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Up to 60% of children with Down syndrome may have a sleep disorder according to a study performed by the University of Michigan in 2009.  The study also revealed that children aged 5-9 were more likely to exhibit inefficient sleep compared to older or younger children with Down Syndrome and that all children with Down  syndrome experienced a significant amount of disrupted sleep compared to typical children.  It is important for healthcare professionals and parents  to recognize the signs and symptoms that accompany sleep disorders among children with Down syndrome so  they can seek appropriate treatment.

Obstructive sleep apnea, is when people stop breathing or experience blocked or shallow breathing during sleep, generally due to an obstruction of the airway.  Obstructive Sleep Apnea in children with Down syndrome may be caused by a small upper airway, enlarged adenoids and tonsils, collapsing throat muscles, large tongues and other health issues. Children with Down syndrome also tend to have poor muscle tone in the upper airway that can sometimes cause their tongue to relax, blocking their airway at night. 

Often, a child with Down syndrome who also has a sleep disorder may go untreated because it may be difficult to distinguish the symptoms.  Children who have Obstructive Sleep Apnea may exhibit failure to thrive (weight loss or poor weight gain), mouth breathing, enlarged tonsils and adenoids, problems sleeping and restless sleep.  They may also exhibit excessive daytime sleepiness, daytime cognitive and behavior problems, including problems paying attention, and aggressive behavior and hyperactivity.

It’s important to diagnose and treat sleep  disorders in children to eliminate and/or manager other health issues.  Efficient sleep has been proven to be a major factor in the healthy growth of all children. 

The true diagnosis for a sleep disorder must be conducted in a sleep laboratory under the care of a sleep technologist during a procedure called a sleep study.  During a sleep study, a trained sleep technologist applies leads and electrodes to the body that will allow for monitoring of oxygen levels, heart rate, sleep staging and limb movements during the night.  Sleep studies may be conducted in a hospital or a free standing lab. Unlike the hospital, some free standing facilities, like Valley Sleep Center, provide a home-like environment with a private room and bathroom for patients.  This sometimes helps to alleviate the stress and anxiety that can occur from a clinical hospital setting. 

The treatment of a sleep disorder will vary depending on the diagnosis of the study.  Some treatments may include throat surgery in which the tonsils or adenoids are removed.  These soft tissues in the throat may be obstructing the airway during the night and will need to be removed by an ear nose and throat specialist. It is important to note, however, that this is not always the most effective form of treatment and children with Down syndrome may be at higher risk for post-surgical complications. 

Another  common and therapeutic form of treatment is with the use of CPAP also known as continuous positive airway pressure.  CPAP is the application of a mask during the night that provides an air pressure to the airway to eliminate the obstruction that causes frequent awakenings during the night.  Although very effective, CPAP may be more challenging for children with Down syndrome because of their struggles to comply with the therapy.  It can be difficult for an adult with sleep apnea to get used to using a CPAP machine.  However, children with Down syndrome may need extra help and attention from parents or caretakers to ensure they’re using the machine. Getting used to the machine does not happen overnight.   Practice and patience are keys to a restful night.

Sleep disorders can occur at any age.  Because children with Down syndrome have an increased risk of sleep abnormalities, in 2001 the American Academy of Pediatrics recommend that primary care physicians question parents about possible sleep disorders when the children are five years old and older. However, no recommendations are made for specific testing. This study recommends objective testing by polysomnography, or sleep study, in all children with Down syndrome.

For children, it’s important that parents and healthcare professionals assist in the progress of treatment, especially where CPAP may be needed.  If you think your child may be experiencing a sleep disorder consult with your pediatrician or a sleep specialist to get appropriate treatment. 

Since 2002, Valley Sleep Center has provided Arizona with diagnostic sleep disorder testing in a home-like atmosphere, ensuring a comfortable, relaxing experience for their patients.  Their physicians are Board Certified Sleep Medicine Specialists and are accredited by the American Academy of Sleep Medicine.  They provide diagnostic testing for a multitude of sleep-related disorders including insomnia, sleep apnea, snoring, excessive day time sleepiness, hypertension, sleepwalking and pediatric sleep problems. For information contact Lauri Leadley at 480-830-3900.
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