Sleep-disordered breathing and sleep macro- and micro-architecture in children with Down syndrome

Background: Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), which is associated with intermittent hypoxia and sleep disruption affecting daytime functioning. We aimed to compare the impact of SDB on sleep quality in children with DS compared to typically developing (TD) children with and without SDB. Methods: Children with DS and SDB (n = 44) were age- and sex-matched with TD children without SDB (TD−) and also for SDB severity with TD children with SDB (TD+). Children underwent overnight polysomnography with sleep macro- and micro-architecture assessed using electroencephalogram (EEG) spectral analysis, including slow-wave activity (SWA, an indicator of sleep propensity). Results: Children with DS had greater hypoxic exposure, more respiratory events during REM sleep, higher total, delta, sigma, and beta EEG power in REM than TD+ children, despite the same overall frequency of obstructive events. Compared to TD− children, they also had more wake after sleep-onset and lower sigma power in N2 and N3. The DS group had reduced SWA, indicating reduced sleep drive, compared to both TD groups. Conclusions: Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children. Impact: SDB in children with DS exacerbates disruption of sleep quality, compared to TD children.The prevalence of SDB is very high in children with DS; however, studies on the effects of SDB on sleep quality are limited in this population.Our findings suggest that SDB has a greater impact on sleep quality in children with DS compared to TD children, and should be screened for and treated as soon as possible.