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

Authors

Fabian Fernandez, University of ArizonaFollow
Casandra C. Nyhuis, University of Arizona
Payal Anand, University of Arizona
Bianca I. Demara, University of Arizona
Norman F. Ruby, Stanford University
Goffredina Spano, University of Arizona
Caron Clark, University of Nebraska-LincolnFollow
Jamie O. Edgin, University of Arizona

Document Type

Article

Date of this Version

2017

Citation

Sleep Medicine 33 (2017), pp. 134-144. http://dx.doi.org/10.1016/j.sleep.2016.12.026

Comments

© 2017 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license.

Abstract

Objectives: To 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.

Methods: A cross-sectional study of 66 infants and young children with DS, aged 5e67 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.

Results: This 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.

Conclusions: Circadian 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.