Sleep and intellectual disability

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released June 6, 1994; last updated October 10, 2016; expires October 10, 2019

This article includes discussion of sleep and intellectual disability, sleep and Angelman syndrome, sleep and autism spectrum disorders, sleep and cerebral palsy, sleep and Down syndrome, sleep and Mowat-Wilson syndrome, sleep and Prader-Willi syndrome, sleep and Rett syndrome, and sleep and Smith-Magenis syndrome. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Key points

 

• Strategies for management vary according to etiology and manifestations of sleep disorders in various syndromes associated with intellectual disability.

 

• Hypnotics and sedating medications are of limited value in the treatment of sleep disorders in intellectually impaired individuals, but melatonin is useful in the treatment of sleep disorders due to disturbances of the sleep-wake cycle.

 

• Behavioral techniques for insomnia should be tried before medication in children with intellectual disability.

 

Excessive daytime sleepiness and REM sleep abnormalities of Prader-Willi syndrome may be manifestations of hypothalamic dysfunction rather than purely secondary to sleep-related breathing disturbances.

 

• Sleep apnea and its adverse effects may improve with continuous positive airway pressure, but obstructive sleep apnea, which may be due to abnormalities in upper airways, usually requires procedures such as adenotonsillectomy.

Historical note and terminology

Sleep disturbances, including insomnia, hypersomnia, and sleep-disordered breathing, are common in individuals with intellectual disability, previously referred to as mental retardation and defined as “a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18” (American Association on Intellectual and Developmental Disabilities 2009). Criteria for the diagnosis of intellectual disability are described in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (American Psychiatric Association 2013). An equivalent term to describe involvement of impaired brain functioning early in life is “intellectual developmental disorder.” Sleep disturbances of various types and degrees are reported in numerous disorders associated with intellectual disability, but will be briefly described in the following conditions where they are significant:

 

• Angelman syndrome
• Autism spectrum disorders
• Cerebral palsy
• Down syndrome
• Mowat-Wilson syndrome
• Prader-Willi syndrome
• Rett syndrome
• Smith-Magenis syndrome

Epileptic encephalopathies, which include epilepsy with continuous spike-wave during slow sleep, eg, Landau-Kleffner syndrome, are beyond the scope of this article, but are described elsewhere in Medlink Neurology.

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