Review articlePrevalence, associated factors and treatment of sleep problems in adults with intellectual disability: A systematic review
Highlights
► The estimated prevalence of sleep problems in adults with ID ranges from 8.5% to 34.1%. ► Challenging behavior, dementia, respiratory disease, visual impairment, psychiatric conditions and medication use are associated with sleep problems. ► Research on sleep problems in adults with ID has mainly focused on subjectively derived data. ► The definitions used to describe a sleep problem are not uniform, and associations are mainly described as correlations.
Introduction
Sleep problems are common in the aging general population. Foley, Monjan, Brown, Simonsick, Wallace, & Blazer (1995) interviewed 9282 community-living persons aged 65 years and over and reported that 43% experience difficulties initiating or maintaining sleep (Foley et al., 1995). Meta-analyses of the change in sleep patterns during the lifespan demonstrate an increase in sleep latency and night waking frequency, and a decrease in total sleep time and sleep efficiency (ratio of time spent asleep to the amount of time spent in bed) with aging (Floyd et al., 2000, Ohayon et al., 2004). Symptoms of insomnia can lead to poorer quality of life, cognitive decline, depression, disability in instrumental activities of daily living (ADLs) and institutionalization (Vaz Fragoso & Gill, 2007). In contrast, a cohort study of 3820 persons aged 60 years and over showed that self-reported long sleep duration was associated with higher mortality rates, even in those with better health status (Mesas, Lopez-Garcia, Leon-Munoz, Guallar-Castillon, & Rodriguez-Artalejo, 2010).
For people with intellectual disability (ID), previous reviews on sleep problems indicate that disruptions of sleep and sleep–wake rhythms are common (Espie, 2000), and the prevalence of sleep problems is higher than in the general population (Doran, Harvey, & Horner, 2006). The estimated prevalence of sleep problems in people with ID varies from 13% to 86%, depending on the age of the studied participants, used diagnostic method and definitions used for a sleep problem (Didden & Sigafoos, 2001). Although these reviews are valuable, they were not done systematically and cover both children and adults (Didden and Sigafoos, 2001, Doran et al., 2006, Espie, 2000).
A criterion to diagnose a sleep problem is that the individual experiences his sleep quality as a burden (ICSD-R, 2001). However, for people with ID it is often hard to communicate their personal sleep experience, and professional caregivers may selectively report problems that disturb themselves or other clients (Brylewski & Wiggs, 1998). This may complicate the detection and subsequent treatment of sleep problems. People with ID nowadays live longer than previously expected, and aging in people with a mild level of ID is even similar to that in the general population (Patja, Livanainen, Vesala, Oksanen, & Ruoppila, 2000). Accordingly, a better insight into sleep problems in adults and older people with ID is first important for optimal care, and second important for working towards a unified and broadly accepted definition for sleep problems in this population.
Therefore, the aim of this systematic review is first to examine how sleep problems are defined in research among this population. Secondly we aim to give an overview of existing literature on sleep problems in adults and older people with ID, in order to investigate the prevalence rate, associated factors (e.g. personal characteristics, medical history) and treatment of sleep problems, taking methodological quality into account.
Section snippets
Search strategy
A systematic literature search was conducted using the electronic databases Medline/PubMed, EMBase, PsycINFO and Web of Science. We selected various different search terms, in order to reduce the chance of missing important information.
Terms for intellectual disability were: mental retardation, intellectual disability, intellectually retarded, intellectually disabled, mental disability, mentally disabled, idiocy, mental deficiency, learning disability, learning disorder, learning disturbance,
Results
The initial search resulted in 1217 studies. Finally, fifty studies met the inclusion criteria.
Fig. 1 shows the flow chart of data selection.
Searching the bibliographies of included studies did not result in additional relevant references that met the selection criteria.
Fifty studies were included for the systematic review. Two studies described the same study population (Brylewski and Wiggs, 1999, Brylewski and Wiggs, 1998). In six studies a clear definition of a sleep problem in the studied
Discussion
This is the first systematic review on the prevalence, associated factors and treatment of sleep problems in adults and older people with intellectual disability (ID). Fifty studies matched the inclusion criteria, of which one study was of high-quality, 14 were well conducted, 14 well conducted but with a high risk of bias and 21 were non-analytical. Informant-based interviews were the most frequently used research method. Sleep problems were most often named as settling problem, night waking
References (62)
- et al.
Sleep problems in children and young adults with developmental disabilities: Home-based functional assessment and treatment
Journal of Behavior Therapy and Experimental Psychiatry
(2002) - et al.
A review of the nature and treatment of sleep disorders in individuals with developmental disabilities
Research in Developmental Disabilities
(2001) - et al.
Grief in adults with mental retardation: Preliminary findings
Research in Developmental Disabilities
(1993) - et al.
Behavioral and psychiatric disorders in Prader–Willi syndrome: A population study in Japan
Brain and Development
(2007) - et al.
An examination of psychotropic medication side effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?
Research in Developmental Disabilities
(2010) - et al.
Adult patients with Prader–Willi syndrome: clinical characteristics, life circumstances and growth hormone secretion
Growth Hormone & IGF Research
(2000) - et al.
Mania and behavioral equivalents: A preliminary study
Research in Developmental Disabilities
(2010) - et al.
Self-injurious behavior and sleep disturbance in adults with developmental disabilities
Research in Developmental Disabilities
(2000) - et al.
Sleep problems in Rett syndrome
Brain and Development
(2007) Environmental changes affect sleep patterns: A case study
Perceptual & Motor Skills
(1995)
Treatment-emergent behavioural side effects with selective serotonin re-uptake inhibitors in adults with learning disabilities
Human Psychopharmacology
A cohort study of the prevalence of sleep problems in adults with intellectual disabilities
Journal of Sleep Research
Successful cognitive manipulation of a stereotypic nightmare in a 40 year old male with Down's syndrome
Behavioural Psychotherapy
Sleep problems and daytime challenging behaviour in a community-based sample of adults with intellectual disability
Journal of Intellectual Disability Research
A questionnaire survey of sleep and night-time behaviour in a community-based sample of adults with intellectual disability
Journal of Intellectual Disability Research
Activity and behavioral rhythm disturbances in adults with mental retardation
Developmental Brain Dysfunction
A population-based health survey of maladaptive behaviours associated with dementia in elderly people with learning disabilities
Journal of Intellectual Disability Research
Psychiatric symptoms of dementia among elderly people with learning disabilities
International Journal of Geriatric Psychiatry
Relapse of depression in people with Down's syndrome
British Journal of Developmental Disabilities
Maladaptive behaviours and symptoms of dementia in adults with Down's syndrome compared with adults with intellectual disability of other aetiologies
Journal of Intellectual Disability Research
Physical conditions and challenging behaviour in people with intellectual disability: A systematic review
Journal of Intellectual Disability Research
Symptoms of dementia among adults with Down's syndrome: A qualitative study
Journal of Intellectual Disability Research
The use of melatonin to treat sleep disorder in adults with intellectual disabilities in community settings—The evaluation of three cases using actigraphy
Journal of Intellectual Disability Research
Sleep and developmental disabilities: assessment, treatment, and outcome measures
Mental Retardation
Evaluation of a bedtime medication regimen on daytime sleep and challenging behaviors of an adult with intellectual disabilities
Mental Health and Developmental Disabilies
Sleep and disorders of sleep in people with mental retardation
Current Opinion in Psychiatry
Sleep studies of adults with severe or profound mental retardation and epilepsy
American Journal on Mental Retardation
Sleep patterns and sleep problems amongst people with mental handicap
Journal of Mental Deficiency Research
Improving sleep–wake schedules amongst people with mental handicaps: Some preliminary case material
Behavioural Psychotherapy
Age-related changes in initiation and maintenance of sleep: A meta-analysis
Research in Nursing & Health
Sleep complaints among elderly persons: An epidemiologic study of three communities
Sleep
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