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Volume 14 No. 10
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Accepted Papers

Scientific Investigations

Prevalence of Sleep Disorders in Adults With Down Syndrome: A Comparative Study of Self-Reported, Actigraphic, and Polysomnographic Findings

Sandra Giménez, MD, PhD1,2,3,4; Laura Videla, MSc5; Sergio Romero, PhD6,7; Bessy Benejam, MSc5; Susana Clos, MSc2,3; Susana Fernández, MD5; Maribel Martínez2; Maria Carmona-Iragui, MD, PhD5,8,9; Rosa M. Antonijoan, MD, PhD2,3; Mercedes Mayos, MD, PhD1,10; Ana Fortuna, MD, PhD1; Patricia Peñacoba, MD1; Vicente Plaza, MD, PhD1,10; Ricardo S. Osorio, MD11; Ram A. Sharma11; Ignasi Bardés, MD5; Anne-Sophie Rebillat, MD12; Alberto Lleó, MD, PhD8,9; Rafael Blesa, MD, PhD8,9; Sebastian Videla, MD5,13; Juan Fortea, MD, PhD5,8,9
1Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2Drug Research Center, Institute for Biomedical Research Sant Pau (IIB Sant Pau), Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Barcelona, Spain; 3Centro de Investigación Biomédica en Red de Enfermedades en Salud Mental CIBERSAM Spain; 4Department of Clinical Psychobiology, University of Barcelona, Spain; 5Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain; 6Biomedical Engineering Research Centre, Department of Automatic Control, Universitat Politècnica de Catalunya, Barcelona, Spain; 7CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain; 8Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona; 9Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas; 10Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CibeRes), Spain; 11Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, New York; 12Institut Jérôme Lejeune, París, France; 13Clinical Research Support Unit. Bellvitge Biomedical Research Institute (IDIBELL) Department of Clinical Pharmacology, University of Barcelona, Barcelona, Spain

Study Objectives:

Sleep problems are often undetected in adults with Down syndrome (DS). Our objective was to determine the prevalence of sleep disorders in adults with DS through self-reported and objective sleep measures.


We performed a community-based cross-sectional study of 54 adults with DS not referred for sleep disorders. Two polysomnography (PSG) sleep studies were performed. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the risk for the sleep apnea syndrome (OSA) was identified using the Berlin Questionnaire (BQ). Participants' sleep/wake pattern was assessed from sleep diaries and by wrist actigraphy. PSQI, ESS, and PSG measures were compared with 35 sex-, age-, and body mass index-matched patients in the control groups.


In PSG measures, adults with DS showed lower sleep efficiency (69 ± 17.7 versus 81.6 ± 11; P < .001), less rapid eye movement sleep (9.4 ± 5.8 versus 19.4 ± 5.1; P < .001), a higher prevalence of OSA (78% versus 14%; P < .001), and a higher apnea-hypopnea index (23.5 ± 24.5 versus 3.8 ± 10.5; P < .001) than patients in the control group. In the DS group, the questionnaires (mean PSQI 3.7 ± 2.9; mean ESS 6.3 ± 4.5 and mean BQ 1 ± 0) did not reflect the sleep disturbances detected on the PSG. Actigraphy data recorded daytime sleep that was not self-reported (118.2 ± 104.2 minutes).


Adults with DS show severe sleep disruption and a high prevalence of OSA, undetected by self-reported sleep measures. Actigraphy, PSG, and validated simplified devices for screening OSA should be routinely recommended for this population because treatment of sleep disorders can contribute to healthy aging.


Giménez S, Videla L, Romero S, Benejam B, Clos S, Fernández S, Martínez M, Carmona-Iragui M, Antonijoan RM, Mayos M, Fortuna A, Peñacoba P, Plaza V, Osorio RS, Sharma RA, Bardés I, Rebillat AS, Lleó A, Blesa R, Videla S, Fortea J. Prevalence of sleep disorders in adults with down syndrome: a comparative study of self-reported, actigraphic, and polysomnographic findings. J Clin Sleep Med. 2018;14(10):1725–1733.

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