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Sleep disorders in children with Down syndrome
Author(s) -
Kawada Tomoyuki
Publication year - 2013
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12165
Subject(s) - actigraphy , polysomnography , sleep (system call) , psychology , insomnia , down syndrome , sleep diary , psychiatry , physical therapy , medicine , electroencephalography , computer science , operating system
SIR–Stores and Stores recently provided an overview of sleep problems in children with Down syndrome. Their purpose was to elucidate the wide spectrum of sleep disorders and a quantitative summary by meta-analysis was not conducted given the limited information available. I have some concerns regarding their report and present the following comments or proposals. First, they recommended sleep monitoring by polysomnography or actigraphy to evaluate quality of sleep. But there are difficulties in conducting physiological monitoring of sleep in children with Down syndrome, which is also observed in children with other developmental disabilities. I have personal experience of the technical problems in continuous monitoring by actigraphy for children with severe disabilities including those with Down syndrome. On this point, Paasch et al. recently reported practical and useful advice for the successful monitoring of children with neurodevelopmental disabilities using electroencephalography and polysomnography. Second, from the definition of insomnia, subjective problems on sleep induction, sleep maintenance, and early morning awakening are also difficult to ascertain by personal report in children with Down syndrome. As an alternative, sleep diary records by parents would be appropriate for children with Down syndrome or other developmental disabilities. Subjective and objective sleep parameters have different meanings for monitoring sleep, and objective sleep parameters from actigraphy in participants with sleep disorders does not always reflect actual sleep status. This problem could be resolved by distinguishing between brain activity using sleep polysomnography and body movement during sleep using actigraphy. Compensatory behaviour such as taking a nap is important when night sleep is not sufficient for children with Down syndrome. When sleep monitoring by actigraphy is conducted, the cut-off point in sensitivity of actigraphy is also important in making a valid sleep/wake evaluation, and validation of actigraphy should also be checked for the target population. Ultimately, the management of sleep disorders in Down syndrome is of critical importance for the children themselves and for their family members.