{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T20:52:57Z","timestamp":1761598377873,"version":"build-2065373602"},"reference-count":60,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003550","name":"Queensland Government","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003550","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: To describe the sleep problems experienced by children with Down syndrome attending a tertiary sleep clinic and relationship with behaviour, function and cognition. Methods: Data were collected from children with Down syndrome aged 3\u201318 years old. Carers completed the Abbreviated Child Sleep Habits Questionnaire, Child Behaviour Checklist and Life-Habits Questionnaire at enrolment. Cognitive assessment (Stanford-Binet 5) was undertaken by a trained psychologist. Children received management for their sleep problem as clinically indicated. Results: Forty-two subjects with a median age of 6.8 years (Interquartile Range-IQR 4.5, 9.8) were enrolled. A total of 92% were referred with snoring or symptoms of Obstructive Sleep Apnoea (OSA), with 79% of those referred having had previous ENT surgery. Thus, 85% of all participants underwent a sleep study and 61% were diagnosed with OSA (OAHI \u2265 1\/h). Based on questionnaires, 86% of respondents indicated that their child had a significant sleep disorder and non-respiratory sleep problems were common. Non-respiratory problems included: trouble going to sleep independently (45%), restless sleep (76%), night-time waking (24%) and bedtime resistance (22%). No significant correlations were found between sleep measures (behavioural and medical sleep problems) and the behavioural, functional or cognitive parameters. Conclusion: Sleep disorders were very common, especially non-respiratory sleep problems. OSA was common despite previous surgery. No association was found between sleep-related problems (snoring, sleep-study-confirmed OSA or non-respiratory sleep problem) and parent-reported behavioural problems, functional impairments or intellectual performance. This may reflect limitations of the measures used in this study, that in this population ongoing problems with daytime function are not sleep related or that a cross-sectional assessment does not adequately take into account the impacts of past disease\/treatments. Further research is required to further evaluate the tools used to evaluate sleep disorders, the impact of those disorder on children with Down syndrome and interventions which improve both sleep and daytime function.<\/jats:p>","DOI":"10.3390\/brainsci11101317","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T09:24:15Z","timestamp":1633339455000},"page":"1317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sleep, Function, Behaviour and Cognition in a Cohort of Children with Down Syndrome"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5035-0744","authenticated-orcid":false,"given":"Jasneek K.","family":"Chawla","sequence":"first","affiliation":[{"name":"Department of Paediatric Respiratory & Sleep Medicine, Queensland Children\u2019s Hospital, Brisbane, QLD 4101, Australia"},{"name":"School of Clinical Medicine, University of Queensland, Brisbane, QLD 4072, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Bernard","sequence":"additional","affiliation":[{"name":"QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD 4072, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Heussler","sequence":"additional","affiliation":[{"name":"Department of Paediatric Respiratory & Sleep Medicine, Queensland Children\u2019s Hospital, Brisbane, QLD 4101, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Burgess","sequence":"additional","affiliation":[{"name":"Department of Paediatric Respiratory & Sleep Medicine, Queensland Children\u2019s Hospital, Brisbane, QLD 4101, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1038\/ejhg.2008.122","article-title":"Twenty-year trends in prevalence and survival of Down syndrome","volume":"16","author":"Irving","year":"2008","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/mrdd.20157","article-title":"Epidemiology of Down syndrome","volume":"13","author":"Sherman","year":"2007","journal-title":"Ment. Retard. Dev. Disabil. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1590\/S1519-69842008000200031","article-title":"Trisomy 21 and Down syndrome: A short review","volume":"68","author":"Sommer","year":"2008","journal-title":"Braz. J. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.smrv.2011.10.003","article-title":"Sleep measurement and monitoring in children with Down syndrome: A review of the literature, 1960\u20132010","volume":"16","author":"Churchill","year":"2012","journal-title":"Sleep Med. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"389","DOI":"10.12688\/f1000research.7506.1","article-title":"The importance of understanding indivdiual differences in Down syndrome","volume":"5","author":"Groet","year":"2016","journal-title":"F1000Research"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1542\/peds.88.1.132","article-title":"Obstructive sleep apnea in children with Down Syndrome","volume":"88","author":"Marcus","year":"1991","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/sleep\/26.8.1006","article-title":"Prevalence of sleep-disordered breathing in children with Down syndrome: Polygraphic findings in 108 children","volume":"26","year":"2003","journal-title":"Sleep"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1136\/adc.66.11.1333","article-title":"Sleep related upper airway obstruction in a cohort with Down\u2019s syndrome","volume":"66","author":"Stebbens","year":"1991","journal-title":"Arch. Dis. Child."},{"key":"ref_9","first-page":"774","article-title":"Obstructive sleep apnoea in children with Down syndrome","volume":"47","author":"Ng","year":"2006","journal-title":"Singap. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1001\/archpedi.157.7.655","article-title":"Prospective polysomnographic analysis of obstructive sleep apnea in Down syndrome","volume":"157","author":"Dyken","year":"2003","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1542\/peds.2012-1671","article-title":"Diagnosis and management of childhood obstructive sleep apnea syndrome. Clinical report","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1136\/adc.2008.146845","article-title":"Sleep problems in a Down syndrome population","volume":"94","author":"Carter","year":"2009","journal-title":"Arch. Dis. Child."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"411","DOI":"10.5664\/jcsm.3618","article-title":"High prevalence of sleep disorders and associated comorbidities in a community sample of children with Down syndrome","volume":"10","author":"Hoffmire","year":"2014","journal-title":"J. Clin. Sleep Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/0009922810384260","article-title":"Parental perceptions of sleep disturbances and sleep disordered breathing in children with Down syndrome","volume":"50","author":"Rosen","year":"2011","journal-title":"Clin. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ridd.2004.12.003","article-title":"Brief report: Parental descriptions if sleep problems in children with autism, Down syndrome and Prader-Willi syndrome","volume":"27","author":"Cotton","year":"2006","journal-title":"Res. Dev. Disabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/j.1365-2788.2011.01435.x","article-title":"Parental report of sleep problems in Down syndrome","volume":"55","author":"Breslin","year":"2011","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ijporl.2015.12.014","article-title":"Sleep problems and obstructive sleep apnoea in children with down syndrome, an overview","volume":"82","author":"Maris","year":"2016","journal-title":"Int. J. Pediatric Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ijpsycho.2013.06.019","article-title":"Sleep deprivation and neurobehavioral functioning in children","volume":"89","author":"Maski","year":"2013","journal-title":"Int. J. Psychophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1093\/sleep\/29.9.1115","article-title":"Neurobehavioural morbidity associated with disordered breathing in sleep in children: A comprehensive review","volume":"29","author":"Beebe","year":"2006","journal-title":"Sleep"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.jpeds.2005.01.043","article-title":"Neuropsychological and psychosocial function in children with a history of snoring or behavioural problems","volume":"146","author":"Blunden","year":"2005","journal-title":"J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1076\/1380-3395(200010)22:5;1-9;FT554","article-title":"Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls","volume":"22","author":"Blunden","year":"2000","journal-title":"J. Clin. Exp. Neuropsych."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.sleep.2010.11.010","article-title":"Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing","volume":"12","author":"Bourke","year":"2011","journal-title":"Sleep Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1056\/NEJMoa1215881","article-title":"A randomized trial of adenotonsillectomy for childhood sleep apnea","volume":"368","author":"Marcus","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/dmcn.12376","article-title":"Obstructive sleep apnea syndrome and cognition in Down Syndrome","volume":"56","author":"Breslin","year":"2014","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5665\/sleep.4326","article-title":"Relationship between sleep disturbance and functional outcomes in daily life habits of children with Down syndrome","volume":"38","author":"Churchill","year":"2015","journal-title":"Sleep"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1016\/j.ridd.2013.03.009","article-title":"The impact of sleep disruption on executive function in Down syndrome","volume":"34","author":"Chen","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1111\/cdev.12443","article-title":"Sleep disturbance and expressive language development in preschool-age children with Down syndrome","volume":"86","author":"Edgin","year":"2015","journal-title":"Child Dev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/jir.12321","article-title":"Sleep problems and temperament in young children with Down syndrome and typically develping controls","volume":"61","author":"Lukowski","year":"2017","journal-title":"J. Intellect. Dis. Res"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/jir.12463","article-title":"Links between sleep and daytime behaviour problems in children with Down syndrome","volume":"62","author":"Esbensen","year":"2018","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1080\/03004430.2016.1180790","article-title":"Sleep disturbances, behavioural problems and adaptive skills in children with DS","volume":"187","author":"Kelmanson","year":"2017","journal-title":"Early Child Dev. Care"},{"key":"ref_31","unstructured":"NICHID SECCYD-Wisconsin (2016, July 26). Children\u2019s Sleep Habit Questionnaire (Abbreviated). 2014. Available online: http:\/\/njaap.org\/wp-content\/uploads\/2016\/04\/Childrens-Sleep-Habits-Questionnaire.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1093\/sleep\/23.8.1d","article-title":"The children\u2019s sleep habits questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children","volume":"23","author":"Owens","year":"2000","journal-title":"Sleep"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1002\/ajmg.a.37096","article-title":"Sleep profiles in children with Down syndrome","volume":"167","author":"Bassell","year":"2015","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1016\/j.ridd.2013.01.031","article-title":"Cross syndrome comparison of sleep problems in children with Down syndrome and Williams syndrome","volume":"34","author":"Ashworth","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_35","first-page":"E22","article-title":"Sleep problems of children with autistic spectrum disorder assessed by childrens sleep habits questionnaire-abbreviated in Indonesia and Japan","volume":"62","author":"Irwanto","year":"2016","journal-title":"Kobe J. Med. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"261","DOI":"10.17711\/SM.0185-3325.2018.038","article-title":"Sleep problems and profiles in attention deficit hyperactivity disorder assessed by the childrens sleep habit questionnaire abbreviated in colombia","volume":"41","year":"2018","journal-title":"Salud Ment."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ejpn.2020.02.012","article-title":"Uncovering sleep in young males with Duchenne muscular dystrophy","volume":"26","author":"Hartman","year":"2020","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1111\/j.1469-8749.2007.00666.x","article-title":"Measuring participation in children with disabilities using the assessment of life habits","volume":"49","author":"Noreau","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_39","unstructured":"Achenbach, T.M., and Rescorla, L.A. (2000). Manual for the ASEBA Preschool Forms and Profiles, University of Vermont."},{"key":"ref_40","unstructured":"Achenbach, T.M., and Rescorla, L.A. (2001). Manual for the ASEBA School-Age Forms and Profiles, University of Vermont."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1024\/\/1422-4917.27.3.183","article-title":"Applicability of the child behaviour checklist in developmentally delayed children","volume":"27","author":"Noterdaeme","year":"1999","journal-title":"Z. Kinder Jugendpsychiatrie Psychother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/j.1469-7610.2006.01712.x","article-title":"Developmental course of psychopathology in youths with and without intellectual disabilities","volume":"48","author":"Dekker","year":"2007","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1111\/1469-7610.00235","article-title":"Emotional and behavioral problems in children and adolescents with and without intellectual disability","volume":"43","author":"Dekker","year":"2002","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1352\/1944-7558-116.1.48","article-title":"The peer-related social competence of young children with Down syndrome","volume":"116","author":"Guralnick","year":"2011","journal-title":"Am. J. Intellect. Dev. Disabil."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Van Gameren-Oosterom, H.B.M., Fekkes, M., Buitendijk, S.E., Mohangoo, A.D., Bruil, J., and Van Wouwe, J.P. (2011). Development, problem behavior, and quality of life in a population based sample of eight-year-old children with Down syndrome. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0021879"},{"key":"ref_46","unstructured":"Roid, G.H. (2003). Stanford-Binet Intellegence Scales, Riverside. [5th ed.]."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s11325-014-0992-y","article-title":"Relationship between sleep, sleep apnea and neuropsychological function in children with Down syndrome","volume":"19","author":"Brooks","year":"2015","journal-title":"Sleep Breath."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/jir.12496","article-title":"Impact of sleep on executive functioning in school-age children with Down syndrome","volume":"62","author":"Esbensen","year":"2018","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1352\/1944-7558-122.3.247","article-title":"Outcome measures for clinical trials in Down syndrome","volume":"122","author":"Esbensen","year":"2017","journal-title":"Am. J. Intellect. Dev. Disabil."},{"key":"ref_50","unstructured":"Berry, R., Brooks, R., Gamaldo, C.E., Harding, S.M., Lloyd, R.M., Marcus, C.L., and Vaughn, B.V. (2016). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, American Academy of Sleep Medicine. Version 2.2."},{"key":"ref_51","unstructured":"Team, R.C. (2013). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/gbb.12198","article-title":"Sleep-like behavior and 24-h rhythm disruption in the Tc1 mouse model of Down syndrome","volume":"14","author":"Heise","year":"2015","journal-title":"Genes Brain Behav."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1037\/h0100743","article-title":"Behavioural approaches to the treatment of sleep problems in children with developmental disorders: What is state of the art?","volume":"1","author":"Richdale","year":"2005","journal-title":"Int. J. Behav. Consult. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1469-8749.2012.04422.x","article-title":"Sleep disorders and their clinical significant in children with Down syndrome","volume":"55","author":"Stores","year":"2012","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/DBP.0000000000000333","article-title":"Use of sleep evaluations and treatments in children with Down syndrome","volume":"37","author":"Esbensen","year":"2016","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/jir.12533","article-title":"Reliability of parent report measures of behaviour in children with Down syndrome","volume":"62","author":"Esbensen","year":"2018","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e20191450","DOI":"10.1542\/peds.2019-1450","article-title":"Cognition after early tonsillectomy for mild OSA","volume":"145","author":"Waters","year":"2020","journal-title":"Pediatrics"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.sleep.2020.12.022","article-title":"Sleep problems in Australian children with Down syndrome: The need for greater awareness","volume":"78","author":"Chawla","year":"2021","journal-title":"Sleep Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00004703-200002000-00005","article-title":"Sleep habits and sleep disturbance in elementary school-aged children","volume":"21","author":"Owens","year":"2000","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3389\/fped.2021.637770","article-title":"Sleep disturbances and patterns in children with neurodevelopmental conditions","volume":"9","author":"Halstead","year":"2021","journal-title":"Front. Pediatr."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/10\/1317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:09:16Z","timestamp":1760166556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/10\/1317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,4]]},"references-count":60,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["brainsci11101317"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11101317","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2021,10,4]]}}}