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Relationship between sleep, sleep apnea, and neuropsychological function in children with Down syndrome

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Abstract

Purpose

To determine whether sleep and sleep disordered breathing (SDB) contribute to the neuropsychological deficits of patients with Down syndrome, and whether treatment of SDB results in improvement in cognitive function.

Methods

In this cohort study, 25 children with Down syndrome underwent overnight polysomnography (PSG), Multiple Sleep Latency Testing (MSLT), and a battery of neuropsychological tests. Patients with SDB underwent a follow up PSG after treatment. All patients repeated the neuropsychological tests 13 months later.

Results

At baseline, there was no relationship between SDB and performance on the neuropsychological tests. However, total sleep time and sleep latency were related to tests of cognitive ability (p < 0.05) and comprehension (p < 0.01). The amount of time in slow-wave sleep correlated with tests of achievement (p < 0.01), and adaptive behavior (p < 0.01). Ten patients had SDB confirmed on PSG. Five of these patients were treated successfully with adenotonsillectomy and/or continuous positive airway pressure. The five who did not tolerate treatment were deficient in tests of adaptive behavior (Vineland p < 0.05) visual–motor integration (Beery p < 0.01) and achievement (Woodcock–Johnson p < 0.05) compared to those successfully treated. After treatment the patients improved in ratings of attention (Conners p < 0.05).

Conclusions

Although SDB is common in children with Down syndrome, it is not a major contributor to their cognitive deficits. Cognitive function is related to the amount of sleep and particularly slow wave sleep. Successful treatment of SDB may improve their attention.

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Abbreviations

CPAP:

Continuous positive airway pressure

ECG:

Electrocardiogram

EOG:

Electrooculogram

EEG:

Electroencephalogram

EMG:

Electromyogram

MSLT:

Multiple Sleep Latency Test

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

REM:

Rapid eye movement

SWS:

Slow wave sleep

SDB:

Sleep disordered breathing

AHI:

Apnea hypopnea index

DS:

Down syndrome

References

  1. Jones KL (1997) Smith’s recognizable patterns of human malformation. WB Saunders, Philadelphia, pp 8–13

    Google Scholar 

  2. Silverman M (1988) Airway obstruction and sleep disruption in Down’s syndrome. Br Med J 296:1618–1619

    Article  CAS  Google Scholar 

  3. Marcus CL, Keens TG, Baustista DB, von Pechmann WS, Ward SLD (1991) Obstructive sleep apnea in children with Down syndrome. Pediatrics 88:132–139

    CAS  PubMed  Google Scholar 

  4. Uong EC, McDonough JM, Tayag-Kier CE, Zhao H, Haselgrove J, Mahboubi S, Schwab RJ, Pack AI, Arens R (2001) Magnetic resonance imaging of the upper airway in children with Down syndrome. Am J Respir Crit Care Med 163:731–736

    Article  CAS  PubMed  Google Scholar 

  5. Stebbens VA, Dennis J, Samuels MP, Croft CB, Southall DP (1991) Sleep related upper airway obstruction in a cohort with Down’s syndrome. Arch Dis Child 66:1333–1338

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Dyken ME, Lin-Dyken DC, Poulton S, Zimmerman MB, Sedars BS (2003) Prospective polysomnographic analysis of obstructive sleep apnea in Down syndrome. Arch Pediatr Adolesc Med 157:655–660

    Article  PubMed  Google Scholar 

  7. Ng DK, Hui HN, Chan CH, Kwok KL, Chow PY, Cheung JM, Leung SY (2006) Obstructive sleep apnea in children with Down syndrome. Singap Med J 47:774–779

    CAS  Google Scholar 

  8. Shott SR, Amin R, Chini B, Heubi C, Hotze S, Akers R (2006) Should all children with Down syndrome be tested? Ach Otolaryngol Head Neck Surg 132:432–436

    Article  Google Scholar 

  9. Loughlin GM, Wynee JW, Victorica BE (1981) Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr 98:435–437

    Article  CAS  PubMed  Google Scholar 

  10. Rowland TW, Nordstrom LG, Bean MS, Burkhardt H (1981) Chronic upper airway obstruction and pulmonary hypertension in Down’s syndrome. Am J Dis Child 135:1050–1052

    CAS  PubMed  Google Scholar 

  11. Rhodes SK, Shimoda KC, Waid LJ, O’Neil PM, Oexmann MJ, Collop NA, Willi SM (1995) Neurocognitive defects in morbidly obese children with obstructive sleep apnea. J Pediatr 127:741–744

    Article  CAS  PubMed  Google Scholar 

  12. Carskadon MA, Pueschel SM, Millman RP (1993) Sleep disordered breathing and behavior in three risk groups: preliminary findings from parental reports. Childs Nerv Syst 9:452–457

    Article  CAS  PubMed  Google Scholar 

  13. Bonnet MH (1993) Cognitive effects of sleep and sleep fragmentation. Sleep 16:565–567

    Google Scholar 

  14. Roehrs T, Merrion M, Pedrosi B, Stepanski E, Zorick F, Roth T (1995) Neuropsychological function in obstructive sleep apnea syndrome (OSAS) compared to chronic obstructive pulmonary disease (COPD). Sleep 18:382–388

    CAS  PubMed  Google Scholar 

  15. Engleman HM, Martin SE, Deary IJ, Douglas NJ (1994) Effect of continuous positive airway pressure treatment on daytime function in sleep apnea/hypopnea syndrome. Lancet 343:572–575

    Article  CAS  PubMed  Google Scholar 

  16. Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Brain Information Service, Los Angeles

    Google Scholar 

  17. Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S (1986) Guidelines for the Multiple Sleep Latency Test (MSLT): a standard measure of sleepiness. Sleep 9:519–524

    CAS  PubMed  Google Scholar 

  18. Baron IS, Fennel EB, Voeller KS (1995) Pediatric neuropsychology in the medical setting. Oxford University Press, New York

    Google Scholar 

  19. Miano S, Bruni O, Elia M et al (2008) Sleep phenotypes of intellectual disability: a polysomnographic evaluation in subjects with Down syndrome and Fragile-X syndrome. Clin Neurophysiol 119:1242–1247

    Article  PubMed  Google Scholar 

  20. Bull MJ (2011) Health supervision for children with Down syndrome. Pediatrics. doi:10.1542/peds.2011-1605

    PubMed  Google Scholar 

  21. Gozal D (1998) Sleep-disordered breathing and school performance in children. Pediatrics 102:616–620

    Article  CAS  PubMed  Google Scholar 

  22. Gozal D, Pope DW (2001) Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics 107:1394–1399

    Article  CAS  PubMed  Google Scholar 

  23. Greenberg GD, Watson RK, Deputla D (1987) Neuropsychological dysfunction in sleep apnea. Sleep 10:25–262

    Google Scholar 

  24. Cheshire K, Engleman H, Deary I, Shapiro C, Douglas NJ (1992) Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch Intern Med 152:538–541

    Article  CAS  PubMed  Google Scholar 

  25. Findley LG, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Suratt PM (1986) Cognitive function in patients with obstructive sleep apnea and associated hypoxemia. Chest 90:686–690

    Article  CAS  PubMed  Google Scholar 

  26. Telakivi T, Kajaste S, Partinen M, Koskenvuo M, Salmi T, Kaprio J (1988) Cognitive function in middle-aged snorers and controls: role of excessive daytime somnolence and sleep-related hypoxic events. Sleep 11:454–462

    CAS  PubMed  Google Scholar 

  27. Decary A, Rouleau I, Montplaisir J (2000) Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery. Sleep 23:369–381

    CAS  PubMed  Google Scholar 

  28. Bucks RS, Olaithe M, Eastwood P (2013) Neurocognitive function in obstructive sleep apnoea: a meta-review. Respirology 18:61–70

    Article  PubMed  Google Scholar 

  29. Derderian SS, Bridenbaugh RH, Rajagopal KR (1988) Neuropsychological symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. Chest 94:1023–1027

    Article  CAS  PubMed  Google Scholar 

  30. Trois MS, Capone GT, Lutz JM, Melendres MC, Schwartz AR, Collop NA et al (2009) Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med 5:317–323

    PubMed Central  PubMed  Google Scholar 

  31. Hars B, Hennevin E (1987) Impairment of learning by cueing during postlearning slow-wave sleep in rats. Neurosci Lett 79:290–294

    Article  CAS  PubMed  Google Scholar 

  32. Wilhelm I, Prehn-Kristensen A, Born J (2012) Sleep-dependent memory consolidation—what can be learnt from children? Neurosci Biobehav Rev 36:1718–1728

    Article  CAS  PubMed  Google Scholar 

  33. Suen JS, Arnold JE, Brooks LJ (1995) Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 121:525–530

    Article  CAS  PubMed  Google Scholar 

  34. Strome M (1986) Obstructive sleep apnea in Down syndrome children: a surgical approach. Laryngoscope 96:1340–1342

    Article  CAS  PubMed  Google Scholar 

  35. Southall DP, Stebbens VA, Mirza R, Lang MH, Croft CB, Shinebourne EA (1987) Upper airway obstruction with hypoxaemia and sleep disruption in Down syndrome. Dev Med Child Neurol 29:734–742

    Article  CAS  PubMed  Google Scholar 

  36. Brooks LJ, Sleeper G (1991) Use of nasal CPAP by children in the home. J Sleep Res 20:212

    Google Scholar 

  37. Brooks LJ, Crooks RL, Sleeper GP (1992) Compliance with nasal CPAP by children with obstructive sleep apnea. Am Rev Respir Dis 145:A556

    Google Scholar 

  38. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification (2007) Iber C (ed) American Academy of Sleep Medicine

  39. Loube DI, Andrada T, Howard RS (1999) Accuracy of respiratory inductance plethysmography for the diagnosis of upper airway resistance syndrome. Chest 115:1333–1337

    Article  CAS  PubMed  Google Scholar 

  40. Thorndike RL, Hagen EP, Sattler JM (1986) The Stanford–Binet intelligence scale, 4th edn. Riverside Publishing Company, Rolling Meadows

    Google Scholar 

  41. Gardner R (1979) The objective diagnosis of minimal dysfunction. Creative Therapies, Cresskill

    Google Scholar 

  42. Beery KE (1989) Revised administration, scoring, and teaching manual for the Developmental Test of Visual–Motor Integration. Modern Curriculum Press, Cleveland

    Google Scholar 

  43. Woodcock R, Mather N (1989) Woodcock–Johnson tests of achievement—revised: standard and supplemental batteries. DLM Teaching Resources, Allen TX

    Google Scholar 

  44. Achenback T (1991) Manual for the child behavior checklist. Department of Psychiatry, University of Vermont, Burlington

    Google Scholar 

  45. Achenbach T (1991) Manual for the teacher report form. Department of Psychiatry, University of Vermont, Burlington

    Google Scholar 

  46. Barkley RA (1990) Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment. Gilford Press, New York

    Google Scholar 

  47. Sparrow SS, Balla DA, Cicchetti DV (1984) Vineland Adaptive Behavior Scales. American Guidance Service, Circle Pines

    Google Scholar 

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Acknowledgements

This work was funded by a grant from the American Lung Association of Ohio.

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Authors and Affiliations

  1. Division of Pulmonary Medicine, Sleep Center, Children’s Hospital of Philadelphia, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Lee J. Brooks & Sofia Konstantinopoulou

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Lee J. Brooks & Molly N. Olsen

  3. Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA

    Ann Mary Bacevice, Andrea Beebe & H. Gerry Taylor

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  1. Lee J. Brooks
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Correspondence to Lee J. Brooks.

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Brooks, L.J., Olsen, M.N., Bacevice, A.M. et al. Relationship between sleep, sleep apnea, and neuropsychological function in children with Down syndrome. Sleep Breath 19, 197–204 (2015). https://doi.org/10.1007/s11325-014-0992-y

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