Sleep and sleep disordered breathing in children with down syndrome: Effects on behaviour, neurocognition and the cardiovascular system

Down syndrome (DS), the most common human chromosomal malformation, has an estimated annual incidence of one in 1000 live births worldwide. Sleep problems are common in children with DS, reported by parents in up to 65% of school-aged children, significantly higher rates than in typically developing (TD) children. Problems include difficulty in sleep initiation and maintenance together with obstructive sleep apnoea (OSA) which affects up to over 90%, of DS children compared with 1-5% in the general paediatric population. Any sleep problem has the potential to exert significant negative effects on daytime behaviour, learning and quality of life in TD children and there is now a growing body of evidence that children with DS are similarly affected. In addition to adverse effects on daytime functioning, OSA has adverse effects on the cardiovascular system and this is a particularly significant issue given the high rates of hypertension and premature cardiac disease in people with DS. This review discusses the effects of sleep problems and OSA on daytime functioning and cardiovascular function in children with DS and evidence of the effectiveness of treatment in improving outcomes and quality of life for these children.