Young children with Down syndrome show normal development of circadian rhythms, but poor sleep efficiency: a cross-sectional study across the first 60 months of life

Abstract

ObjectivesTo evaluate sleep consolidation and circadian activity rhythms in infants and toddlers with Down syndrome (DS) under light and socially entrained conditions within a familiar setting. Given previous human and animal data suggesting intact circadian regulation of melatonin across the day and night, it was hypothesized that behavioral indices of circadian rhythmicity would likewise be intact in the sample with DS.MethodsA cross-sectional study of 66 infants and young children with DS, aged 5–67 months, and 43 typically developing age-matched controls. Sleep and measures of circadian robustness or timing were quantified using continuous in-home actigraphy recordings performed over seven days. Circadian robustness was quantified via time series analysis of rest-activity patterns. Phase markers of circadian timing were calculated alongside these values. Sleep efficiency was also estimated based on the actigraphy recordings.ResultsThis study provided further evidence that general sleep quality is poor in infants and toddlers with DS, a population that has sleep apnea prevalence as high as 50% during the preschool years. Despite poor sleep quality, circadian rhythm and phase were preserved in children with DS and displayed similar developmental trajectories in cross-sectional comparisons with a typically developing (TD) cohort. In line with past work, lower sleep efficiency scores were quantified in the group with DS relative to TD children. Infants born with DS exhibited the worst sleep fragmentation; however, in both groups, sleep efficiency and consolidation increased across age. Three circadian phase markers showed that 35% of the recruitment sample with DS was phase-advanced to an earlier morning schedule, suggesting significant within-group variability in the timing of their daily activity rhythms.ConclusionsCircadian rhythms of wake and sleep are robust in children born with DS. The present results suggest that sleep fragmentation and any resultant cognitive deficits are likely not confounded by corresponding deficits in circadian rhythms.

Distribution and age of onset of psychopathological risk in a cohort of children with Down syndrome in developmental age

“…In the 0–2 years age group, we found no evidence of autistic behaviors, opposite provocative disorders, attention deficit/hyperactivity disorders nor externalizing or internalizing symptoms. However, consistent with the literature, we observed sleep disorders in 25% of cases (4 out of 16) [7] and mastication dysfunction in 12.5% of children (2 out of 16) [6]. Between 2 and 3 years of age, ODD behavior and anxiety arise.…”

Alterations of specific cortical GABAergic circuits underlie abnormal network activity in a mouse model of Down syndrome

“…The increase in β-γ-band power and enhanced neural synchronization in these frequency ranges in Ts mice is consistent with recent evidence indicating augmented hippocampal-PFC synchronization and LFP γ-band power during natural non-REM sleep in Ts65Dn mice ( Alemany-González et al, 2020 ). This suggests that the alterations of γ-oscillations observed here could play a role in the pathophysiology of sleep disruptions reported in DS children ( Fernandez et al, 2017 ) and adults ( Giménez et al, 2018 ).…”

Cardiorespiratory sleep studies at home: experience in research and clinical cohorts

“…Overall, an average of 1.2–1.3 home studies per child was required to achieve adequate data. This is encouraging, particularly as the largest group was young children with Down syndrome who are often restless sleepers23 and can be challenging to study. These data suggest that home CRPG is feasible and offers a realistic option for diagnostic testing in children.…”