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Sleep Issues and Developmental Disabilities PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Sleep Issues and Developmental Disabilities" by Michael Mak, MD, FRCPC.
This medical PowerPoint presentation discusses how sleep disturbances can have significant negative impacts on individuals with developmental disabilities.
Sleep issues are common among individuals with developmental disabilities. Some of the most common developmental disabilities associated with sleep disturbances include autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), Down syndrome, and cerebral palsy.
Individuals with ASD often have difficulty falling and staying asleep, as well as disrupted sleep patterns. This may be due to sensory processing difficulties, such as hypersensitivity to noise or light, which can make it difficult to fall asleep. Additionally, individuals with ASD may have anxiety or obsessive-compulsive behaviors that can interfere with sleep.
ADHD is also associated with sleep disturbances, including difficulty falling and staying asleep, and restless sleep. Children with ADHD may have trouble settling down at night due to hyperactivity or impulsivity, and they may have difficulty waking up in the morning.
Individuals with Down syndrome often have sleep apnea, which can cause snoring, pauses in breathing during sleep, and disrupted sleep. This is due to the characteristic facial features and small airways that are common in individuals with Down syndrome.
Cerebral palsy can also be associated with sleep disturbances, such as difficulty falling asleep and staying asleep, as well as frequent waking during the night. This may be due to physical discomfort or pain, spasticity or stiffness in the muscles, or other medical issues.
Sleep disturbances can have significant negative impacts on individuals with developmental disabilities, including impaired cognitive functioning, behavior problems, and poor quality of life. Therefore, it is important to identify and address sleep issues in individuals with developmental disabilities in order to improve their overall well-being.

Tags : Sleep Issues, Developmental Disabilities, autism spectrum disorder, attention deficit hyperactivity disorder, ADHD, Down syndrome, cerebral palsy, Child Neurology, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 1497 | Downloads : 1

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Sleep Issues and Developmental Disabilities Michael Mak, MD, FRCPCSleep Medicine Specialist, Consultation/Liaison Psychiatrist Assistant Professor, Department of Psychiatry, Western University
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March 29, 2017 Speaker Disclosure Speaking honorarium: Abbvie and Otsuka/Lundbeck Alliance. Shareholder: Neurozone MSH.
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Objectives Normal Sleep and Assessment Tools Autism Spectrum Disorders Down’s Syndrome Intellectual Disability
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Normal Sleep Architecture and Assessment Tools
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Sleep Architecture Two types of sleep: non-rapid eye-movement (NREM) sleep and rapid eye-movement (REM) sleep. NREM sleep is divided into stages 1, 2, and 3 (SWS), representing a continuum of relative depth. REM sleep is dream sleep. Each has unique characteristics including variations in brain wave patterns, eye movements, and muscle tone.
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REM vs NREM Sleep NREM and REM sleep alternate cyclically during sleep periods. The function of alternations between these two types of sleep is not yet understood, but irregular cycling and/or absent sleep stages are associated with sleep disorders. Example: an abrupt shift from deep sleep to light sleep and wakefulness may cause night terrors.
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NREM to REM Cycling Normal sleep begins with a short period of NREM stage 1 progressing through stage 2, followed by stages 3 and finally to REM. REM will cycle back to NREM sleep throughout the night. NREM sleep constitutes about 75 to 80 percent of total time spent in sleep, and REM sleep constitutes the remaining 20 to 25 percent. The average length of the first NREM-REM sleep cycle is 90 minutes. The second, and later, cycles are longer lasting (up to 120 minutes).
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NREM to REM Cycling SWS is seen in the first third of the night. As the sleep episode progresses, stage 2 begins to account for the majority of NREM sleep, and SWS may sometimes altogether disappear. REM sleep increases as the night progresses and is longest in the last third of the sleep episode.
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Sleep Assessment Tools Sleep Diary Sleep History Physical Examination Actigraphy Polysomnography
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Sleep Diary
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Sleep History “Do you have any concerns regarding your child’s sleep?” “Does your child take more than 30 minutes to fall asleep at bedtime?” “Once asleep, does he stay asleep?” “Does your child seem excessively sleepy during daytime? “Have you heard your child snore or stop breathing during the night?”
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Actigraphy Worn on non-dominant hand Cheaper and less cumbersome than PSG Likely higher compliance
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Normal
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Polysomnography
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Polysomnography Measurements Electroencephalogram (EEG) – distinguishes between wakefulness and various sleep stages. Electrooculogram (EOG) – monitors eye movements. Electromyogram (EMG) – measures muscle tone on chin and limbs. ECG, airflow, video-recording, sound, effort of respiration, oxygen saturation, body positioning.
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Polysomnography Gold standard assessment tool for sleep disorders Not well tolerated by all Home testing an option
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Implication of Sleep Disturbances Sleep disturbances are a common problem in childhood – 25% in preschool and school-aged children Problems not only with children, but affects families. Increased parental stress, depression, poor marital relationships, and even child abuse
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Epidemiology in DD Population Sleep problems occur in up to 89% of ASD children, 86% of ID children, and 65% of children with Down Syndrome. Sleep disturbances likely associated with behavioural and psychological problems in developmental disability population.
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Summary Sleep divided into NREM and REM sleep. Evaluated by subjective and objective means. Sleep complaints common in young children. Even more common in developmental disabilities.
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Autism Spectrum Disorders
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ASD and Sleep Disturbances Insufficient sleep = worsening of core ASD symptoms Increased stereotypic behaviours, social, communication and cognitive difficulties Increased self-injury, non-compliance, irritability, tantrums and aggression Relationship of cognitive impairment and severity of sleep problems is mixed
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ASD and Sleep Disturbances Appear to persist through lifetime. Most studies focused on high functioning ASD (greater communication and cooperation with PSG and actigraphy).
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ASD and Sleep Problems Mixed phenotype = NO ONE TYPICAL SLEEP PROBLEM Sleep problems often go untreated.
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Pathophysiology Disturbed reception to circadian rhythm entrainment - light, meal timing, social contacts. Disrupted melatonin secretion. Clock gene abnormalities. Comorbidities leading to sleep disruption: GI symptoms; epilepsy; anxiety, ADHD. Medications: SSRIs, antipsychotics.
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Polysomnographic Findings Decreased REM sleep and TST Increased leg movements, SWS, and REM sleep latency Higher loss of REM atonia
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ASD - Insomnia Prolonged sleep onset latency Increased wake after sleep onset Early morning awakenings May translate to increased bedtime resistance and excessive daytime sleepiness
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Non-Pharmacological Treatments Behavioural Therapy Parents overwhelmingly prefer non-medication treatments
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Non-Pharmacological Treatments Sleep hygiene Setting appropriate bedtime and set routine Minimizing TV/LCD/LED exposure Reducing emotional and behavioural stimulation at night
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Non-Pharmacological Treatments Elimination of association between sleep and prerequisite conditions (e.g. bottle of milk, co-sleeping, being on the couch). Structured behavioural program improved: pre-sleep disturbances, falling sleep alone, night waking and co-sleeping.
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Non-Pharmacological Treatments Bright light therapy AM exposure = advance sleep onset time PM exposure = delay sleep onset time
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Melatonin Endogenous hormone secreted by the pineal gland Nocturnal secretion beginning at nightfall, peaking at 0300AM Secretion is suppressed by light (suprachiasmatic nuclei of hypothalamus) Major role: regulation of sleep (timing of sleepiness and circadian rhythm control)
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Melatonin Sleep problems occur when melatonin secretion is disturbed. O’Hare et al; Kulman et al: low serum melatonin in autistic children Abnormally elevated night time melatonin levels in ASD - Malfunctioning melatonin function?
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Melatonin 0.3 – 3mg Timing subject to debate Shortens sleep onset latency Increases total sleep time Does not affect midsleep awakenings ?Safe Unregulated food product
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Clonidine 0.05 – 1mg Shortens sleep onset latency Decreases midsleep awakenings Caution re: rebound hypertension; in cardiac and depressed populations
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Other Medications Only in specific situations Sedating antipsychotics (olanzapine, quetiapine, risperidone) at bedtime in those with other indications Trazodone (beware of priapism) ?zolpidem/zopiclone
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Other Medications Not recommended Benzodiazepines - higher chance of paradoxical effect, cognitive impairment, limited by tolerance Chloral hydrate Diphenhydramine (Benadryl), hydroxyzine
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ASD - Parasomnias Abnormal behaviours in sleep Night Terrors Confusional Arousals
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ASD - Parasomnias 54% in children with ASD Treatment Time Last resort: clonazepam at bedtime (Caution re: paradoxical agitation)
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ASD – Circadian Rhythm Disorders Delayed Sleep Phase - associated with severe ASD. Irregular Sleep Wake Cycle - polyphasic sleep; early decrease in physiologic total sleep time. Advanced Sleep Phase - rare
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ASD – Circadian Rhythm Disorders Treatments Melatonin 0.3 – 3mg Bright light therapy Behavioural approaches – avoiding blue light; sound proofing
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Future Research Ares Low functioning ASD Longitudinal studies - ?Sleep improves with chronological vs. developmental age
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Trisomy 21: Down’s Syndrome
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Myriad of Sleep Disturbances Bedtime resistance Increased parasomnias Excessive daytime sleepiness Increased sleep anxiety (improving with age) Midsleep awakenings (improving with age) Long sleep onset latency (improving with age)
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OSA in Down Syndrome 50% have obstructive sleep apnea. Related to facial morphology and hypotonia.
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OSA
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Facial Morphology Midface hypoplasia Retrognathia
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Oropharyngeal Morphology
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Treatment Tonsilloadenoidectomy
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Treatments
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Summary DS highly associated with sleep apnea Testing is suggested for all patients if they snore Treatments in young people include surgery, CPAP in older population
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Intellectual Disability
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ID 39% of adults with severe intellectual disabilities have insomnia Melatonin shown to decrease SOL and WASO Very few of these receive CBT-i and those that do have mixed results (studies are confounded by use of melatonin)
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ID 34.6% of ID adults were obese (BMI > 30) vs. 20.6% from general population. 28.9% of ID adults were overweight (BMI 25 – 29.9) vs. 34.1% from general population. May exhibit disturbed circadian rhythms (esp. moderate to severe ID individuals) Obese patients more likely to have sleep disordered breathing and/or sleep-related hypoventilation
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Summary ID associated with insomnia Melatonin best studied treatment Higher rates of obesity = need for greater apnea screening
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References Antshel KM, Zhang-james Y, Faraone SV. The comorbidity of ADHD and autism spectrum disorder. Expert Rev Neurother. 2013;13(10):1117-28. Braam W, Didden R, Smits M, Curfs L. Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study. J Intellect Disabil Res. 2008;52(Pt 3):256-64. Buckley AW, Rodriguez AJ, Jennison K, et al. Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Arch Pediatr Adolesc Med. 2010;164(11):1032-7. Carter M, Mccaughey E, Annaz D, Hill CM. Sleep problems in a Down syndrome population. Arch Dis Child. 2009;94(4):308-10. Cohen S, Conduit R, Lockley SW, Rajaratnam SM, Cornish KM. The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. J Neurodev Disord. 2014;6(1):44.
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References Devnani PA, Hegde AU. Autism and sleep disorders. J Pediatr Neurosci. 2015;10(4):304-7. Doran SM, Harvey MT, Horner RH. Sleep and developmental disabilities: assessment, treatment, and outcome measures. Ment Retard. 2006;44(1):13-27. Garstang J, Wallis M. Randomized controlled trial of melatonin for children with autistic spectrum disorders and sleep problems. Child Care Health Dev. 2006;32(5):585-9. Ming X, Mulvey M, Mohanty S, Patel V. Safety and efficacy of clonidine and clonidine extended-release in the treatment of children and adolescents with attention deficit and hyperactivity disorders. Adolesc Health Med Ther. 2011;2:105-12. Weiskop S, Richdale A, Matthews J. Behavioural treatment to reduce sleep problems in children with autism or fragile X syndrome. Dev Med Child Neurol. 2005;47(2):94-104. Wiggs L. Sleep problems in children with developmental disorders. J R Soc Med. 2001;94(4):177-9.