Elsevier

Sleep Medicine Reviews

Volume 16, Issue 5, October 2012, Pages 477-488
Sleep Medicine Reviews

Clinical review
Sleep measurement and monitoring in children with Down syndrome: A review of the literature, 1960–2010

https://doi.org/10.1016/j.smrv.2011.10.003Get rights and content

Summary

Children with Down syndrome (DS) are at risk for sleep disturbances due to the anatomical features of the syndrome. Over the past 50 years research studies have measured sleep in children with DS to characterize sleep architecture and its relation to developmental delay. In the 1980s sleep disordered breathing (SDB) was recognized as a major cause of sleep disturbance in DS. The aim of this comprehensive review is to synthesize studies and present the historical context of evolving technologies, methodologies, and knowledge about SDB and DS. Future research opportunities and practice implications are discussed.

Section snippets

Objective

Published accounts of sleep research in Down syndrome (DS) have appeared in the literature since the 1960s. The purpose and methodologies of the studies have been diverse, each contributing differently to the current state of the science on sleep in DS. To our knowledge, a comprehensive synthesis of research findings about sleep and its characteristics in children with DS has not been published. The goal of this manuscript is to critically review and synthesize the history, methodologies, and

Style and selection criteria of review

This review employs an inclusive methodology and narrative style to comprehensively examine previous accomplishments of sleep research in children with DS. As such it differs from a traditional quantitative systematic review which would focus on a well-defined question, narrowly focused on selective research with conforming measures. Because previous sleep research in children with DS asked diverse questions, implemented a variety of methodologies and standardized sleep monitoring and scoring

Basic research – measurement of sleep architecture in relation to intellectual disability

The first studies of sleep in DS described normal and abnormal sleep architecture. In basic research, DS presented a homogeneous group with respect to etiology of DD, with well-defined physical characteristics and was considered representative of DD.*28, *29, 31, 34 Studies reported 3 to 5 sleep cycles alternating between non-rapid-eye movement (NREM) sleep and rapid eye movement (REM) sleep. REM sleep had been discovered in the early 1950s, and since the 1960s a link had been observed between

Discussion

In examining sleep in children with DS, it is important to consider the measurement of sleep in the context of advancing technology, varying research methodologies and research ethics, changing attitudes about DS, and different cultural and geographic settings. Some of the research studies in this review, though probably conforming to the standards of the day, would not be acceptable in today's regulatory and ethical environment.

Often early studies did not specify recruitment methods and were

Conclusions

Recent studies emphasize the importance of childhood determinants of health in adulthood.64 Because of the longer life expectancy in children with DS, it is important to maximize comprehensive health in their childhood to build a foundation for their adult health. Optimal sleep is essential for health, yet studies to date consistently report sleep concerns in children with DS. Many studies lack a theoretical framework to explain the overall picture of sleep problems in children with DS. Prior

Acknowledgments

Biobehavioral Nursing Research Training Grant National Institute of Nursing Research T32 NR007106 (SSC, CAL). HRSA Division of Maternal Child Health T32 0007 (SSC, GMK). Center for Research on Management of Sleep Disturbances. NINR, NR011400 (GMK, CAL, TMW). The authors wish to thank Dean D. Churchill, Ph.D., for his critical review and comments in the early stages of developing this manuscript. Also, the authors wish to thank Jean Krieger, M.D., Ph.D., for his thorough review and comments on

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      An increasingly recognised important additional comorbidity in this group are sleep disorders [4,5]. Obstructive sleep apnoea (OSA) is common in the DS population [4,6] with prevalence estimates ranging widely from 24 to 59% in studies from community samples. A recent meta-analysis reported prevalence rates as high as 69–76% [4,6,7].

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