Cognitive status in Down syndrome individuals with sleep disordered breathing deficits (SDB)
Introduction
Down syndrome has often been associated with cognitive deficits as well as breathing difficulties during sleep.
Subjects with Down syndrome tend to obtain low scores at tests measuring visual-perceptual abilities (Saviolo-Negrin, Soresi, Baccichetti, Pozzan, & Trevisan, 1990), visuospatial organization and short-term memory (Devenny et al., 1996; Vicari, Carlesimo, & Caltagirone, 1995), planning and attention (Das, Divis, Alexander, Parrila, & Naglieri, 1995), and verbal performance and language, in general (Berry, Groeneweg, Gibson, & Brown, 1984; Chapman, Schwartz, & Bird, 1991; Greenspan & Delaney, 1983; Loveland & Kelley, 1988; Vicari et al., 1995).
Cognitive deficits on the part of subjects with Down syndrome are closely related with sleep-disordered breathing (SDB) deficits, as previous studies have reported (Engleman, Kingshott, Martin, & Douglas, 2000; Naegele, Thouvard, & Pepin, 1995; Scheltens et al., 1991). SDB deficits include more than ten apneas in one hour of sleep, hypoventilation and arterial oxygen desaturation and have often been described in subjects with Down syndrome (Clark, Schmidt, & Schuller, 1980; Kasian, Duncan, Tyrrell, & Oman-Ganes, 1987; Loughlin, Wynne, & Victoria, 1981; Marcus, Keens, Bautista, Pechman, & Davidson, 1991). These subjects have many predisposing factors for SDB deficits such as midfacial and mandibular hypoplasia, glosoptosis, an abnormally small upper airway with superficially positioned tonsils and relative tonsillar and adenoidal encroachment, increased secretions, an increased incidence of lower respiratory tract anomalies, obesity and generalized hypotonia with resultant collapse of the airway during inspiration (Fink, Madaus, & Walker, 1975; Southall et al., 1987; Strome, 1986).
In view of the above findings, we performed polysomnographic studies in individuals with Down syndrome and tested their visuoperceptual skills and their mental state in search of any kind of relation between the results of the polysomnographic study, and their performance in the trials testing their visuoperceptual skills and mental state. Therefore, the aim of our study was to document the prevalence of SDB and cognitive deficits in adults with Down syndrome.
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Materials and methods
Twelve individuals, 6 males and 6 females, with Down syndrome were recruited from a day care Down Syndrome Institute. Their mean age was 21.66±4.11. Informed consent was obtained from the parents or the guardians of each subject. This was the reason for which the particular 12 individuals were chosen, since the polysomnograms were performed during night sleep at home and the cooperation of the parents or the guardians of the individuals with Down syndrome was necessary for the normal
Results
The results of the polysomnographic studies showed that all 12 individuals presented apneas more than 10 per hour and desaturation rates <95%, which were abnormal. The mean number of apneas was 28.75, SD 5.29 and of desaturation levels 86.00, SD 7.89. Seven out of 12 individuals snored, mean: .58, SD .51 and all 12 individuals had normal heart rates, mean: 59.41, SD 8.07. Epworth Sleepiness Scales (ESS) were normal (5.9±2.2) for all individuals.
Scores at the Mini-Mental state were very low both
Discussion
Our study shows that individuals with Down syndrome are likely to have SDB deficits, a finding that lends support to previous studies, which found SDB deficits among Down population (Clark et al., 1980; Kasian et al., 1987; Loughlin et al., 1981; Marcus et al., 1991).
In addition, although the number of apneas was not related with the total score of RPM, it was related with the number of correct responses given for set A of RPM. This finding indicates that the more apneas a person has, the more
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