Sleep assessment in adults with Down syndrome: correlation between functionality and polysomnographic findings

Abstract

Background Sleep disorders have a negative impact on health, being associated with neurocognitive problems, cardiovascular diseases and obesity, influencing children's development and learning.

Objective To assess the sleep pattern of people with Down syndrome (DS) and correlate changes with functionality and behavior.

Methods A cross-sectional study was conducted to evaluate the sleep pattern in adults with DS > 18 years old. Twenty-two participants were assessed using the Pittsburgh Sleep Quality Index, the Functional Independence Measure and the Strengths and Difficulties Questionnaire, and the 11 who presented indications of disorders by the screening questionnaires were referred to polysomnography. Statistical tests were performed using a significance level of 5%, including sample normality tests and correlation tests (sleep and functionality).

Results Impairment in sleep architecture was found due to an increase in the rate of awakenings in 100% of the participants, a decrease in the number of slow waves, and a high prevalence of sleep disordered breathing (SDB), with higher averages in the Apnea and Hypopnea Index (AHI) in the group. There was a negative correlation between sleep quality and global functionality (p = 0.011) and the motor (p = 0.074), cognitive (p = 0.010), and personal care (p = 0.072) dimensions in the group. Global and hyperactivity behavior changes were related to worse sleep quality (p = 0.072; p = 0.015, respectively).

Conclusion There is an impairment in the sleep quality of adults with DS, with an increase in the rate of awakenings, a decrease in the number of slow waves, and a high prevalence of SDB affecting this population in the functional and behavioral aspects.

Resumo

Antecedentes Os distúrbios de sono têm impacto negativo na saúde, estando associados a problemas neurocognitivos, doenças cardiovasculares e obesidade, influenciando no desenvolvimento e aprendizado.

Objetivo Avaliar o padrão de sono de pessoas com síndrome de Down (SD) e correlacionar as alterações com a funcionalidade e comportamento.

Métodos Foi realizado um estudo transversal para avaliação do padrão de sono em adultos com SD > 18 anos. Foram avaliados 22 participantes, através do Índice de Qualidade do Sono de Pittsburgh, da Medida de Independência Funcional e do Questionaário de Capacidades e Dificuldades. Os 11 participantes que apresentaram indicativos de presença de distúrbios pelos questionários de triagem foram indicados a polissonografia. Os testes estatísticos foram realizados com nível de significância de 5%, incluindo testes de normalidade e testes de correlação (sono e funcionalidade).

Resultados Foi encontrado prejuízo na arquitetura de sono pelo aumento do índice de despertares em 100% dos participantes, diminuição na quantidade de ondas lentas, e alta prevalência de distúrbio respiratório do sono (DRS), com maiores médias nos Índices de Apneia e Hipopneia (IAH). Houve correlação negativa entre a qualidade de sono e a funcionalidade global (p = 0,011), e as dimensões motora (p = 0,074), cognitiva (p = 0,010) e cuidados pessoais (p = 0,072). As alterações de comportamento global e comportamentos de hiperatividade foram relacionados à pior qualidade do sono (p = 0,072; p = 0,015, respectivamente).

Conclusão Existe prejuízo na qualidade de sono de adultos com SD, com aumento de índice de despertares, diminuição na quantidade de ondas lentas, e alta prevalência de DRS, afetando essa população nos aspectos funcionais e comportamentais.

Keywords

Down Syndrome - Sleep - Sleep Wake Disorders - Polysomnography - Physical Functional Performance

Palavras-chave

Síndrome de Down - Sono - Transtornos do Sono-Vigília - Polissonografia - Desempenho Físico Funcional

Authors' Contributions

MRC: conceptualization, methodology, investigation, data curation, writing - original draft, writing - review & editing; KBS, BVO, ARAA: investigation; RC: formal analysis and data curation; SMBA: conceptualization, methodology, investigation, data curation, writing - review & editing, project administration, and funding acquisition.

Support

The present study was funded by the Mackenzie Research and Innovation Fund (Mackpesquisa) – Mackenzie Presbyterian Institute (MPI). The MPI had no influence on study design, data acquisition, analyses, interpretation, and reporting.

Publication History

Received: 31 October 2022

Accepted: 23 January 2023

Article published online:
28 June 2023

• References

• 1 Kruszka P, Porras AR, Sobering AK. et al. Down syndrome in diverse populations. Am J Med Genet A 2017; 173 (01) 42-53
• 2 Grieco J, Pulsifer M, Seligsohn K, Skotko B, Schwartz A. Down syndrome: Cognitive and behavioral functioning across the lifespan. Am J Med Genet C Semin Med Genet 2015; 169 (02) 135-149
• 3 Churchill SS, Kieckhefer GM, Landis CA, Ward TM. Sleep measurement and monitoring in children with Down syndrome: a review of the literature, 1960-2010. Sleep Med Rev 2012; 16 (05) 477-488
• 4 Maris M. Verhulst s, Wojciechowski M, Van de Heyning P, Boudewyns A. Sleep problems and obstructive sleep apnea in children with down syndrome, an overview. Int J Pediatr Otorhinolaryngol 2016; 82: 12-15
• 5 da Rocha M, Ferraz RCM, Guo Chen V, Antonio Moreira G, Raimundo Fujita R. Clinical variables determining the success of adenotonsillectomy in children with Down syndrome. Int J Pediatr Otorhinolaryngol 2017; 102: 148-153
• 6 Santos RA, Costa LH, Linhares RC, Pradella-Hallinan M, Coelho FMS, Oliveira GDP. Sleep disorders in Down syndrome: a systematic review. Arq Neuropsiquiatr 2022; 80 (04) 424-443
• 7 Breslin JH, Edgin JO, Bootzin RR, Goodwin JL, Nadel L. Parental report of sleep problems in Down syndrome. J Intellect Disabil Res 2011; 55 (11) 1086-1091
• 8 Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A. Prevalence of obstructive sleep apnea in children with Down syndrome. Sleep 2016; 39 (03) 699-704
• 9 Churchill SS, Kieckhefer GM, Bjornson KF, Herting JR. Relationship between sleep disturbance and functional outcomes in daily life habits of children with Down syndrome. Sleep 2015; 38 (01) 61-71
• 10 Giménez S, Videla L, Romero S. et al. Prevalence of Sleep Disorders in Adults With Down Syndrome: A Comparative Study of Self-Reported, Actigraphic, and Polysomnographic Findings. J Clin Sleep Med 2018; 14 (10) 1725-1733
• 11 Bertolazi AN, Fagondes SC, Hoff LS. et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 2011; 12 (01) 70-75
• 12 Riberto M, Miyazaki MH, Jucá SSH, Sakamoto H, Pinto PPN, Battistella LR. Validação da Versão Brasileira da Medida de Independência Funcional. Acta Fisiatr 2004; 11 (02) 72-76
• 13 Fleitlich B, Cortazar PG, Goodman R. Questionário de Capacidades e Dificuldades (SDQ). Rev Infanto Neuropsiquiatr Infânc Adolesc. 2000; 8 (01) 44-50
• 14 Glenn S, Cunningham C, Nananidou A, Prasher V, Glenholmes P. Using the strengths and difficulties questionnaire with adults with Down syndrome. Res Dev Disabil 2013; 34 (10) 3343-3351
• 15 Berry RB, Budhiraja R, Gottlieb DJ. et al; American Academy of Sleep Medicine, Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 2012; 8 (05) 597-619
• 16 Togeiro SMGP, Smith K. Métodos diagnósticos nos distúrbios do sono. Bras J Psiquiatr. 2005; 27 (supl I): 8-15
• 17 Figueiredo Filho DB, Silva Júnior JA. Desvendando os Mistérios do Coeficiente de Correlação de Pearson (r). Rev Política Hoje 2009; 18 (01) 115-146
• 18 Lee KA, Landis C, Chasens ER. et al. Sleep and chronobiology: recommendations for nursing education. Nurs Outlook 2004; 52 (03) 126-133
• 19 Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol 2019; 19 (11) 702-715
• 20 Trois MS, Capone GT, Lutz JA. et al. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med 2009; 5 (04) 317-323
• 21 Carvalho AA, Amorim FF, Santana LA, Almeida KJQ, Santana ANC, Neves FAR. STOP-Bang questionnaire should for moderate to severe obstructive sleep apnea. PLoS One 2020; 15 (05) ):
• 22 Ridore S, Debbarma S, Nazir R, Bennett DS, Sedky K. Obstructive sleep apnea in individuals with Down syndrome: a meta-analytic literature review. Journal of Sleep and Sleep Disorder Research 2017; 1 (02) 1-15
• 23 Stores RJ. Sleep problems in adults with Down syndrome and their family carers. J Appl Res Intellect Disabil 2019; 32 (04) 831-840
• 24 Covelli V, Raggi A, Meucci P, Paganelli C, Leonardi M. Ageing of people with Down's syndrome: a systematic literature review from 2000 to 2014. Int J Rehabil Res 2016; 39 (01) 20-28
• 25 Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146 (05) 1387-1394
• 26 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010; 11 (05) 441-446
• 27 Catterall JR, Calverley PM, Shapiro CM, Flenley DC, Douglas NJ. Breathing and oxygenation during sleep are similar in normal men and normal women. Am Rev Respir Dis 1985; 132 (01) 86-88
• 28 Capone GT, Aidikoff JM, Taylor K, Rykiel N. Adolescents and young adults with Down syndrome presenting to a medical clinic with depression: co-morbid obstructive sleep apnea. Am J Med Genet A 2013; 161A [phone]
• 29 Al-Sharman A, Siengsukon CF. Performance on a functional motor task is enhanced by sleep in middle-aged and older adults. J Neurol Phys Ther 2014; 38 (03) 161-169