Literature and parental reports suggest that young children with chronic illness or disability, particularly those diagnosed with neurodevelopmental disorders, have a significantly higher prevalence of sleep problems than typically developing children of similar age. In the majority of cases, symptoms have a multifactorial etiology, with the child’s somatic condition, associated neurological and psychiatric disorders, as well as relationship characteristics and environmental circumstances, influencing their presentation. In groups of children with chronic illness, atypical developmental trajectories, specific neurological functioning and behavioral phenotypes, sleep disorders are underdiagnosed because it is difficult to separate the child’s illness from the characteristics and consequences of sleep symptoms in the complex symptom picture. For families of children with chronic illnesses or disabilities, the presence of sleep disorders can further complicate adjustment to more challenging life situations and have a significant impact on the well-being and quality of life of the family members. Children with Down syndrome face the challenges of the special needs groups of children that are the focus of our study, where syndrome-specific features, chronic somatic conditions, and structural and functional changes in the nervous system contribute in complex ways to the increased prevalence of sleep-related problems. In addition to early identification of sleep problems, prevention and intervention initiatives in practice can prevent, treat and alleviate a range of short- and long-term negative developmental and behavioral consequences, and contribute to improving the relationship characteristics and quality of life of affected children and their families. Orv Hetil. 2024; 165(36): 1411–1422.
A szakirodalmi adatok és szülők beszámolói alapján a krónikus betegséggel élő, illetve fogyatékosságban érintett – és különösen az idegrendszer fejlődési zavarával diagnosztizált – kisgyermekek körében jelentősen nagyobb az alvásproblémák előfordulásának gyakorisága, hasonló korú, tipikus fejlődésmenetű gyermekcsoportokkal összehasonlítva. A tünetek az esetek többségében multifaktoriális etiológia talaján bontakoznak ki, megjelenésüket a gyermek szomatikus állapota, a társuló neurológiai és pszichiátriai zavarok, valamint a kapcsolati jellemzők és a környezeti körülmények együttesen befolyásolják. Krónikus betegséggel küzdő, atipikus fejlődésmenetű, sajátos idegrendszeri működéssel és viselkedési fenotípussal jellemezhető gyermekcsoportokban az alvászavar aluldiagnosztizált jelenség, mivel a komplex tüneti képben nehezen különíthető el a gyermek állapotának, valamint az alvástünetek jellegzetességeinek és következményeinek megjelenése. A krónikus betegséggel élő vagy fogyatékosságban érintett gyermeket nevelő családok esetében a fokozott kihívást jelentő élethelyzetekhez való alkalmazkodást tovább nehezítheti az alvászavarok megjelenése, melyek jelentős hatást gyakorolhatnak a családtagok jóllétére és életminőségére. A Down-szindrómában érintett gyermekek a tanulmányunk fókuszában álló speciális szükségletű gyermekcsoportok kihívásaival egyszerre találkoznak, esetükben az egyes szindrómaspecifikus jellemzők, a krónikus szomatikus állapotok, valamint az idegrendszer strukturális és funkcionális elváltozásai komplex módon járulnak hozzá az alvással összefüggő problémák gyakoribb előfordulásához. A gyakorlatban alkalmazott prevenciós és intervenciós szemléletű kezdeményezések az alvásproblémák korai azonosítása mellett számos rövid és hosszú távú negatív fejlődési, illetve viselkedési következmény megelőzését és kezelését, enyhítését teszik lehetővé, hozzájárulva az érintett gyermekek és családtagjaik kapcsolati jellemzőinek és életminőségének javításához. Orv Hetil. 2024; 165(36): 1411–1422.
Purebl Gy. The psychology of sleep. In: G. Németh Gy. (ed.) Hungarian sleep book. [Az alvás pszichológiája. In: G. Németh Gy. (szerk.) Magyar alváskönyv.] Galenus Kiadó, Budapest, 2019; pp. 19–48. [Hungarian]
Carter KA, Hathaway NE, Lettieri CF. Common sleep disorders in children. Am Fam Physician 2014; 89: 368–377.
Choi EK, Jung E, Van Riper M, et al. Sleep problems in Korean children with Down syndrome and parental quality of life. J Intellect Disabil. 2019; 63: 1346–1358.
Joyce A, Dimitriou D. Sleep-disordered breathing and cognitive functioning in preschool children with and without Down syndrome. J Intellect Disabil. 2017; 61: 778–791.
Paul IM, Savage JS, Anzman-Frasca S, et al. INSIGHT Responsive parenting intervention and infant sleep. Pediatrics 2016; 138: e20160762–2.
Chawla JK, Burgess S, Heussler H. The impact of sleep problems on functional and cognitive outcomes in children with Down syndrome: a review of the literature. J Clin Sleep Med. 2020;16: 1785–1795.
Fucà E, Costanzo F, Celestini L, et al. Characterization of sleep disturbances in children and adolescents with Down syndrome and their relation with cognitive and behavioral features. Int J Environ Res Public Health 2021; 18: 5001.
Góczán-Szabó I, Prónay B. Atypical development, mental health, family. In: Danis I, Németh T, Prónay B, et al. (eds.) Theory and practice of early childhood mental health support I. Developmental theories and empirical results. [Atipikus fejlődés, lelki egészség, család. In: Danis I, Németh T, Prónay B, et al. (szerk.) A kora gyermekkori lelki egészség támogatásának elmélete és gyakorlata I. Fejlődéselméletek és empirikus eredmények.] Semmelweis Egyetem, Egészségügyi Közszolgálati Kar, Mentálhigiéné Intézet, Budapest, 2020; pp. 330–363. [Hungarian]
Lukowski AF, Milojevich HM. Sleep problems and temperament in young children with Down syndrome and typically developing controls. J Intellect Disabil Res. 2016; 61: 221–232.
Owens J, Burnham MM. Sleep disorders. In: Zeanah CH Jr. (ed.) Handbook of infant mental health. 4th ed. The Guilford Press, New York, NY, 2018; pp. 365–391.
Tietze AL, Zernikow B, Michel E, et al. Sleep disturbances in children, adolescents, and young adults with severe psychomotor impairment: impact on parental quality of life and sleep. Dev Med Child Neurol. 2014; 56: 1187–1193.
Esbensen AJ, Schworer EK, Hoffman EK, et al. Child sleep linked to child and family functioning in children with Down syndrome. Brain Sci. 2021; 11: 1170.
Papoušek M. Disorders of behavioral and emotional regulation: clinical evidence for a new diagnostic concept. In: Papoušek M, Schieche M, Wurmser H. (eds.) Disorders of behavioral and emotional regulation in the first years of life. ZERO TO THREE, Washington, DC, 2008; pp. 53–84.
Bull MJ. Down syndrome. N Engl J Med. 2020; 382: 2344–2352.
Galland BC, Taylor BJ, Elder DE, et al. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med Rev. 2012; 16: 213–222.
Schlieber M, Han J. The role of sleep in young children’s development: a review. J Genet Psychol. 2021; 182: 205–217.
Balog P, Tesch D, Poós A. Background factors of childhood sleep disorders: interparental conflicts, parent-child attachment, parenting style and the quality of parent-child relationship. [A gyermekkori alvászavarok háttértényezői: a szülők közötti konfliktusok, a szülő-gyermek kötődés, a nevelési stílus és a szülő-gyermek kapcsolat minősége.] Orv Hetil. 2024; 165: 652–663. [Hungarian]
El-Sheikh M, Sadeh AI. Sleep and development: introduction to the monograph. Monogr Soc Res Child Dev. 2015; 80: 1–14.
Field T. Infant sleep problems and interventions: a review. Infant Behav Dev. 2017; 47: 40–53.
Knappe S, Pfarr AL, Petzoldt J, et al. Parental cognitions about sleep problems in infants: a systematic review. Front Psychiatry 2020; 11: 554221.
American Academy of Sleep Medicine. International Classification of Sleep Disorders. Diagnostic and coding manual. Westchester, IL, 2005; pp. 148–152.
Diagnostic classification of mental health and developmental disorders of infancy and early childhood. ZERO TO THREE, Washington, DC, 2016. [A csecsemő- és kora gyermekkori lelki egészség és fejlődés zavarainak diagnosztikai klasszifikációs rendszere.] Medicina Könyvkiadó, Budapest, 2019. [Hungarian]
Varma P, Conduit R, Junge M, et al. A systematic review of sleep associations in parents and children. J Child Fam Stud. 2021; 30: 2276–2288.
Hysing M, Sivertsen B, Stormark KM, et al. Sleep in children with chronic illness, and the relation to emotional and behavioral problems – a population-based study. J Pediatr Psychol. 2009; 34: 665–670.
Lewandowski AS, Ward TM, Palermo TM. Sleep problems in children and adolescents with common medical conditions. Pediatr Clin North Am. 2011; 58: 699–713.
Ghanizadeh A, Faghih M. The impact of general medical condition on sleep in children with mental retardation. Sleep Breath 2011, 15: 57–62.
Allen JM, Graef DM, Ehrentraut JH, et al. Sleep and pain in pediatric illness: a conceptual review. CNS Neurosci Ther. 2016; 22: 880–893.
Williams J, Lange B, Sharp G, et al. Altered sleeping arrangements in pediatric patients with epilepsy. Clin Pediatr. 2000; 39: 635–642.
Chamlin SL, Mattson CL, Frieden IJ, et al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med. 2005; 159: 745–750.
Hemmingsson H, Stenhammar AM, Paulsson K. Sleep problems and the need for parental night-time attention in children with physical disabilities. Child Care Health Dev. 2009; 35: 89–95.
Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016; 154(1 Suppl): S1–S41.
Liu J, Zhang X, Zhao Y, et al. The association between allergic rhinitis and sleep: a systematic review and meta-analysis of observational studies. PLoS ONE 2020; 15: e0228533.
Chang YS, Chiang BL. Mechanism of sleep disturbance in children with atopic dermatitis and the role of the circadian rhythm and melatonin. Int J Mol Sci. 2016; 17: 462.
Sheldon SH. Medical disorders resulting in problem sleeplessness in children. UpToDate, Waltham, MA, 2016, 1–50.
Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016; 47: 69–94.
Galántai D, Benedek P, Horváth T. The efficacy of STOP-BANG questionnaire in screening of benign snoring and mild obstructive sleep apnea. [A STOP-BANG kérdőív hatékonysága a benignus horkolás és az enyhe obstruktív alvási apnoe kiszűrésében.] Orv Hetil. 2023; 164: 265–272. [Hungarian]
Molnár V, Molnár A, Lakner Z, et al. Analysis of the most important features of obstructive sleep apnoea. [Az obstruktív alvási apnoe főbb jellemzőinek vizsgálata.] Orv Hetil. 2022; 163: 586–592. [Hungarian]
Benedek P. Obstructive sleep apnea syndrome in childhood. [A gyermekkori obstruktív alvási apnoe szindróma.] Gyermekgyógyászat 2009; 60: 103–105. [Hungarian]
Marcus CL, Brooks LJ, Ward SD, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130: e714–e755.
Paruthi S. Evaluation of suspected obstructive sleep apnea in children. UpToDate, Waltham, MA, 2017 May.
Poisson A, Nicolas A, Bousquet I, et al. Smith-Magenis syndrome: molecular basis of a genetic-driven melatonin circadian secretion disorder. Int J Mol Sci. 2019; 20: 3533.
Winsor AA, Richards C, Bissell S, et al. Sleep disruption in children and adolescents with epilepsy: a systematic review and meta-analysis. Sleep Med Rev. 2021; 57: 101416.
Horwood L, Mok E, Li P, et al. Prevalence of sleep problems and sleep-related characteristics in preschool- and school-aged children with cerebral palsy. Sleep Med. 2018; 50: 1–6.
Klapp JM, Hall TA, Riley AR, et al. Sleep disturbances in infants and young children following an acquired brain injury. J Clin Sleep Med. 2022; 18: 2387–2395.
Brown KA, Parikh S, Patel DR. Understanding basic concepts of developmental diagnosis in children. Transl Pediatr. 2020; 9(Suppl 1): S9–S22.
Lányiné Engelmayer Á. Intellectual disability and psychological development. [Intellektuális képességzavar és pszichés fejlődés.] Medicina Könyvkiadó, Budapest, 2017. [Hungarian]
Angriman M, Caravale B, Novelli L, et al. Sleep in children with neurodevelopmental disabilities. Neuropediatrics 2015; 46: 199–210.
Shelton AR, Malow B. Neurodevelopmental disorders commonly presenting with sleep disturbances. Neurotherapeutics 2021; 18: 156–169.
D’Souza D, D’Souza H, Horváth K, et al. Sleep is atypical across neurodevelopmental disorders in infants and toddlers: a cross-syndrome study. Res Dev Disabil. 2020; 97:103549.
Dueck A, Reis O, Bastian M, et al. Feasibility of a complex setting for assessing sleep and circadian rhythmicity in a fragile X cohort. Front Psychiatry 2020; 11: 361.
Morris CA, Mervis CB. Williams syndrome. Cassidy and Allanson’s management of genetic syndromes. John Wiley & Sons, Hoboken, NJ, 2020; pp. 1021–1038.
Craig SG, Weiss MD, Hudec KL, et al. The functional impact of sleep disorders in children with ADHD. J Atten Disord. 2017; 24: 499–508.
Larsson I, Aili K, Lönn M, et al. Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): a systematic literature review. Sleep Med. 2023; 102: 64–75.
Dykens EM. Psychiatric and behavioral disorders in persons with Down syndrome. Ment Retard Dev Disabil Res Rev. 2007; 13: 272–278.
Santos RA, Costa LH, Linhares RC, et al. Sleep disorders in Down syndrome: a systematic review. Arq Neuropsiquiatr. 2022; 80: 424–443.
Bokov P, Boujemla I, Dahan J, et al. Obstructive sleep apnea in children with Down syndrome: contribution of upper airway and chemosensitivity. Pediatr Res. 2023; 94: 1990–1997.
Walter LM, Varkey JM, Gu C, et al. Sleep disordered breathing improvement prevents worsening of autonomic dysfunction in children with Down syndrome. Sleep Med. 2023; 107: 219–228.
Basil JS, Santoro SL, Martin LJ, et al. Retrospective study of obesity in children with Down syndrome. J Pediatr. 2016; 173: 143–148.
Konstantinopoulou S, Tapia IE, Kim JY, et al. Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome. Sleep Med. 2016; 17: 18–24.
Chen CC, Spanò G, Edgin JO. The impact of sleep disruption on executive function in Down syndrome. Res Dev Disabil. 2013; 34: 2033–2039.
Anand V, Shukla G, Gupta N, et al. Association of sleep apnea with development and behavior in Down syndrome: a prospective clinical and polysomnographic study. Pediatr Neurol. 2021; 116: 7–13.
Lal C, White DR, Joseph JE, et al. Sleep-disordered breathing in Down syndrome. Chest 2015; 147: 570–579.
Scheuring N, Danis I, Papp E, et al. Sleeping problems in early childhood II. Bedtime difficulties. [Alvási problémák csecsemő- és kisgyermekkorban II. Altatási és elalvási nehézségek.] Gyermekgyógyászat 2015; 66: 208–215. [Hungarian]
Hédervári-Heller É. Parent-infant consultation and therapy. [A szülő-csecsemő konzultáció és terápia.] Animula Kiadó, Budapest, 2020. [Hungarian]
Cierpka M. Regulatory disorders in infants. assessment, diagnosis, and treatment. Springer International Publishing, Cham, 2016.
Olsen AL, Ammitzbøll J, Olsen EM, et al. Problems of feeding, sleeping and excessive crying in infancy: a general population study. Arch Dis Child. 2019; 104: 1034–1041.
Hámori E. Early relationship disorders. 2nd ed. [A korai kapcsolat zavarai. 2. kiadás.] Oriold és Társai Kiadó, Budapest, 2020. [Hungarian]
Bassell JL, Phan H, Leu R, et al. Sleep profiles in children with Down syndrome. Am J Med Genet. 2015; 167: 1830–1835.
Barros da Silva R, Barbieri-Figueiredo MD, Van Riper M. Breastfeeding experiences of mothers of children with Down syndrome. Compr Child Adolesc Nurs. 2019; 42: 250–264.
Yuge K, Nagamitsu S, Ishikawa Y, et al. Long-term melatonin treatment for the sleep problems and aberrant behaviors of children with neurodevelopmental disorders. BMC Psychiatry 2020; 20: 445.
Bruni O, Angriman M, Melegari MG, et al. Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders. Expert Opin Pharmacother. 2019; 20: 2257–2271.
Drozd F, Leksbø TS, Størksen HT, et al. An overview of reviews for preventing and treating sleep problems in infants. Acta Paediatr. 2022; 111: 2071–2076.
Reuter A, Silfverdal S, Lindblom K, et al. A systematic review of prevention and treatment of infant behavioural sleep problems. Acta Paediatr. 2020; 109: 1717–1732.