Sleep problems in children and adolescents with common medical conditions

Sleep Disturbance in Caregivers of Children With Respiratory and Atopic Disease

OBJECTIVE

To examine sleep patterns and sleep disturbances in caregivers of children with chronic illness.

METHODS

Caregivers of children with atopic dermatitis (AD, n = 35), asthma (AS, n = 27), atopic dermatitis and asthma (AD + AS, n = 57), ventilator assistance (VENT, n = 61), or typically developing (HEALTHY, n = 63) completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and three items examining reasons for parent sleep disruption.

RESULTS

Compared with healthy families, caregivers of children with chronic illness reported poorer sleep quality, more symptoms of insomnia, and chronic partial sleep deprivation. VENT and AD caregivers had higher rates of sleep disruptions due to caregiving, whereas AS caregivers reported more sleep disruptions from stress about the child's health.

CONCLUSIONS

Deficient and poor-quality sleep in caregivers of children with chronic illness may have a significant impact on their health and well-being, as well as caregiving responsibilities. These data provide important information for pediatric psychologists working with these families.

Daily Sleep Patterns, Sleep Quality, and Sleep Hygiene Among Parent-Child Dyads of Young Children Newly Diagnosed With Juvenile Idiopathic Arthritis and Typically Developing Children

OBJECTIVES

Describe daily sleep patterns, sleep quality, and sleep hygiene in 2-5-year-old children newly diagnosed with juvenile idiopathic arthritis (JIA) and their parents in comparison with typically developing (TD) children and parents.

METHODS

Participants (13 JIA, 16 TD parent-child dyads) wore actigraphs for 10 days. Parents completed sleep diaries and sleep hygiene survey.

RESULTS

Children with JIA had significantly less total sleep time, lower sleep efficiency (SE), and longer naps than TD children. Parents of children with JIA had significantly earlier bedtimes, more wake after sleep onset (WASO) and lower SE than TD parents. Parent-child SE and WASO were interrelated in JIA dyads. Sleep hygiene practices were inconsistent in both groups of children.

CONCLUSIONS

Inadequate amounts of sleep and poor sleep quality were common in parent-child dyads. Early interventions to improve sleep duration and promote sleep hygiene practices may alleviate future sleep problems and improve parent and child well-being.

Evaluation of an Ecologically Valid Group Intervention to Address Sleep Health in Families of Children With Allergic Diseases

Sleep issues in children with allergic diseases may be a result of illness related factors (e.g., itching, wheezing) and/or poor sleep habits due to disrupted routines and parental permissiveness. However, the ability of parents to attend a multi-session sleep intervention may be limited. Thus we examined the validity of a one-time sleep health group intervention for parents of children with allergic diseases. Ninety-three parents of children who were admitted to a two-week intensive day hospital treatment program completed measures of child sleep habits (Children's Report of Sleep Patterns), parent sleep habits (Sleep Hygiene Inventory), parent sleep quality (Pittsburgh Sleep Quality Index), and parental insomnia symptoms (Insomnia Severity Index) before the group intervention and one-month after program discharge; 54 parents attended the sleep health group. Sleep habits and sleep quality improved for both parents and children at the one-month follow-up. However, improvements were seen regardless of group attendance. Potential reasons for the lack of difference between those who did and did not participate in group are presented, and implications of this study for pediatric psychologist in practice are discussed.

Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis

INTRODUCTION

Rheumatoid arthritis as one of the most common autoimmune diseases is known to be one of the leading causes of disability. Sleep disorders have direct influence on patient's life. According to studies, sleep problems are known to have negative impact on well-being and functioning, but the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood. This study aimed to investigate the relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis patients.

METHODS

In a descriptive -correlative study, 210 patients with rheumatoid arthritis referred to Tabriz medical university clinics selected by convenience sampling and were assessed by Sleep Disorders Questionnaire (SDQ), Epworth Sleepiness Scale (ESS), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS). Data were analyzed using SPSS-13 by descriptive statistics such as frequency, mean (SD) and inferential statistics including Spearman correlation analysis, linear regression, χ(2),t-test and ANOVA.

RESULTS

The mean age of participants was 48.41(12.92) years in which most of them (74%) were female. The mean (SD) quality of life was 40.51(22.94), sleepiness 13.14 (5.6) and pain 6.09 (2.14). There was significant negative relationship between some sleep disorders such as (naps, apnea, asphyxia,…) and pain with quality of life but pain severity had more effect on QOL compared to sleep problems. Furthermore, participants had low quality of life with more restriction in physical (mean=34.71) and general health (mean=34.42).

CONCLUSION

Sleep problems and pain were associated with poor quality of life in Rheumatoid Arthritis patients.

Examination of the Factor Structure of the Adolescent Sleep-Wake Scale (ASWS)

This study examined the factor structure of the Adolescent Sleep-Wake Scale (ASWS) among 491 adolescents (12-18 years) with and without pediatric health conditions. Exploratory factor analyses were conducted using iterated principal axis factoring with varimax rotation. Highly cross-loading items were systematically removed and analyses were rerun until a clean solution was attained. The final solution explained 57.1% of the total model variance, including 10 items and three factors: Falling Asleep and Reinitiating Sleep-Revised, returning to Wakefulness-Revised, and Going to Bed-Revised. Internal consistency reliability scores were acceptable to good, with the exception of the Going to Bed-Revised subscale for the healthy sample. Adolescents with chronic pain reported significantly poorer overall sleep quality and more problems in falling asleep, reinitiating sleep, and returning to wakefulness as compared to healthy adolescents, providing preliminary evidence for construct validity of the new factors. The resulting ASWS version is a concise assessment tool with empirically derived, distinct behavioral sleep dimensions that can be used for clinical and research purposes.

Child allergic symptoms and mental well-being: the role of maternal anxiety and depression

OBJECTIVE

To determine whether maternal mental health mediates the relationship between eczema or asthma symptoms and mental well-being in children.

STUDY DESIGN

Analysis of 7250 children from the Avon Longitudinal Study of Parents and Children. Child mental well-being at 8 years was measured by the Strengths and Difficulties Questionnaire. Binary outcomes were high 'internalizing' (anxious/depressive) and 'externalizing' (oppositional/hyperactive) problems (high was >90th percentile). Child rash and wheeze categories were 'none'; 'early onset transient' (infancy/preschool only); 'persistent' (infancy/preschool and at school age); and 'late onset' (school age only). Maternal anxiety and depression were reported during pregnancy and when child was 8 years old.

RESULTS

Persistent wheezing symptoms were associated with high externalizing (OR 1.74, 95% CI, 1.41-2.15) and internalizing (1.67, 1.35-2.06) problems compared with never wheeze. Maternal anxiety and depression, and disrupted child sleep, attenuated these associations. Persistent rash (externalizing: 1.74, 1.40-2.15; internalizing: 1.42, 1.16-1.74) and late onset rash (externalizing: 1.62, 1.17-2.25; internalizing: 1.46, 1.07-1.99) symptoms were associated with poorer mental well-being compared with no rash at any age. Maternal anxiety and depression, particularly when child was aged 8 years rather than during pregnancy, accounted for the association with internalizing symptoms and partly for externalizing symptoms. Sleep disruption did not mediate the association.

CONCLUSIONS

Maternal anxiety and depression may mediate the association between child rash and wheeze and child mental well-being.

Systematic review and meta-analysis of behavioral interventions for pediatric insomnia

OBJECTIVE

To evaluate and quantify the evidence for behavioral interventions for pediatric insomnia.

METHODS

Meta-analysis of 16 controlled trials and qualitative analysis of 12 within-subject studies were conducted (total n = 2,560).

RESULTS

Meta-analysis found significant effects for four specified sleep outcomes: sleep-onset latency, number of night wakings, and duration of night wakings, and sleep efficiency, with small to large effect sizes across the controlled clinical trials involving typical children. No significant effects were found for the two studies conducted with special needs populations. Finally, within-subjects studies demonstrated significant effects for all sleep outcomes with large effect sizes. Risk of bias assessment and GRADE ratings of the quality of the evidence are described.

CONCLUSION

Moderate-level evidence supports behavioral interventions for pediatric insomnia in young children. However, low evidence for children, adolescents, and those with special needs (due to a lack of studies that met inclusion criteria) highlights the need for future research.

Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review

BACKGROUND

Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (or JIA). However, little is known about the frequency and severity of sleep disturbance(s) and the factors that are associated with sleep problems in children with JIA. The mechanism(s) of the relationships characterizing the development or exacerbation of sleep problems in children with JIA are still unknown, however studies have reported an association. The purpose of this study was to synthesize existing research related to sleep problems in children with JIA.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. An experienced librarian conducted searches in MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to January 2012, to identify potentially relevant citations. Two members independently selected, rated methodological quality using the QUIPS tool, and extracted data from included studies.

RESULTS

Ten studies were included and findings varied across studies; studies were mostly cross-sectional, or case-controlled designs, with only one cohort study available. Four studies found that children and adolescents diagnosed with JIA had significantly more sleep disturbances when compared to healthy controls. Pain was most often associated with sleep disturbances. The heterogeneous findings highlight the complex relationships between JIA and sleep, and low methodological quality of studies in the field.

CONCLUSIONS

This review supports an association between poor sleep and increased symptoms related to JIA, specifically the experience of pain. However, results need to be interpreted cautiously given the inconsistent findings regarding factors associated with sleep problems in JIA, the limited evidence available, and its low quality. Furthermore it is not yet determined if the poor sleep patterns predate the symptoms reported with JIA. More research is vital to understanding the factors that predict or perpetuate poor sleep in children and adolescents diagnosed with JIA.

Clinical Implications of Impaired Sleep

Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.

Longitudinal course and risk factors for fatigue in adolescents: the mediating role of sleep disturbances

OBJECTIVES

This study (1) examines fatigue over 1 year in adolescents with chronic pain (n = 61) and depressive disorders (n = 51) compared with healthy adolescents (n = 60), (2) identifies longitudinal risk factors, and (3) tests sleep disturbances as a mediator between depression and fatigue.

METHODS

Adolescents completed questionnaires at baseline, 6, and 12 months. Mixed effects models examined associations between risk factors and fatigue; structural equation modeling assessed contemporaneous and longitudinal mediation.

RESULTS

Results revealed fatigue persisted at 1 year follow-up, with adolescents in the clinical samples experiencing greater fatigue than healthy youth at all time points (ps < .001). Age, baseline depression, and baseline sleep disturbances predicted longitudinal fatigue for the total sample (ps < .05), with variation in predictors by subgroup. Sleep quality mediated the contemporaneous effects of depression on fatigue in the clinical samples (ps < .05).

CONCLUSIONS

Findings underscore the longitudinal course of fatigue and suggest that improving sleep disturbances may reduce fatigue in clinical samples.

A systematic review of sleep in pediatric pain populations

OBJECTIVE

The primary aim of this systematic review was to examine the evidence for a pain-sleep relationship in children with persistent pain by reviewing studies using single and mixed pediatric persistent pain samples.

METHODS

Electronic searches of Medline, PubMed, the Cochrane Database of Systematic Reviews, and PsycINFO were conducted to identify all relevant empirical studies. Studies were included in the review if the majority of participants were between 0 and 17 years and from one of the following pediatric pain populations: juvenile idiopathic arthritis, sickle cell disease, migraine/headache, functional abdominal pain, juvenile fibromyalgia syndrome, chronic musculoskeletal pain, or mixed populations including the aforementioned conditions.

RESULTS

Research from single and mixed sample studies support the hypothesis that children and adolescents with persistent pain suffer from sleep impairment. Literature addressing factors that may influence or mediate the pain-sleep relationship and the functional outcomes of the pain-sleep relationship was reviewed, and a model of the interrelationships with pain and sleep was developed.

CONCLUSION

Findings from this review highlight the need to assess and treat sleep problems in children presenting with persistent pain. Health care providers should consider conducting routine sleep screenings, including a comprehensive description of sleep patterns and behaviors obtained through clinical interview, sleep diaries, and/or the use of standardized measures of sleep. Future research focusing on investigating the mechanisms associating sleep and pediatric persistent pain and on functional outcomes of poor sleep in pediatric pain populations is needed.

Medical comorbidity of sleep disorders in children and adolescents

PURPOSE OF REVIEW

Sleep disorders in children and adolescents often present with various medical comorbidities. The aim of this review is to present the recent literature findings on this issue.

RECENT FINDINGS

The major medical comorbid conditions that accompany insomnia or short sleep duration in children and adolescents are obesity and metabolic syndrome, growth hormone deficiency, allergic conditions, various disorders accompanied by chronic pain, neoplasms and blood malignancies, and genetic and congenital disorders. Hypersomnia is mainly related to malignancies. Children and adolescents with obstructive sleep apnoea syndrome or sleep-disordered breathing may suffer from obesity and metabolic syndrome, polycystic ovaries, hypothyroidism, asthma, epilepsy, various ear nose throat disorders, congenital malformations or genetic conditions. Parasomnias may be comorbid with some medical conditions, but the main challenge in their evaluation is the differential diagnosis from nocturnal epileptic seizures.

SUMMARY

The co-occurrence of sleep disorders and medical conditions in childhood and adolescence is quite frequent and has an impact on general health and quality of life.

Sleep Behaviors and Parent Functioning in Young Children With Type 1 Diabetes

This study evaluates sleep characteristics among young children with type 1 diabetes and associations with parent sleep and emotional functioning and diabetes care. Study participants included twenty-four parents of young children with type 1 diabetes (ages 2-5) enrolled in a pilot study of a randomized-controlled trial. Child sleep characteristics were within normal limits. However, increased child bedtime resistance and behavioral insomnia were related to greater parent stress, anxiety, and depression and use of an intensive insulin regimen. Type 1 diabetes management may impact child and parent sleep as well as parent emotional functioning. Implications for practice are presented.

Sleep Patterns in Children with Cystic Fibrosis

This study examined sleep patterns and the association between sleep and perceived health for children with and without CF. Ninety families (45 CF) completed questionnaires about the child's sleep and health. Significant group differences were found for sleep patterns (bedtime, wake time, total sleep time), symptoms of sleep disordered breathing, and sleep disturbances. Poorer perceived health was associated with sleep disturbances among children with CF, but not for children without CF. This study highlights the importance of including sleep in the evaluation of children with CF, as both medical and behavioral interventions can improve the sleep of children with CF.

The assessment of sleep in pediatric chronic pain sufferers

The aim of this study is to review the options available for assessing sleep in pediatric chronic pain populations. One subjective measure of sleep (questionnaires) and two objective measures (polysomnography and actigraphy) were reviewed. The following databases were searched from their inception to June 2011: PsycINFO, ERIC, FRANCIS, MEDLINE, PsycARTICLES, Global health, Inspec, Health and Psychosocial Instruments, CINAHL, Scopus and ProQuest Dissertations and Theses databases. A total of nine sleep questionnaires were identified, two of which proved to be reliable and valid when used with pediatric chronic pain patients and, according to evidence-based assessment criteria, can be regarded as "well-established" instruments. Objective measures have been used less frequently. Both polysomnography (PSG) and actigraphy (ACT) have been used in five different studies. PSG is a reliable method for assessing sleep stage problems but is costly and intrusive. Actigraphy is cheaper, more ecological and easier to use than PSG but it deals only with the objective dimension of sleep (total sleep time, sleep efficiency, etc). In order to improve the reliability and validity of the assessment of sleep, a multi-level and multi-method approach is suggested: sleep measurement should be extended to include both objective and subjective assessment.

The longitudinal course, risk factors, and impact of sleep disturbances in children with traumatic brain injury

This study aimed to examine the prevalence and trajectory of sleep disturbances and their associated risk factors in children up to 24 months following a traumatic brain injury (TBI). In addition, the longitudinal association between sleep disturbances and children's functional outcomes was assessed. This was a prospective study of a cohort of children with TBI and a comparison cohort of children with orthopedic injury (OI). Parental reports of pre-injury sleep disturbances were compared to reports of post-injury changes at 3, 12, and 24 months. Risk factors for sleep disturbances were examined, including severity of TBI, presence of psychosocial problems, and pain. Sleep disturbances were also examined as a predictor of children's functional outcomes in the areas of adaptive behavior skills and activity participation. Both cohorts (children with TBI and OI) displayed increased sleep disturbances after injury. However, children with TBI experienced higher severity and more prolonged duration of sleep disturbances compared to children with OI. Risk factors for disturbed sleep included mild TBI, psychosocial problems, and frequent pain. Sleep disturbances emerged as significant predictors of poorer functional outcomes in children with moderate or severe TBI. Children with TBI experienced persistent sleep disturbances over 24 months. Findings suggest a potential negative impact of disturbed sleep on children's functional outcomes, highlighting the need for further research on sleep in children with TBI.

Daytime and nighttime sleep patterns in adolescents with and without chronic pain

OBJECTIVE

The aims of the current study were to characterize daytime and nighttime sleep patterns of adolescents with chronic pain, and to compare their sleep patterns to a healthy age- and sex-matched cohort.

METHODS

Sixty-one adolescents from a pain clinic and 60 age- and sex-matched youth from the community (mean age = 15.07; 69% female) participated. Participants underwent 10 days of actigraphic sleep monitoring to assess total sleep time (minutes of estimated sleep at night), wake minutes after initial sleep onset, sleep efficiency, and occurrence of sleep during the day.

RESULTS

Adolescents with chronic pain and healthy youth had similar nighttime sleep patterns (total sleep time, wake minutes after initial sleep onset, and sleep efficiency). However, adolescents with chronic pain spent more time sleeping during the day than their healthy peers. Longer daytime sleep was associated with more activity limitations in youth with chronic pain.

CONCLUSIONS

Although previous research using self-report methodology has indicated that adolescents with chronic pain commonly endorse poor sleep, findings from the current study suggest that these complaints may not be explained by differences in nighttime sleep patterns as measured by actigraphy. Use of multidimensional sleep assessment may help to understand the potential impact of sleep on chronic pain in adolescents.