Sleep disturbances in individuals with down syndrome: An overview.

Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.

Examination of Risk for Sleep-Disordered Breathing Among College Football Players.

CONTEXT: Professional football linemen are at risk for sleep-disordered breathing (SDB) compared with other types of athletes. It is currently unknown whether college football linemen display a similar risk profile. OBJECTIVE: (1) To determine for the first time whether college football linemen show risk for SDB and (2) test the hypothesis that SDB risk is higher in college football linemen compared with an athletic comparison group. DESIGN: Descriptive laboratory study. SETTING: The Health Risk Assessment Laboratory. PARTICIPANTS: Male football linemen (n = 21) and track (n = 19) Division I athletes between the ages of 18 and 22 years. INTERVENTIONS: Participants completed the Multivariable Apnea Prediction Index and Epworth Sleepiness Scale surveys, validated measures of symptoms of sleep apnea and daytime sleepiness, respectively. Neck and waist circumferences, blood pressure, Modified Mallampati Index (MMPI), and tonsil size were determined, followed by body composition assessment using dual-energy X-ray absorptiometry. MAIN OUTCOME MEASURES: Scores from surveys, anthropometric data, MMPI, and body composition. RESULTS: Survey data demonstrated a deficiency in sleep quality and efficiency, coinciding with increased self-reported symptoms of apnea (Multivariable Apnea Prediction Index = 0.78) in college linemen relative to track athletes. Neck circumference (44.36 cm), waist circumference (107.07 cm), body mass index (35.87 kg/m2), and percent body fat (29.20%), all of which exceeded the clinical predictors of risk for obstructive sleep apnea, were significantly greater in linemen compared with track athletes. Multivariable Apnea Prediction variables were significantly correlated with MMPI, neck circumference, percent body fat, body mass index, and systolic blood pressure (r ≥ .31, P < .05), indicating that college football linemen are at increased risk for SDB. CONCLUSIONS: Risk factors for SDB recognized in professional football linemen are also present at the college level. Screening may minimize present or future risk for SDB, as well as the downstream risk of SDB-associated metabolic and cardiovascular disease.

Direct and Indirect Associations of Sleep Knowledge and Attitudes With Objective and Subjective Sleep Duration and Quality via Sleep Hygiene.

Although a few studies have examined sleep knowledge and attitudes as predictors of sleep behavior, the question of which better predicts actual sleep behavior is still open. Furthermore, the construct of sleep attitudes has been inconsistently defined and measured. We examined both sleep knowledge and attitudes to determine their unique associations with sleep hygiene behaviors, and direct and indirect associations with objective and subjective sleep outcomes. College students (N = 218) completed a series of questionnaires before and after wearing a FitBit Flex accelerometer for 7 days. We collected objective sleep duration and quality using this apparatus, while participants reported subjective sleep outcomes, hygiene behaviors, knowledge, and attitudes. Analyses controlled for self-reported depression, diagnosed sleep disorder, and sleep-related medications. For both objective and subjective measures, more positive sleep attitudes but not greater sleep knowledge was directly associated with longer sleep duration, and indirectly (through sleep hygiene) with better sleep quality. The role of sleep attitudes in sleep-related behaviors and outcomes deserves further investigation as a potentially modifiable factor in sleep intervention efforts.

Sleep characteristics, body mass index, and risk for hypertension in young adolescents.

Inadequate sleep has been identified as a risk factor for a variety of health consequences. For example, short sleep durations and daytime sleepiness, an indicator of insufficient sleep and/or poor sleep quality, have been identified as risk factors for hypertension in the adult population. However, less evidence exists regarding whether these relationships hold within child and early adolescent samples and what factors mediate the relationship between sleep and risk for hypertension. Using data from the Study of Early Child Care and Youth Development, the present study examined body mass index (BMI) as a possible mediator for the effects of school-night sleep duration, weekend night sleep duration, and daytime sleepiness on risk for hypertension in a sample of sixth graders. The results demonstrated gender-specific patterns. Among boys, all three sleep characteristics predicted BMI and yielded significant indirect effects on risk for hypertension. Oppositely, only daytime sleepiness predicted BMI among girls and yielded a significant indirect effect on risk for hypertension. The findings provide clarification for the influence of sleep on the risk for hypertension during early adolescence and suggest a potential need for gender-specific designs in future research and application endeavors.

Sleep and Risk for Metabolic Syndrome, Hypertension, Diabetes and Obesity Among Community-Dwelling Older Adults.

Older adults often face a variety of health problems that are found less frequently in younger populations. Metabolic syndrome and other related diseases are common due to a variety of age and lifestyle factors. Sleep, often operationalized only as duration, quality, or apnea diagnosis, is associated with worse health outcomes across the lifespan. However, sleep is multi-faceted and may require a collection of measures in order to reflect this. This study examined a suite of self-reported sleep habits (risk for sleep apnea, night time duration, nap duration, quality, timing, and consistency of duration and timing) and physiological data in a sample of 144 older adults. Sleep-related variables as a group predicted risk for metabolic syndrome, hypertension, and diabetes but was not a clear predictor of obesity. Of the individual measures, risk for apnea and consistency of sleep duration throughout the week predicted risk for metabolic syndrome (apnea b = .64, p < .05; duration inconsistencies b = .22, p < .05). The findings of the study suggest that greater consistency in sleep schedules may benefit the health of older adult populations' risk for these disorders.

Sleep attitudes as a predictor of sleep outcomes: a secondary data analysis.

OBJECTIVES: Attitudes have been widely studied as predictors of a number of social and health behaviors. However, attitudes predicting sleep outcomes have only recently been examined, despite sleep being conceptualized as an important health behavior. Prior research has demonstrated that attitudes toward sleep are associated with sleep hygiene, sleep duration and quality (Peach & Gaultney, 2017; Peach, Gaultney, Ruggiero, 2018). Sleep attitudes interact with varying demographic identities, such as age, gender, race, and perceived socioeconomic status (SES) (Ruggiero, Peach, & Gaultney, 2019). The present study hypothesized that (1) sleep attitudes would be indirectly associated with sleep outcomes (duration and quality) via sleep hygiene, and, (2) this indirect effect would be modified by specific demographic variables (age, gender, race, and perceived SES; moderated mediation). METHOD: One hundred and seventy-two adults from the United States completed an anonymous survey on sleep characteristics and health. RESULTS: Results confirmed the first hypothesis, indicating that sleep attitudes were significantly and indirectly associated with both sleep duration and sleep quality via sleep hygiene. Additionally, gender and SES further modified these significant indirect effects, meaning hypothesis two was partially supported. CONCLUSIONS: Results are discussed in terms of their implications for the importance and variability of sleep attitudes, and future research directions are considered.

Parents of children with periodic limb movement disorder versus sleep-disordered breathing report greater daytime mood and behavior difficulties in their child: the importance of using ICSD-2nd Edition criteria to define a PLMD study group.

Data from 249 children referred to a pediatric sleep clinic were analyzed. The first question of interest examined whether an International Classification of Sleep Disorders-Second Edition (ICSD-2)-based diagnosis of periodic limb movement disorder (PLMD) or sleep-disordered breathing (SDB) would more strongly associate with parental perceptions of daytime attention and behavior problems in their child. The second question was whether the outcome would differ based on PLMD diagnostic criteria-that is, previously used criteria to define PLMD (Periodic Limb Movement Index [PLMI] < 5 per hour vs. PLMI >or= 5 per hour only) versus the ICSD-2 criteria. Parents of children with ICSD-2-defined PLMD perceived more problems with daytime behavior and attention, more symptoms of internalizing and externalizing, longer sleep latency, and more difficulty falling back to sleep than did parents of children with SDB. Most effects were lost when groups were defined by PLMI alone. The PLMI had acceptable sensitivity but low specificity in diagnosing PLMD.

Possible insomnia predicts some risky behaviors among adolescents when controlling for depressive symptoms.

This study investigated whether previously reported links between sleep and risk taking among adolescents (E. M. O'Brien & J. A. Mindell, 2005) are associated-concurrently, longitudinally, or both-with sleep or underlying depression. The present study analyzed data from a nationally representative sample of 4,353 adolescents in the United States who had participated in Waves I and II of the National Longitudinal Study of Adolescent Health (J. R. Udry, 1998). In the present study, grade, gender, depressive symptoms, and possible insomnia served as predictor variables to calculate the odds ratios for 4 categories of risky behaviors. After the authors accounted for other predictors, possible insomnia significantly predicted smoking, delinquency (within each wave but not longitudinally), and drinking and driving (Wave II and longitudinally). Possible insomnia may contribute to some types of risky behaviors over the effects of depressive symptoms.

Association of sleep attitudes with sleep hygiene, duration, and quality: a survey exploration of the moderating effect of age, gender, race, and perceived socioeconomic status.

OBJECTIVES: Sleep health is becoming more widely accepted as a possible preventative strategy against chronic disease and negative psychosocial outcomes. It is important to understand whether attitudes towards sleep vary by demographic characteristics and how potential differences in sleep attitudes could impact sleep outcomes. The present study examined whether there were demographic differences in sleep attitudes and whether the interaction between demographic characteristics and sleep attitudes impacted sleep outcomes (e.g. sleep hygiene, duration, and quality). METHODS: One hundred seventy-two adults from across the United States completed an anonymous survey on sleep and health. RESULTS: Sleep attitudes varied according to age, gender, and race, with more positive sleep attitudes reported by older adults, women, and those who identified as White. Although positive sleep attitudes predicted more sleep and better quality sleep, this association varied as a function of several demographic characteristics. A more complex picture arose for the interaction between demographics and sleep attitudes predicting sleep outcomes. CONCLUSIONS: Future research should continue to discover for whom favorable sleep attitudes are beneficial and explore when and how sleep attitudes may be altered.

Charlotte Attitudes Towards Sleep (CATS) Scale: A validated measurement tool for college students.

OBJECTIVE: Using a 4-phase study design, the present study developed and tested the Charlotte Attitudes Towards Sleep (CATS) Scale, a measurement tool for assessing sleep attitudes in college students. PARTICIPANTS: Participants were 706 undergraduate students recruited at a southeastern university and on a national recruitment Web site between October 2013 and April 2015. METHODS: All participants completed the CATS Scale. Participants then completed either a measure of social desirability, faulty sleep beliefs, or measures of sleep and sleep hygiene. Phase 3 participants (N = 168) completed the CATS Scale 2 weeks later to examine test-retest reliability. RESULTS: Analyses indicated that the scale was content valid, internally consistent, and independent of social desirability, yielded acceptable temporal stability, and demonstrated concurrent validity in relation to sleep behaviors and outcomes. CONCLUSIONS: The CATS Scale is a theoretically driven instrument with promising psychometric properties that may prove beneficial for future research and application efforts among college students.

Fetal rate of behavioral inhibition and preference for novelty during infancy.

BACKGROUND: Correlations between infant measures of information processing and later IQ have been established, and a few studies have extended this continuum by examining links between various fetal measures and cognitive measures during infancy. AIMS: This study compared fetal rate of behavioral habituation among infants identified as at high or low cognitive risk. STUDY DESIGN: This study was a retrospective examination of differences in fetal rate of behavioral habituation as a function of cognitive risk status at 6.5 and 9 months postpartum, using an independent two-group design. SUBJECTS: Participants were 32 infants who were born between 36 and 42 weeks gestational age at normal birth weight and had normal APGAR scores. OUTCOME MEASURES: The Fagan Test of Infant Intelligence (FTII) was used to obtain a measure of preference for novelty, which served as the basis for identification of infants at high or low risk for cognitive difficulty. These infants had undergone up to three habituation trials using a vibroacoustic stimulus during fetal development. RESULTS: Infants who were classified as being at high cognitive risk at 6 months had required more trials to habituation as fetuses. CONCLUSIONS: Fetal rate of behavioral habituation is associated with information processing during the first 6 months of infancy. We suggest that fetal habituation may be influenced by early cognitive mechanisms and therefore represents an immature but real form of information processing.

Prenatal cocaine exposure and infants' preference for novelty and distractibility.

The authors used the Fagan Test of Infant Intelligence (J. F. Fagan, L. T. Singer, J. E. Montie, & P. A. Shepherd, 1986) to examine preferences for novelty and to evaluate several indicators of attention (off- and on-task indexes and durations) in 6- and 9-month-old infants who had been prenatally exposed to cigarette smoke only or to cocaine plus other substances. The infants were matched for socioeconomic status. The authors found no group differences in preference for novelty, but the off-task distractibility index and duration were affected by exposure history and showed effects of dosage at the 9-month test time. Infants exposed to cocaine had a higher off-task index and a shorter average off-task look duration than did infants in the other groups. The authors interpreted this pattern of behavior as an indicator of distractibility or stimulation seeking. There were no group differences in measures involving on-task looks or duration at either test time. Correlations between the off-task look index and duration and teratogen use produced moderate correlations at 9 months of age. The authors calculated partial correlations between teratogen exposure and the off-task index at each trimester. Cocaine use during the 1st and 2nd trimesters was significantly correlated with the off-task index at 9 months of age, even when the authors controlled for neonatal measures (e.g., gestational age, birth weight) and during the 1st trimester when they controlled for alcohol and cigarette exposure.

Improving predictive accuracy of a survey measure of risk for narcolepsy.

Narcolepsy is a brain disorder that may go unrecognized and untreated for many years. The ability to use easily obtained survey information about symptoms of narcolepsy would facilitate identification of individuals potentially at risk for narcolepsy who could be referred for further testing. The purpose of the present study was to explore whether a survey instrument could successfully distinguish narcolepsy from other sleep disorders using data that could easily be obtained from a community or general patient sample. The hypothesized model added the Epworth Sleepiness Scale to a narcolepsy symptoms checklist to explore whether it improved accuracy of classification. Data related to symptoms were extracted from medical records of patients with a known diagnosis of narcolepsy, obstructive sleep apnea, or insomnia. The sample was then randomly split in half, allowing exploratory and confirmatory binary logistic regression. Adding the Epworth Sleepiness Scale score to the original list of symptoms more accurately classified those with or without narcolepsy. Although these findings require additional testing before they can be confirmed and generalized, they suggest that a self-report screening instrument for narcolepsy with acceptable accuracy is possible.

Sleep, impulse control, and sensation-seeking predict delinquent behavior in adolescents, emerging adults, and adults.

PURPOSE: The present study examined delinquent behavior from adolescence into adulthood within the dual systems model of adolescent risk-taking, which identifies maturational patterns of socioemotional and cognitive control systems as predictors of risk-taking. The role of sleep was also investigated within the relationship. METHODS: Hierarchical regression and path analysis examined delinquency at three waves (1996, 2001, and 2008) of the National Longitudinal Study of Adolescent Health. RESULTS: Impulse control and sensation-seeking predicted concurrent delinquent behavior at all three waves, demonstrating the developmental shift as described within the dual systems model in which the relative contribution of sensation-seeking decreases from adolescence into adulthood, whereas the relative contribution of impulse control improves. Data also revealed that sleep duration and delayed bedtimes had both direct and indirect associations with delinquent behavior during adolescence; sleep duration did not directly predict such activity during later waves. CONCLUSION: The dual systems model of adolescent risk-taking appears to be predictive of delinquent behavior during adolescence and the transition into adulthood. Preliminary findings suggest the importance of considering both adolescent sleep and cognitive and socioemotional development during research and prevention efforts of delinquent behavior.

Pediatric periodic limb movement disorder: sleep symptom and polysomnographic correlates compared to obstructive sleep apnea.

STUDY OBJECTIVES: Although periodic limb movements in sleep (PLMS) have been described in multiple pediatric publications, periodic limb movement disorder (PLMD) has not. The aims of this study were to describe the prevalence, sleep-related correlates, and polysomnographic correlates of PLMD in a large pediatric case series, and compare these to pediatric obstructive sleep apnea (OSA). METHODS: All PLMD cases (defined by International Classification of Sleep Disorders, 2nd edition criteria + respiratory disturbance index [RDI] < 3) and OSA cases (defined by RDI ≥ 3 + PLMS < 5), from a single pediatric sleep practice, over a 2-year time span, were included. Chart, questionnaire, and polysomnographic data were compiled. Of 468 referred children, 66 PLMD cases were identified (14%). RESULTS: The PLMD cases, mean age 8.1 years (range 1-17), were clinically characterized by frequent sleep onset and maintenance problems, difficulty awakening, restless sleep, leg pain/discomfort at night, and parasomnias. Compared to 90 OSA children, those with PLMD had a history of significantly more sleep onset and maintenance problems, leg pain/discomfort at night, parasomnias, getting out of bed at night, and family history of restless legs syndrome. Polysomnographically, PLMD cases had more awakenings, stage 1 sleep, stage shifts, and spontaneous arousals. CONCLUSIONS: These data indicate that pediatric PLMD has important clinical and polysomnographic correlates. In addition, PLMD has many characteristics that are different from pediatric OSA, suggesting that PLMD is a distinct pediatric sleep disorder, of which clinicians should be aware.

The prevalence of sleep disorders in college students: impact on academic performance.

OBJECTIVE: To examine the prevalence of risk for sleep disorders among college students by gender and age, and their associations with grade point average (GPA). PARTICIPANTS: Participants were 1,845 college students at a large, southeastern public university. METHODS: A validated sleep disorder questionnaire surveyed sleep data during the 2007-2008 academic year. Students' GPAs were obtained from the office of the registrar. RESULTS: Twenty-seven percent of students were at risk for at least one sleep disorder. African American and Asian students reported less risk for insomnia and fewer poor sleep practices relative to white and Latino students. Students reported insufficient sleep and a discrepancy between weekday and weekend amount of sleep. Students at risk for sleep disorders were overrepresented among students in academic jeopardy (GPA < 2.0). CONCLUSIONS: Many college students are at risk for sleep disorders, and those at risk may also be at risk for academic failure.

Parent-reported periodic limb movement, sleep disordered breathing, bedtime resistance behaviors, and ADHD.

The purpose of this study was to compare the relative strength of association between symptoms of attention deficit/hyperactivity disorder (ADHD) with sleep disordered breathing (SDB), periodic limb movement disorder (PLMD), and bedtime resistance behaviors (BRBs). The Pediatric Sleep Questionnaire was completed by parents of 283 children. Scales were derived to indicate risk for specific sleep disorders, then correlated with symptoms of ADHD. Strong independent interrelationships between symptoms of PLMD and symptoms of ADHD emerged, with potential additional contributions by bedtime resistance. These interrelationships remained after controlling for age, SDB, sleepiness, or BRBs. These data suggest ADHD symptoms may be especially related to PLMD but that insufficient sleep duration secondary to bedtime resistance and noncompliance may make an independent contribution.