Sleep and Activity Patterns of Children with Down Syndrome in Relation to Sleep Disordered Breathing

Abstract

<bold>Background and purpose:</bold> Sleep disordered breathing (SDB) is a major health problem in children with Down syndrome (DS), and may adversely affect not only health, but also accomplishment of life's daily activities and habits. Obesity is a known risk factor of SDB in the general population, but in children with DS there have been conflicting reports on the role of obesity in SDB. The goal of this dissertation is to: 1) review the current state of knowledge in sleep of children with DS; 2) describe sleep patterns, and examine the relationship of sleep disturbances, including SDB, with the accomplishment of daily life habits; and 3) describe activity patterns, and evaluate the relationships between SDB, sleep duration, obesity and physical activity (PA) in a sample of children with DS. <bold>Methods:</bold> A review of the English language literature between 1960 and 2012 was completed, studies were described and synthesized. An Internet sample of 139 parents of children ages 5 to 18 years (110 parents of children with DS, 29 parents of children with typical development [TD]), completed a 45-minute online survey. The survey included previously tested and established subjective instruments on sleep characteristics; the Children's Sleep Habits Questionnaire (CSHQ), the Life Habits Questionnaire (LIFE-H), and Children's Physical Activity Questionnaire (CPAQ). Patterns of sleep, life habits accomplishment, and PA were described and compared between children with DS and TD. The associations of sleep indicators with life habits accomplishment, and SDB and sleep duration with obesity and PA were evaluated in a series of regression analyses. <bold>Results:</bold> The presence of SDB in a large proportion of children with DS is well documented in the literature. Sleep disturbances did impact the accomplishment of daily life habits over and above the impact of DS itself. The impact of SDB on life habits accomplishment figures prominently among eight measured domains of sleep disturbances. While children with DS had longer sleep duration compare with children with TD, SDB is a significant explanatory factor in duration of sleep among all children. Presence of SDB symptoms was associated with a 38-minute decrease in sleep duration (95% confidence interval [CI]: 12- 64 minute decrease, probability [p] =0.005). A dose response relationship was observed between overweight and SDB. Obese children (body mass index > 95th percentile) had almost a six-fold risk for presence of SDB symptoms (odds ratio [OR] =5.78, 95% CI=1.90-17.61, p=0.002). Every hour increase of moderate to vigorous PA was associated with a 13% reduction in risk of obesity (OR=0.87, 95% CI=0.78-0.96, p=0.006). <bold>Conclusions:</bold> SDB is a major contributor to compromised accomplishment of daily life habits in children with DS. Overweight and obesity are implicated in contributing to SDB. Interventions for increasing PA and reducing obesity in children with DS have the potential to decrease the symptoms of SDB and improve the accomplishment of life habits and life quality.