Sleep Issues in Down Syndrome by Dr.Manvir Bhatia
Channel: Neurology Sleep Centre
Date: 2022-12-14

In this video Dr.Manvir Bhatia addressing sleep issues in down syndrome to patients, parents and doctors.

Down Syndrome
It is a genetic disorder which is caused when an abnormal cell division results in an extra full or partial copy of chromosome no 21, which is also called trisomy 21. In this condition a baby is born with an extra chromosome no 21. This extra chromosome causes delay in child physical and mental development.

WHY SLEEP ISSUES OCCUR 
Down syndrome (DS) is the most common inherited chromosomal disorder, occurring in roughly one in 700 live births, and is caused by the presence of an additional copy of chromosome 21
The two common causes of sleep disturbances in children with Down syndrome are physical, breathing-related sleep problems and behavioral sleep problems
Breathing-related sleep problems, which are particularly common in children with Down syndrome when compared with children with other types of learning disability, and behavioral sleep problems, which can be successfully managed using behavior modification techniques.
A second common underlying cause of sleep deprivation is behavioral issues prevalent in children with Down syndrome
The higher prevalence and severity of OSA in patients with DS may be related to unique upper airway anatomic features as well as increased risk for obesity, hypothyroidism, gastro esophageal reflux disease, and generalized hypotonic. 
Many of the manifestations of OSA in patients with DS are similar to those seen in the general population, the relative morbidity is significantly higher
Obstructive sleep apnea results from Hypotonia, Macroglossia and midface Hypoplasia.
Central sleep apnea is relatively rare in adults with DS due to:
• Facial structure differences
• Narrow airway in the nose and throat
• Low muscle tone
• Poor coordination of airway movements
• Obesity
  SYMPTOMS OF SLEEP ISSUE
• Fall asleep during driving
• Struggle to stay awake when inactive, such as when watching television or reading
• Have difficulty paying attention or concentrating at work, school, or home
• Have performance problems at work or school
• Often get told by others that you look sleepy
• Have difficulty with your memory
• Have slowed responses
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep

DIAGNOSIS AND  TREATMENT

Obstructive sleep apnea (OSA) is very common in children with Down syndrome and can have significant harmful effects on the child. It is hence critical to have an early diagnosis. 
The American Academy of Pediatrics recommends that all children with Down syndrome have a polysomnography (PSG), or a sleep study, by 4 years of age. 
Treatment options generally involve upper airway surgery (primarily adenotonsillectomy) and continuous positive airway pressure (CPAP); however, various adjunctive therapies including intranasal steroids, palatal expansion, and or pharyngeal exercises , dental appliances, along with weight-reduction strategies, nasal steroids, and oral leukotriene modifiers as adjunctive treatments are also available. 
Tonsil and Adenoid Removal 
There are treatment options available for OSA. Some people with Down syndrome have relatively smaller jaw bones, cheekbones, and eye sockets and narrow nasal passages. 

Adenotonsillectomy does not always cure sleep apnea. Some individuals with Down syndrome experience OSA that continues even after surgery to remove tonsils and adenoids, known as “residual” OSA. 
CPAP/BiPAP Use 
Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) therapy is often used as a secondary treatment after surgery.  
Other treatments: 
• A high-flow nasal cannula used at night
• Anti-inflammatory medications
• Dental devices worn at night that push the lower jaw forward

PREVENTION
There are some principles which helps your child to fall asleep and stay asleep. 
• Establish a clear and regular routine. Establish a routine set of activities surrounding bed time. . 
• Reward and reinforce good behavior. 
• Create a relaxing bedtime setting,
• Follow a consistent bedtime routine. Set aside 10 to 30 minutes to get your child ready to go to sleep each night.
• Interact with your child at bedtime. 
• Keep your children from TV programs, movies, and video games that are not right for their age.
• At bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas.

For more information visit-www.neurologysleepcentre.com
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