in the DS groups was examined. OUTCOMES AND RESULTS Youth with DS-S had reduced total, frontal, parietal, and temporal brain volumes relative to DS and TD peers. They also had higher rates of congenital heart defects than the DS-only group; however, this comorbidity did not appear to account for morphometry differences. CONCLUSIONS AND IMPLICATIONS Parent-reported sleep problems in DS appear to relate to global and localized volume reductions. These preliminary results have implications for understanding the neural correlates of poor sleep in DS; they also highlight the importance of examining relations between sleep and other medical comorbidities.
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Affiliation(s)
- Nancy Raitano Lee
- Drexel University, 3141 Chestnut St., Stratton Hall, Suite 119, Philadelphia 19104, United States.
| | - Megan Perez
- Drexel University, 3141 Chestnut St., Stratton Hall, Suite 119, Philadelphia 19104, United States
| | - Taralee Hamner
- Drexel University, 3141 Chestnut St., Stratton Hall, Suite 119, Philadelphia 19104, United States
| | | | - Liv S Clasen
- National Institute of Mental Health, Bethesda, MD, United States
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28
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Agar G, Oliver C, Trickett J, Licence L, Richards C. Sleep disorders in children with Angelman and Smith-Magenis syndromes: The assessment of potential causes of disrupted settling and night time waking. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103555. [PMID: 31838315 DOI: 10.1016/j.ridd.2019.103555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep problems are common in Smith-Magenis (SMS) and Angelman syndromes (AS). Effectiveness of interventions depends on appropriate assessment, complicated by compromised self-report and health and behaviour difficulties. Studying settling and waking in these syndromes could inform assessment. AIMS To describe settling and waking behaviours in children at high-risk of sleep and health problems, using direct observation. METHODS AND PROCEDURES Video and actigraphy data were collected for 12 participants with AS (Mean age = 8.02, SD = 2.81) and 11 with SMS (Mean age = 8.80, SD = 2.18). Settling (30 min prior to sleep onset) and night waking were coded for nineteen behaviours relating to pain, challenging behaviour and caregiver interaction. Lag sequential analyses were conducted for pain-related behaviours. OUTCOMES AND RESULTS Percentage of time spent in behaviours was calculated. Parent-child interactions (0.00-9.93 %) and challenging behaviours (0 %) were rare at settling and waking in both groups. In the AS group, pain-related behaviours were more likely to occur before waking than by chance (p < 0.001). CONCLUSIONS AND IMPLICATIONS Findings highlight the importance of considering pain as a cause of sleep problems in AS. The principle and methodology could be extended to individuals with ID experiencing sleep problems.
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Affiliation(s)
- Georgie Agar
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Jayne Trickett
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Lucy Licence
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK; School of Psychology, 52 Pritchatts Road, University of Birmingham, UK
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29
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Lukowski AF, Slonecker EM, Milojevich HM. Sleep problems and recall memory in children with Down syndrome and typically developing controls. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 96:103512. [PMID: 31743853 PMCID: PMC7316139 DOI: 10.1016/j.ridd.2019.103512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Research conducted with typically developing (TD) infants and children generally indicates that better habitual sleep and sleep after learning are related to enhanced memory. Less is known, however, about associations between sleep and recall memory in children with Down syndrome (DS). AIMS The present study was conducted to determine whether parent-reported sleep problems were differentially associated with encoding, 1-month delayed recall memory, and forgetting over time in children with DS and those who were TD. METHODS AND PROCEDURES Ten children with DS (mean age = 33 months, 5 days) and 10 TD children (mean age = 21 months, 6 days) participated in a two-session study. At each session, recall memory was assessed using an elicited imitation paradigm. Immediate imitation was permitted at the first session as an index of encoding, and delayed recall was assessed 1 month later. In addition, parents provided demographic information and reported on child sleep problems. OUTCOMES AND RESULTS Although parents did not report more frequent sleep problems for children with DS relative to TD children, regression-based moderation analyses revealed that more frequent sleep problems were associated with increased forgetting of individual target actions and their order by children with DS. Evidence of moderation was not found when examining encoding or delayed recall. CONCLUSIONS AND IMPLICATIONS Although group differences were not found when considering parent-reported sleep problems, more frequent sleep problems were positively associated with increased forgetting by children with DS relative to those who were TD. Although future experimental work is needed to determine causality, these results suggest that improved sleep in children with DS might reduce forgetting, ultimately improving long-term recall memory.
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30
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Brennan LC, Kirkham FJ, Gavlak JC. Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton. Nat Sci Sleep 2020; 12:907-936. [PMID: 33204196 PMCID: PMC7667585 DOI: 10.2147/nss.s146608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/11/2019] [Indexed: 01/09/2023] Open
Abstract
Obstructive sleep-disordered breathing (SDB), which includes primary snoring through to obstructive sleep apnea syndrome (OSAS), may cause compromise of respiratory gas exchange during sleep, related to transient upper airway narrowing disrupting ventilation, and causing oxyhemoglobin desaturation and poor sleep quality. SDB is common in chronic disorders and has significant implications for health. With prevalence rates globally increasing, this condition is causing a substantial burden on health care costs. Certain populations, including people with sickle cell disease (SCD), exhibit a greater prevalence of OSAS. A review of the literature provides the available normal polysomnography and oximetry data for reference and documents the structural upper airway differences between those with and without OSAS, as well as between ethnicities and disease states. There may be differences in craniofacial development due to atypical growth trajectories or extramedullary hematopoiesis in anemias such as SCD. Studies involving MRI of the upper airway illustrated that OSAS populations tend to have a greater amount of lymphoid tissue, smaller airways, and smaller lower facial skeletons from measurements of the mandible and linear mental spine to clivus. Understanding the potential relationship between these anatomical landmarks and OSAS could help to stratify treatments, guiding choice towards those which most effectively resolve the obstruction. OSAS is relatively common in SCD populations, with hypoxia as a key manifestation, and sequelae including increased risk of stroke. Combatting any structural defects with appropriate interventions could reduce hypoxic exposure and consequently reduce the risk of comorbidities in those with SDB, warranting early treatment interventions.
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Affiliation(s)
- Lucy Charlotte Brennan
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fenella Jane Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Johanna Cristine Gavlak
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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31
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Joyce A, Hill CM, Karmiloff-Smith A, Dimitriou D. A Cross-Syndrome Comparison of Sleep-Dependent Learning on a Cognitive Procedural Task. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:339-353. [PMID: 31199684 DOI: 10.1352/1944-7558-124.4.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sleep plays a key role in the consolidation of newly acquired information and skills into long term memory. Children with Down syndrome (DS) and Williams syndrome (WS) frequently experience sleep problems, abnormal sleep architecture, and difficulties with learning; thus, we predicted that children from these clinical populations would demonstrate impairments in sleep-dependent memory consolidation relative to children with typical development (TD) on a cognitive procedural task: The Tower of Hanoi. Children with DS (n = 17), WS (n = 22) and TD (n = 34) completed the Tower of Hanoi task. They were trained on the task either in the morning or evening, then completed it again following counterbalanced retention intervals of daytime wake and night time sleep. Children with TD and with WS benefitted from sleep for enhanced memory consolidation and improved their performance on the task by reducing the number of moves taken to completion, and by making fewer rule violations. We did not find any large effects of sleep on learning in children with DS, suggesting that these children are not only delayed, but atypical in their learning strategies. Importantly, our findings have implications for educational strategies for all children, specifically considering circadian influences on new learning and the role of children's night time sleep as an aid to learning.
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Affiliation(s)
- Anna Joyce
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Catherine M Hill
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Annette Karmiloff-Smith
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
| | - Dagmara Dimitriou
- Anna Joyce, Centre for Innovative Research Across the Life Course, Coventry University, England; Catherine M. Hill, Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, England; Annette Karmiloff-Smith, Deceased 19th December 2016; and Dagmara Dimitriou, Lifespan Learning and Sleep Laboratory, University College London (UCL), Institute of Education, London, England
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32
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Surtees AD, Oliver C, Jones CA, Evans DL, Richards C. Sleep duration and sleep quality in people with and without intellectual disability: A meta-analysis. Sleep Med Rev 2018; 40:135-150. [DOI: 10.1016/j.smrv.2017.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Use and Effectiveness of Sleep Medications by Parent Report in Individuals with Williams Syndrome. J Dev Behav Pediatr 2018; 38:765-771. [PMID: 28937452 DOI: 10.1097/dbp.0000000000000503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep disorders are common in individuals with Williams syndrome (WS), and sleep disturbance has a significant negative effect on attention, learning, and behavior. The use of sleep-inducing medicine in individuals with WS has not been widely investigated. The objective of this study was to evaluate the use and effectiveness of sleep medications among a large sample of individuals with WS by parent survey. METHODS A survey of the use and effectiveness of sleep medications was completed by 513 (of 2846) members of the Williams Syndrome Association. The online survey asked for the age at initiation, degree of effectiveness (helpful, somewhat helpful, and not helpful), and side effects. RESULTS One hundred thirty participants (25%) indicated that their family member with WS had taken medication to help with sleep. Melatonin was the most commonly reported medication taken for sleep, with 91% of parents reporting that it was "helpful" or "somewhat helpful" for their child with WS. Those who reported taking melatonin reported very few, if any, side effects. CONCLUSION This parent-completed survey is a preliminary study showing the positive benefit of melatonin for individuals with WS who have disrupted sleep. The findings support the need for further study of the use of melatonin, in addition to behavioral sleep aids, given evidence that sleep disturbance negatively influences cognition and behavior.
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34
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Esbensen AJ, Hoffman EK. Impact of sleep on executive functioning in school-age children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:569-580. [PMID: 29696706 PMCID: PMC6005178 DOI: 10.1111/jir.12496] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/15/2017] [Accepted: 04/01/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sleep problems have an impact on executive functioning in the general population. While children with Down syndrome (DS) are at high risk for sleep problems, the impact of these sleep problems on executive functioning in school-age children with DS is less well documented. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports and neuropsychology assessments of executive functioning among school-age children with DS. METHOD Thirty school-age children with DS wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Children completed a neuropsychology assessment of their inhibitory control, ability to shift and working memory. Their parents and teachers completed rating scales to assess these same constructs of executive functioning. RESULTS Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire (CSHQ), but not actigraph-measured sleep period or efficiency, were predictive of parent reports of concerns with inhibitory control, shifting and working memory, and of teacher reports of inhibitory control. No measure of sleep was predictive of executive functioning as measured by the neuropsychology assessment. CONCLUSION The study findings corroborate the preliminary literature that parent-reported sleep problems are related to executive functioning in school-age children with DS, particularly in the area of inhibitory control across home and school. These findings have implications for understanding contributing factors to academic performance and school behaviour in school-age children with DS.
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Affiliation(s)
- A J Esbensen
- Division of Developmental and Behavioral Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, School of Medicine, Cincinnati, OH, USA
| | - E K Hoffman
- Division of Developmental and Behavioral Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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35
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Galland BC, Short MA, Terrill P, Rigney G, Haszard JJ, Coussens S, Foster-Owens M, Biggs SN. Establishing normal values for pediatric nighttime sleep measured by actigraphy: a systematic review and meta-analysis. Sleep 2018; 41:4954015. [DOI: 10.1093/sleep/zsy017] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 01/25/2023] Open
Affiliation(s)
- Barbara C Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | - Philip Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Gabrielle Rigney
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Jillian J Haszard
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Scott Coussens
- School of Psychology, Flinders University, Adelaide, Australia
- Cognitive Neuroscience Laboratory, University of South Australia, Adelaide, Australia
| | - Mistral Foster-Owens
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- Department of Paediatrics, The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
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36
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Esbensen AJ, Hoffman EK, Beebe DW, Byars KC, Epstein J. Links between sleep and daytime behaviour problems in children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:115-125. [PMID: 29282827 PMCID: PMC5775033 DOI: 10.1111/jir.12463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/11/2017] [Accepted: 11/29/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. METHOD Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. RESULTS Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. CONCLUSION The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome.
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Affiliation(s)
- A J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E K Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - D W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K C Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Joyce A, Dimitriou D. Sleep-disordered breathing and cognitive functioning in preschool children with and without Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:778-791. [PMID: 28612424 DOI: 10.1111/jir.12387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/28/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sleep affects children's cognitive development, preparedness for school and future academic outcomes. People with Down syndrome (DS) are particularly at risk for sleep-disordered breathing (SDB). To our knowledge, the association between SDB and cognition in preschoolers with DS is unknown. METHODS We assessed sleep by using cardiorespiratory polygraphy in 22 typically developing (TD) preschoolers and 22 with DS. Cognition was assessed by using the Mullen Scales of Early Learning and behaviour by using the Strengths and Difficulties Questionnaire (SDQ). The MacArthur Communicative Development Inventory (MCDI) measured language level. We predicted that sleep problems would be associated with lower cognitive and behavioural functioning. RESULTS In TD children, longer sleep duration was associated with higher scores on MCDI expressive language and fewer emotional symptoms such as fear and unhappiness on the SDQ, whilst SDB was associated with increased conduct problems and less prosocial behaviour on the SDQ. Conversely, for children with DS, SDB was associated with increased language understanding and use of actions and gestures on the MCDI. CONCLUSIONS The findings in the TD group support our hypotheses. We recommend that sleep problems are screened for and treated as even mild SDB may prompt poorer cognition and behaviour. For children with DS, we expect that multiple factors in this complex syndrome mask or mediate the association between sleep and cognitive development and tighter controls are necessary to uncover effects of sleep. We propose longitudinal studies as a necessary tool to assess the precise impact of sleep on cognitive development in accounting for individual differences in DS.
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Affiliation(s)
- A Joyce
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Coventry, UK
| | - D Dimitriou
- Lifespan Learning & Sleep Lab, Department of Psychology and Human Development, UCL Institute of Education, London, UK
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Increased overall cortical connectivity with syndrome specific local decreases suggested by atypical sleep-EEG synchronization in Williams syndrome. Sci Rep 2017; 7:6157. [PMID: 28733679 PMCID: PMC5522417 DOI: 10.1038/s41598-017-06280-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022] Open
Abstract
Williams syndrome (7q11.23 microdeletion) is characterized by specific alterations in neurocognitive architecture and functioning, as well as disordered sleep. Here we analyze the region, sleep state and frequency-specific EEG synchronization of whole night sleep recordings of 21 Williams syndrome and 21 typically developing age- and gender-matched subjects by calculating weighted phase lag indexes. We found broadband increases in inter- and intrahemispheric neural connectivity for both NREM and REM sleep EEG of Williams syndrome subjects. These effects consisted of increased theta, high sigma, and beta/low gamma synchronization, whereas alpha synchronization was characterized by a peculiar Williams syndrome-specific decrease during NREM states (intra- and interhemispheric centro-temporal) and REM phases of sleep (occipital intra-area synchronization). We also found a decrease in short range, occipital connectivity of NREM sleep EEG theta activity. The striking increased overall synchronization of sleep EEG in Williams syndrome subjects is consistent with the recently reported increase in synaptic and dendritic density in stem-cell based Williams syndrome models, whereas decreased alpha and occipital connectivity might reflect and underpin the altered microarchitecture of primary visual cortex and disordered visuospatial functioning of Williams syndrome subjects.
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Esbensen AJ, Hoffman EK. Reliability of parent report measures of sleep in children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:210-220. [PMID: 27469584 PMCID: PMC5424471 DOI: 10.1111/jir.12315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/20/2016] [Accepted: 06/22/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Behavioural sleep disturbances are common among children with Down syndrome (DS). However, tools used to detect and evaluate behavioural sleep disturbances were developed for typically developing children and have not been evaluated for use among children with DS. The current study evaluates the psychometric properties of three measures of behavioural sleep disturbances that are currently being used with children with intellectual and developmental disabilities, including children with DS. METHOD Caregivers of 30 children with DS rated their child's sleep with the Behavioral Evaluation of Disorders of Sleep (BEDS), Children's Sleep Habits Questionnaire (CSHQ) and Sleep Disturbances Scale for Children (SDSC). Caregivers also provided information on sleep diagnoses and completed a 7-night sleep and behaviour diary. RESULTS The study investigated the rate of detecting sleep problems, internal consistency, and convergent and concurrent validity of the BEDS, CSHQ and SDSC. Children with DS were reported to exhibit behavioural sleep disturbances at different rates depending on the measure used; 0% BEDS, 79.3% CSHQ and 17.2% SDSC. Internal consistency was comparable for all three measures for their total scores. However, when evaluating the internal consistency of subscale scores, those on the CSHQ and SDSC performed more strongly. The subscales of the CSHQ performed best when evaluating convergent and concurrent validity, with the SDSC subscales performing moderately well. CONCLUSION The study findings suggest that, among children with DS, the CSHQ and its subscales performed in a psychometrically sound and theoretically appropriate manner in relation to other measures of sleep, medical history of sleep problems, and daily reports of sleep and associated behaviours. The SDSC performed moderately well. When evaluating behavioural sleep disturbances among children with DS, the CSHQ is recommended based on its stronger psychometric properties.
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Affiliation(s)
- A J Esbensen
- Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, OH,, USA
| | - E K Hoffman
- Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, OH,, USA
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Fernandez F, Nyhuis CC, Anand P, Demara BI, Ruby NF, Spanò G, Clark C, Edgin JO. Young children with Down syndrome show normal development of circadian rhythms, but poor sleep efficiency: a cross-sectional study across the first 60 months of life. Sleep Med 2017; 33:134-144. [PMID: 28449894 PMCID: PMC5423393 DOI: 10.1016/j.sleep.2016.12.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate sleep consolidation and circadian activity rhythms in infants and toddlers with Down syndrome (DS) under light and socially entrained conditions within a familiar setting. Given previous human and animal data suggesting intact circadian regulation of melatonin across the day and night, it was hypothesized that behavioral indices of circadian rhythmicity would likewise be intact in the sample with DS. Methods A cross-sectional study of 66 infants and young children with DS, aged 5–67 months, and 43 typically developing age-matched controls. Sleep and measures of circadian robustness or timing were quantified using continuous in-home actigraphy recordings performed over seven days. Circadian robustness was quantified via time series analysis of rest-activity patterns. Phase markers of circadian timing were calculated alongside these values. Sleep efficiency was also estimated based on the actigraphy recordings. Results This study provided further evidence that general sleep quality is poor in infants and toddlers with DS, a population that has sleep apnea prevalence as high as 50% during the preschool years. Despite poor sleep quality, circadian rhythm and phase were preserved in children with DS and displayed similar developmental trajectories in cross-sectional comparisons with a typically developing (TD) cohort. In line with past work, lower sleep efficiency scores were quantified in the group with DS relative to TD children. Infants born with DS exhibited the worst sleep fragmentation; however, in both groups, sleep efficiency and consolidation increased across age. Three circadian phase markers showed that 35% of the recruitment sample with DS was phase-advanced to an earlier morning schedule, suggesting significant within-group variability in the timing of their daily activity rhythms. Conclusions Circadian rhythms of wake and sleep are robust in children born with DS. The present results suggest that sleep fragmentation and any resultant cognitive deficits are likely not confounded by corresponding deficits in circadian rhythms. Circadian activity rhythms are robust in young children with Down syndrome. Early morning activity is phase-advanced in a subgroup. Infants with Down syndrome show significant sleep fragmentation. Sleep efficiency improves with age in children with Down syndrome, but still lags the trajectory seen in typical development.
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Affiliation(s)
- Fabian Fernandez
- Departments of Psychology and Neurology, BIO5 Institute, University of Arizona, Tucson, USA; Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, USA.
| | - Casandra C Nyhuis
- Department of Psychology, University of Arizona, Tucson, USA; Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, USA
| | - Payal Anand
- Department of Psychology, University of Arizona, Tucson, USA; Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, USA
| | - Bianca I Demara
- Department of Psychology, University of Arizona, Tucson, USA; Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, USA
| | - Norman F Ruby
- Biology Department, Stanford University, Stanford, USA
| | - Goffredina Spanò
- Department of Psychology, University of Arizona, Tucson, USA; Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, USA
| | - Caron Clark
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, USA
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, USA; Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, USA
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Berencsi A, Gombos F, Kovács I. Capacity to improve fine motor skills in Williams syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:956-968. [PMID: 27485486 DOI: 10.1111/jir.12317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Individuals with Williams syndrome (WS) are known to have difficulties in carrying out fine motor movements; however, a detailed behavioural profile of WS in this domain is still missing. It is also unknown how great the capacity to improve these skills with focused and extensive practice is. METHOD We studied initial performance and learning capacity in a sequential finger tapping (FT) task in WS and in typical development. Improvement in the FT task has been shown to be sleep dependent. WS subjects participating in the current study have also participated in earlier polysomnography studies, although not directly related to learning. RESULTS WS participants presented with great individual variability. In addition to generally poor initial performance, learning capacity was also greatly limited in WS. We found indications that reduced sleep efficiency might contribute to this limitation. CONCLUSIONS Estimating motor learning capacity and the depth of sleep disorder in a larger sample of WS individuals might reveal important relationships between sleep and learning, and contribute to efficient intervention methods improving skill acquisition in WS.
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Affiliation(s)
- A Berencsi
- Laboratory for Psychological Research, Pázmány Péter Catholic University, Budapest, Hungary.
- Bárczi Gusztáv Faculty of Special Education, Institute for Methodology of Special Education and Rehabilitation, Eötvös Loránd University, Budapest, Hungary.
| | - F Gombos
- Laboratory for Psychological Research, Pázmány Péter Catholic University, Budapest, Hungary
- Department of General Psychology, Pázmány Péter Catholic University, Budapest, Hungary
| | - I Kovács
- Laboratory for Psychological Research, Pázmány Péter Catholic University, Budapest, Hungary
- Department of General Psychology, Pázmány Péter Catholic University, Budapest, Hungary
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Karmiloff-Smith A, Al-Janabi T, D'Souza H, Groet J, Massand E, Mok K, Startin C, Fisher E, Hardy J, Nizetic D, Tybulewicz V, Strydom A. The importance of understanding individual differences in Down syndrome. F1000Res 2016; 5:F1000 Faculty Rev-389. [PMID: 27019699 PMCID: PMC4806704 DOI: 10.12688/f1000research.7506.1] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 12/24/2022] Open
Abstract
In this article, we first present a summary of the general assumptions about Down syndrome (DS) still to be found in the literature. We go on to show how new research has modified these assumptions, pointing to a wide range of individual differences at every level of description. We argue that, in the context of significant increases in DS life expectancy, a focus on individual differences in trisomy 21 at all levels-genetic, cellular, neural, cognitive, behavioral, and environmental-constitutes one of the best approaches for understanding genotype/phenotype relations in DS and for exploring risk and protective factors for Alzheimer's disease in this high-risk population.
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Affiliation(s)
- Annette Karmiloff-Smith
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, WC1E 7HX, UK
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
| | - Tamara Al-Janabi
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Hana D'Souza
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, WC1E 7HX, UK
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
| | - Jurgen Groet
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- The Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, E1 2AT, UK
| | - Esha Massand
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, WC1E 7HX, UK
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
| | - Kin Mok
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, WC1N 3BG, UK
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Carla Startin
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Elizabeth Fisher
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Department of Neurodegenerative Disease, Institute of Neurology, London, WC1N 3BG, UK
| | - John Hardy
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, WC1N 3BG, UK
| | - Dean Nizetic
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- The Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, E1 2AT, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Biopolis, 138673, Singapore
| | - Victor Tybulewicz
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Francis Crick Institute, London, NW7 1AA, UK
- Department of Medicine, Imperial College London, London, W12 0NN, UK
| | - Andre Strydom
- The London Down Syndrome Consortium (LonDownS), University College London, London, UK
- Division of Psychiatry, University College London, London, W1T 7NF, UK
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Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A. Sleep problems and obstructive sleep apnea in children with down syndrome, an overwiew. Int J Pediatr Otorhinolaryngol 2016; 82:12-5. [PMID: 26857307 DOI: 10.1016/j.ijporl.2015.12.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children with Down syndrome (DS) have a high prevalence of sleep problems, including behavioural sleep disturbances and obstructive sleep apnea. Sleep problems are associated with a wide range of adverse health effects. Since children with DS are already known to have many comorbidities, they are particularly susceptible for the negative impact of sleep problems. Aim of this study is (1) to evaluate the prevalence of sleep problems in children with DS, (2) compare the prevalence of sleep problems in children with DS with a community sample of typical developing school-aged children, and (3) to correlate the existence of sleep problems in children with DS and OSA. METHODS Children enrolled at the multidisciplinary Down team of the University Hospital Antwerp and seen at the ENT department were eligible for this study. The prevalence of sleep problems was evaluated by the use of the Child Sleep Habits Questionnaire (CSHQ) and a full overnight polysomnography was performed to screen for obstructive sleep apnea. RESULTS Parents of fifty-four children with DS, aged 7.5 years (5.4-11.6), completed the CSHQ and an overall prevalence of sleep problems was found in 74.1%. In 57.1% of the children OSA was diagnosed with a median obstructive apnea-hypopnea index (oAHI) 7.25/h (5.7-9.8). Overall sleep problems were not age-or gender related, however boys suffer more from daytime sleepiness. Symptoms of sleep disordered breathing correlate with parasomnias, a longer sleep duration and more daytime sleepiness. No correlation was found between sleep problems and underlying OSA. CONCLUSION Children with Down syndrome have a significantly higher prevalence of sleep problems, compared to normal developing healthy school-aged children. We didn't find any correlation between the parental report of sleep problems and underlying OSA, or OSA severity.
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Affiliation(s)
- Mieke Maris
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, Edegem 2650, Belgium.
| | - Stijn Verhulst
- Department of Paediatrics, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, Edegem 2650, Belgium.
| | - Marek Wojciechowski
- Department of Paediatrics, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, Edegem 2650, Belgium.
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, Edegem 2650, Belgium.
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, Edegem 2650, Belgium.
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Gregory AM, Sadeh A. Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science. J Child Psychol Psychiatry 2016; 57:296-317. [PMID: 26412255 DOI: 10.1111/jcpp.12469] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. FINDINGS To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. CONCLUSIONS While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Ashworth A, Hill CM, Karmiloff-Smith A, Dimitriou D. The Importance of Sleep: Attentional Problems in School-Aged Children With Down Syndrome and Williams Syndrome. Behav Sleep Med 2016; 13:455-71. [PMID: 25127421 DOI: 10.1080/15402002.2014.940107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In typically developing (TD) children, sleep problems have been associated with day-time attentional difficulties. Children with developmental disabilities often suffer with sleep and attention problems, yet their relationship is poorly understood. The present study investigated this association in school-aged children with Down syndrome (DS) and Williams syndrome (WS). Actigraphy and pulse oximetry assessed sleep and sleep-disordered breathing respectively, and attention was tested using a novel visual Continuous Performance Task (CPT).Attentional deficits were evident in both disorder groups. In the TD group, higher scores on the CPT were related to better sleep quality, higher oxyhemoglobin saturation (SpO2), and fewer desaturation events. Sleep quality, duration, and SpO2 variables were not related to CPT performance for children with DS and WS.
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Affiliation(s)
- Anna Ashworth
- a Department of Psychology and Human Development Institute of Education , London
| | - Catherine M Hill
- b Division of Clinical Neuroscience , School of Medicine, University of Southampton
| | | | - Dagmara Dimitriou
- a Department of Psychology and Human Development Institute of Education , London
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Tomalski P, Moore DG, Ballieux H, Kushnerenko EV, Johnson MH, Karmiloff-Smith A. Separating the effects of ethnicity and socio-economic status on sleep practices of 6- to 7-month-old infants. LEARNING AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.lindif.2015.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esbensen AJ. Sleep problems and associated comorbidities among adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:68-79. [PMID: 26521721 PMCID: PMC5424472 DOI: 10.1111/jir.12236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND Sleep problems, including sleep apnoea and behavioural sleep disturbances, are common among adults with Down syndrome (DS). Despite a preliminary understanding of potential medical and behavioural comorbidities of these sleep problems among children with DS, little is known about comorbid conditions associated with these sleep problems among adults with DS. Understanding causes and sequelae of sleep problems in this ageing population is essential to providing quality health screening and treatment. The current study examines the physical health problems, mental health conditions, functional abilities and behavioural problems associated with sleep apnoea and behavioural sleep disturbances among adults with DS. METHOD Family caregivers participated in clinical interviews and completed questionnaires, providing reports regarding 75 adults with DS. Caregivers reported on sleep problems, physical and mental health conditions, daily living skills and behaviours regarding their ageing family member with DS. RESULTS Sleep apnoea was associated with more common other respiratory concerns, and more frequent visits to physicians, but not with some expected medical comorbidities (cardiac). Behavioural sleep disturbances (delayed sleep onset, night-time awakenings and morning awakenings) were associated with poorer health, more frequent overnight hospital and emergency department visits, more common cardiac conditions, less common thyroid condition, more common mental health conditions (anxiety, depression and dementia) and a higher rate of daytime behaviour problems. CONCLUSION The study findings suggest that there are differential correlates for the various sleep problems in adults with DS, which warrant attention when screening for medical and mental health comorbidities, assessing behavioural problems and in treatment planning for ageing adults with DS.
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Affiliation(s)
- A J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Esbensen AJ, Schwichtenberg AJ. Sleep in Neurodevelopmental Disorders. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51:153-191. [PMID: 28503406 PMCID: PMC5424624 DOI: 10.1016/bs.irrdd.2016.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Individuals with intellectual and developmental disabilities (IDD) experience sleep problems at higher rates than the general population. Although individuals with IDD are a heterogeneous group, several sleep problems cluster within genetic syndromes or disorders. This review summarizes the prevalence of sleep problems experienced by individuals with Angelman syndrome, Cornelia de Lange syndrome, Cri du Chat syndrome, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Smith-Magenis syndrome, Williams syndrome, autism spectrum disorder, and idiopathic IDD. Factors associated with sleep problems and the evidence for sleep treatments are reviewed for each neurodevelopmental disorder. Sleep research advancements in neurodevelopmental disorders are reviewed, including the need for consistency in defining and measuring sleep problems, considerations for research design and reporting of results, and considerations when evaluating sleep treatments.
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Ashworth A, Hill CM, Karmiloff-Smith A, Dimitriou D. A cross-syndrome study of the differential effects of sleep on declarative memory consolidation in children with neurodevelopmental disorders. Dev Sci 2015; 20. [PMID: 26690566 PMCID: PMC5347847 DOI: 10.1111/desc.12383] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022]
Abstract
Sleep plays an active role in memory consolidation. Because children with Down syndrome (DS) and Williams syndrome (WS) experience significant problems with sleep and also with learning, we predicted that sleep‐dependent memory consolidation would be impaired in these children when compared to typically developing (TD) children. This is the first study to provide a cross‐syndrome comparison of sleep‐dependent learning in school‐aged children. Children with DS (n = 20) and WS (n = 22) and TD children (n = 33) were trained on the novel Animal Names task where they were taught pseudo‐words as the personal names of ten farm and domestic animals, e.g. Basco the cat, with the aid of animal picture flashcards. They were retested following counterbalanced retention intervals of wake and sleep. Overall, TD children remembered significantly more words than both the DS and WS groups. In addition, their performance improved following night‐time sleep, whereas performance over the wake retention interval remained stable, indicating an active role of sleep for memory consolidation. Task performance of children with DS did not significantly change following wake or sleep periods. However, children with DS who were initially trained in the morning continued to improve on the task at the following retests, so that performance on the final test was greater for children who had initially trained in the morning than those who trained in the evening. Children with WS improved on the task between training and the first retest, regardless of whether sleep or wake occurred during the retention interval. This suggests time‐dependent rather than sleep‐dependent learning in children with WS, or tiredness at the end of the first session and better performance once refreshed at the start of the second session, irrespective of the time of day. Contrary to expectations, sleep‐dependent learning was not related to baseline level of performance. The findings have significant implications for educational strategies, and suggest that children with DS should be taught more important or difficult information in the morning when they are better able to learn, whilst children with WS should be allowed a time delay between learning phases to allow for time‐dependent memory consolidation, and frequent breaks from learning so that they are refreshed and able to perform at their best.
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Affiliation(s)
- Anna Ashworth
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, UK
| | - Catherine M Hill
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | | | - Dagmara Dimitriou
- Lifespan Learning and Sleep Laboratory, UCL, Institute of Education, UK
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