What I'm reading...Note the UK recommendations that ALL children have a pediatric sleep specialist see them until 5 years.....JR

Sleep disorders and their clinical significance in children with Down syndrome

1. GREGORY STORES¹, 
2. REBECCA STORES²

Article first published online: 2 SEP 2012

Aim  Our aim was to review basic aspects of sleep disorders in children with Down syndrome in the light of present-day findings of such disorders in children in general, including other groups of children with developmental disabilities.

Methods  A literature search of adverse developmental effects of sleep disturbance, types of sleep disturbance in children with Down syndrome, their aetiology, including possible contributions of physical and psychiatric comorbidities and medication effects, principles of assessment and diagnosis, and treatment issues, was carried out.

Results  Sleep disturbance is particularly common in children with developmental disorders including Down syndrome. Although there are just three basic sleep problems (sleeplessness or insomnia, excessive daytime sleepiness, and parasomnias) there are many possible underlying causes (sleep disorders), the nature of which dictates the particular treatment required. In children with Down syndrome, in addition to the same influences in other children, various comorbid physical and psychiatric conditions are capable of disturbing sleep. Possible adverse medication effects also need to be considered.

Interpretation  Screening for sleep disorders and their causes should be routine; positive findings call for detailed diagnosis. Management should acknowledge the likely multifactorial aetiology of the sleep disorders in Down syndrome. Successful treatment can be expected to alleviate significantly the difficulties of both child and family.

Abbreviation

OSA

Obstructive sleep apnoea, obstructive sleep apnea

What this paper adds

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   This paper draws attention to the multifactorial nature of sleep disorders in children with Down syndrome.
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   Sleep disorders are linked with their origins, including comorbid conditions and medication effects.
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   Routine repeated clinical screening for sleep disorders and their possible causes is encouraged.
  
  
  "Compared with the rate in typically developing children, overall rates reported for children with Down syndrome have varied from 31% to 54%. This increased rate was generally similar to that reported in other learning disability^† syndromes (although particularly high rates are given for some neurodevelopmental disorders such as Smith–Magenis syndrome and, to a lesser extent, Angelman syndrome)."
  
  
  "However, screening for sleep symptoms simply highlights the possibility of a sleep disorder and does not constitute a diagnosis. 

  Adequate identification of a sleep disorder requires comprehensive clinical enquiry consisting of detailed histories especially about the sleep problem, the child’s 24-hour sleep–wake pattern including parenting practices, developmental details, family history, and family circumstances.⁵⁴ 

  Both physical and behavioural examination may well be appropriate, and possibly further assessment in the form of sleep diary records and objective sleep studies such as actigraphy or polysomnography. Referral for assessment at a specialist paediatric service or sleep disorders clinic may be needed. 

  The Royal College of Paediatrics and Child Health report³⁷ recommended regular screening for overnight hypoxia in infants with Down syndrome until the age of 5 years."
  
  
  Link to article here