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Sleep microstructure evaluation in a gifted child
Gifted children are those who present remarkable performance in any of the following domains: intellectual ability, academic performance, creative or productive thinking, leadership, talent for arts or psychomotor ability. Some studies showed that gifted children present sleep disturbances, such as difficulties in initiating and maintaining sleep, shorter sleep duration, earlier morning awakenings, obstructive sleep apnea and parasomnias.
The aim of this study is to report a case of a gifted child who presents sleep disturbance, to evaluate its sleep microstructure and to correlate with cognition.
We used clinical history, physical examination, psychological assessment, polysomnography and sleep microstructure evaluation by means of cyclic alternating pattern (CAP) to report this case of a 14-year-old male child. He was clinically evaluated in Associação Paulista para Altas Habilidades e Superdotação with a report including psychological, pedagogic and specific ability tests that showed above average abilities in such domains: artistic, linguistic, mathematical and musical areas.
On clinical history, patient reports difficulty in falling asleep, sleep fragmentation, nightmares and reduced total sleep time. Physical examination showed Mallampati II and palatine tonsils III. Polysomnography evidenced an increased apnea/hypopnea index (12.4 events/h), with a predominance of obstructive events and a minimum SpO2 of 82%, with normal sleep efficiency and normal sleep architecture. CAP parameters showed an increased percentage of A1, decreased percentage of A2 and A3 subtypes and increased CAP rate in slow wave sleep.
This case report shows CAP modifications in a gifted child and could represent a correlation of sleep oscillations with the degree of mental ability. Although we found obstructive sleep apnea (OSA) in this patient, OSA plays a different role in sleep microstructure (it reduces CAP rate and A1 index). Some studies showed that verbal skills are correlated with CAP rate in sleep slow waves and with high A1 index. There is an interaction between higher cognitive functions and the regulation of sleep. The increase in A1 CAP subtypes might point to a possible hyperfunction of these brain structures , which might play a role in a better cognitive performance. The decreased percentage of A2 and A3 subtypes may be associated with lower arrousability, therefore, lower activation of posterior cortex.
gifted child, sleep microstructure, cyclic alternating pattern.
Relato de Caso
HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA USP (FMUSP) - São Paulo - Brasil
MAIRA MEDEIROS HONORATO FERRARI, GABRIELA VANINA TOSCANINI, ADA CRISTINA GARCIA TOSCANINI, ROSA HASAN, LETICIA MARIA SANTORO AZEVEDO SOSTER, ANDREA CECILIA TOSCANINI