Sleep problems in children and adolescents with common medical conditions

An evaluation of psychosocial sleep interventions for children with chronic health conditions: A systematic review

Chronic health conditions (CHC; e.g., cystic fibrosis, type 1 diabetes) in children are associated with disease-specific physical symptoms that contribute to a high prevalence of sleep problems. Sleep problems exacerbate other health-related sequelae and can impede therapeutic response to health treatments, increasing the overall complexity of symptom management. Psychosocial sleep interventions (PSI) improve sleep in children with typical development and neurodevelopmental conditions. Yet, the effectiveness of PSI for children with CHC has scarcely been investigated. This systematic review appraises the literature examining the effectiveness and acceptability of PSI for children with CHC. A search identified 20 studies that met inclusion criteria. Data related to participant characteristics, sleep targets, research design and methods, measures, sleep outcomes and collateral effects were extracted. Study rigor was then evaluated. Most studies evaluated youth-directed Cognitive Behavioral Therapy for Insomnia or parent-implemented behavioral sleep interventions. Twelve studies demonstrated positive sleep treatment effects and four demonstrated mixed effects. Collateral improvements were reported in child mental health and parental health and well-being, though physical health benefits for children were not consistently reported. One, five and 14 studies were rated as having strong, adequate, and weak methodological rigor respectively. Recommendations for clinical practice and future research are made.

Harmonizing data on correlates of sleep in children within and across neurodevelopmental disorders: lessons learned from an Ontario Brain Institute cross-program collaboration

There is an increasing desire to study neurodevelopmental disorders (NDDs) together to understand commonalities to develop generic health promotion strategies and improve clinical treatment. Common data elements (CDEs) collected across studies involving children with NDDs afford an opportunity to answer clinically meaningful questions. We undertook a retrospective, secondary analysis of data pertaining to sleep in children with different NDDs collected through various research studies. The objective of this paper is to share lessons learned for data management, collation, and harmonization from a sleep study in children within and across NDDs from large, collaborative research networks in the Ontario Brain Institute (OBI). Three collaborative research networks contributed demographic data and data pertaining to sleep, internalizing symptoms, health-related quality of life, and severity of disorder for children with six different NDDs: autism spectrum disorder; attention deficit/hyperactivity disorder; obsessive compulsive disorder; intellectual disability; cerebral palsy; and epilepsy. Procedures for data harmonization, derivations, and merging were shared and examples pertaining to severity of disorder and sleep disturbances were described in detail. Important lessons emerged from data harmonizing procedures: prioritizing the collection of CDEs to ensure data completeness; ensuring unprocessed data are uploaded for harmonization in order to facilitate timely analytic procedures; the value of maintaining variable naming that is consistent with data dictionaries at time of project validation; and the value of regular meetings with the research networks to discuss and overcome challenges with data harmonization. Buy-in from all research networks involved at study inception and oversight from a centralized infrastructure (OBI) identified the importance of collaboration to collect CDEs and facilitate data harmonization to improve outcomes for children with NDDs.

Sleep and quality of life characteristics in a pediatric population with chronic obstructive respiratory diseases

PURPOSE

To describe sleep and quality of life of pediatric patients with chronic obstructive respiratory diseases and to ascertain whether or not sleep quality correlates with quality of life in this population.

METHODS

Participants aged 5 to 18 years with cystic fibrosis (CF), severe asthma, or postinfectious bronchiolitis obliterans (PIBO) receiving regular follow-up at a pediatric respiratory medicine center were recruited. Two questionnaires were used: the Brazilian version of the Sleep Disturbance Scale for Children (SDSC) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

A total of 46 individuals were included: 30 with CF, 9 with severe asthma, and 7 with PIBO. Almost two-thirds of the patients and their parents or guardians scored at least 39 points on the SDSC, suggesting poor sleep quality. Significantly higher overall median scores were observed in those with severe asthma. Patients and their parents or guardians scored a median of 77 and 80 points respectively on the Peds-QL, with parents of patients with CF scoring higher than any other group. There was a moderate inverse correlation between sleep disorders and quality of life (r = - 0.532 for patients and r = - 0.606 for parents; p < 0.001).

CONCLUSION

Children and adolescents with chronic obstructive respiratory diseases experience impairment in their sleep quality and quality of life. Sleep disorders and quality of life have a moderate negative correlation.

Disengagement coping and sleep problems among trauma-exposed adolescents

BACKGROUND

The formation of healthy sleep patterns is a critical component of positive adolescent development. Dysregulated sleep habits can put youth at risk for the development of a multitude of inimical outcomes, particularly among those who are exposed to a traumatic event.

DESIGN AND METHODS

The present study investigated the links between voluntary disengagement coping (e.g., avoidance, denial, wishful thinking) and sleep outcomes among 86 trauma-exposed and non-exposed adolescents between the ages of 12-17 (Mage = 15.44, SD = 1.51; 41.9% female).

RESULTS

The relationship between voluntary disengagement coping and sleep outcomes was significant only among trauma-exposed adolescents, such that greater use of voluntary disengagement strategies was associated with greater sleep disturbances and greater daytime dysfunction.

CONCLUSIONS

Targeting disengagement coping may be an important strategy to improve sleep health among trauma-exposed adolescents. Continued efforts in improving the efficacy of trauma-exposed adolescent intervention strategies are needed.

Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents

Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.

EMDR in pediatric hospital setting: a case report of an adolescent with cancer

Introduction

Childhood cancer is rare, but it is the most frequent serious event with a high risk of traumatization for children, adolescents, parents and siblings. EMDR is widely studied as clinical intervention that addressed cancer-related stressors among cancer adult population, but to our knowledge, no researches have been conducted among children and adolescent with cancer.

Methods

The purpose of this case study is to describe for the first time the application of the EMDR protocol in a pediatric hospital setting with a 17-years-old Italian adolescent who received a diagnosis of leukemia. He accessed the psychological support service complaining of feelings of anxiety and general discomfort. EMDR protocol started after the diagnosis and ended after the usual eight phases. The Impact of Event Scale-Revised (IES-R) was used to assess stress disorders symptoms as outcome at the baseline (before the First Phase) and at the end of the EMDR protocol (after the Eight Phase).

Results

By using EMDR protocol the patient reported a decrease of emotional activation after a few EMDR sessions.

Conclusion

EMDR protocol may be effective for pediatric cancer patients in treating stress disorders symptoms and it can be proposed immediately after diagnosis as a standard care also in pediatric hospital setting.

Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study

Purpose

Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase.

Methods

Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program.

Results

Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated.

Conclusions

Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.

Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions

STUDY OBJECTIVES

This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating implementation science methods to advance pediatric BSI research.

METHODS

We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying implementation science strategies to address identified gaps across the continuum of translational research.

RESULTS

Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply implementation science theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies.

CONCLUSIONS

Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Implementation science theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations.

CITATION

Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med. 2023;19(7):1321-1336.

Prevalence and risk factors for pain-specific school absenteeism in adolescents with recurrent pain: A prospective population-based design

BACKGROUND

Adolescents with recurrent pain miss out from school more often than pain-free peers. Research has so far used cross-sectional designs, focusing on non-specific absenteeism in clinical samples. Hence, it is unknown whether estimates of absenteeism are specifically linked to the pain itself or reflects the characteristics of clinical samples.

OBJECTIVES

This study aimed to prospectively explore pain-related school absenteeism in a non-clinical sample, its variance and potential risk factors.

METHODS

This prospective study followed a cohort of 1300 Sweden-based adolescents (mean age = 16.9; 17.2% immigrants; 62.7% girls) with recurrent pain (headache, abdominal and/or musculoskeletal pain) through self-reports at two assessment points 12 months apart.

RESULTS

Overall, 64.2% reported any absenteeism at follow-up and about half of these (26.2%) reported frequent absenteeism. Adolescents who indicated missing school were more often girls, slightly older and had a higher overall pain burden and stressor levels. Yet, after adjusting for previous absenteeism, independent predictors were age, pain intensity, medication use and stress associated with school attendance. Further to this, immigrant status predicted frequent absenteeism.

CONCLUSIONS

Many adolescents with pain frequently miss out from school due to pain. Identified risk factors points at pain characteristics and coping, stressors associated with participation and advancing age. Taken together, the burden of pain and its correlates emerge earlier and escalate with increasing age hence, early interventions targeting broader domains are needed.

SIGNIFICANCE

This study adds substantially to the field by estimating the prevalence of pain-specific school absenteeism in a large sample of adolescents with recurrent pain in the general population using a prospective design. Furthermore, it identifies risk factors of pain-specific absenteeism from a broader context of the adolescent's life with independent predictors being the previous history of absenteeism, age, immigrant status, pain intensity, medication use and stress related to school attendance.

Sleep Disturbances in Adolescents With Idiopathic Intracranial Hypertension

BACKGROUND

We aimed to assess the presence of sleep disturbances in adolescents with idiopathic intracranial hypertension (IIH) and to determine whether demographic, anthropometric, and clinical factors are associated with disrupted sleep.

METHODS

Sleep disturbances and patterns were evaluated in a cohort of adolescents (aged 12 to 18 years) with ongoing IIH and compared with a healthy age- and sex-matched control group. All participants responded to three self-rating questionnaires: the School Sleep Habits Survey (SSHS), the Pediatric Sleep Questionnaire (PSQ), and the Depression, Anxiety, and Stress Scale. The study group's demographic, clinical, laboratory, and radiological data were documented, and their association with sleep patterns was examined.

RESULTS

Thirty-three adolescents with ongoing IIH and 71 healthy controls were included. There was a significantly higher prevalence of sleep disturbances in the IIH group compared with the controls (SSHS, P < 0.001 and PSQ, P < 0.001), as well as of their independent subscales: sleep-related breathing disorders (P = 0.006), daytime sleepiness (P = 0.04), sleep/wake disruptions (P < 0.001), and sleep-related depressive tendencies (P < 0.001). According to subgroup analyses, these differences were also present between the normal-weight adolescents but not between the overweight IIH and control adolescents. No differences were found in the demographic, anthropometric, and IIH disease-related clinical measures between individuals with IIH with disrupted and normal sleep patterns.

CONCLUSIONS

Sleep disturbances are common among adolescents with ongoing IIH, irrespective of their weight and disease-related characteristics. Screening adolescents with IIH for sleep disturbances is recommended as part of their multidisciplinary management.

The CSHQ-DE Questionnaire Uncovers Relevant Sleep Disorders in Children and Adolescents with Long COVID

Acute SARS-CoV-2 infections in children and adolescents are usually mild. However, they can suffer from ongoing symptoms, generally referred to as long COVID. Sleep disorders are one of the most frequent complaints in long COVID although precise data are missing. We assessed the sleep behavior of children and adolescents who presented at our outpatient clinic between January 2021 and May 2022 with the Children’s Sleep Habits Questionnaire (CSHQ-DE). We compared the sleep behavior at three different time points: pre-COVID-19; post-COVID-19 at the initial presentation; and post-COVID-19 at re-presentation. Data from 45 patients were analyzed. Of those, 64% were female and the median age was 10 years (range: 0–18 years). Asymptomatic or mild COVID-19 disease was experienced in 89% of patients; 11% experienced moderate disease. The initial presentation occurred at a median of 20.4 weeks (6 weeks–14 months) after the infection. The CSHQ-DE score increased significantly from pre-COVID-19 (45.82 ± 8.7 points) to post-COVID-19 (49.40 ± 8.3 points; p ≤ 0.01). The score then normalized at re-presentation (46.98 ± 7.8; p = 0.1). The greatest changes were seen in the CSHQ-DE subscale score “daytime sleepiness”. Our data showed that children and adolescents with long COVID often suffer from sleep disturbances. For most children and adolescents, these sleep disorders decreased over time without any further medical intervention aside from a basic sleep consultation.

Sleep and asthma management in youth with poorly-controlled asthma and their caregivers: a qualitative approach

OBJECTIVE

Youth with poorly-controlled asthma are at increased risk for sleep disturbances caused by nocturnal symptoms like coughing. Asthma-related sleep disturbances can have downstream consequences for youth with asthma and their families. This study aims to describe (1) sleep disturbances in adolescents with poorly-controlled asthma and their caregivers and (2) the relationship between sleep and asthma management.

METHODS

Adolescents with poorly-controlled asthma and their caregivers completed the Family Asthma Management System Scale (FAMSS), a semi-structured interview that assesses youth asthma management within the family context. Interviews were audio-recorded and transcribed. Two authors coded each transcript for sleep-related data in NVivo using descriptive content analysis.

RESULTS

Thirty-three adolescents ages 12-15 years old (M = 13.2, SD = 1.2) with poorly-controlled asthma and their caregivers participated in this study. Four main themes emerged: sleep difficulties, sleep environment, sleep and self-management, and fatigue and self-management. 42% of youth and caregivers reported worse nocturnal asthma symptoms (e.g. coughing) that caused frequent nighttime awakening. Approximately 27% of caregivers expressed distress over their child's nocturnal asthma and described their management strategies (e.g. co-sleeping, nighttime symptom monitoring). Adolescents described sleepiness as a barrier to asthma self-management tasks (e.g. medication adherence, response to exacerbation).

CONCLUSION

Interview responses demonstrated the considerable interrelationship of sleep and asthma management in adolescents with poorly-controlled asthma. Asthma providers should consider discussing sleep difficulties with their adolescent patients and their families. Addressing these difficulties may help adolescents improve their asthma self-management and help caregivers better cope with their child's disease.

Sleep Duration Buffers The Effects of Adversity on Mental Health Among Recently Immigrated Latinx Adolescents

The rate of Latinx migration to the U.S. has risen rapidly over the last several decades. Recognizing that Latinx migrant youth are exposed to a high rate of adverse events and that sleep has potential buffering effects on mental health, the current study aimed to examine sleep duration as a moderator of the link between childhood adversity and emotional and behavioral symptoms among Latinx migrant youth. One hundred and twelve first-generation migrants of Latinx ethnicity (and 46 caregivers) participated in this study; the average age was 19 (SD = 2). Participants self-reported demographics: 59.8% of participants were male, with the racial breakdown as follows: 38.8% white, 6.1% black, 4.1% mixed race, and 51% marked "other." Data were collected from a public high school for immigrant youth in the Southwestern U.S. and included average sleep duration, Adverse Childhood Experiences; the Child PTSD Symptoms Scale and the Child Behavior Checklist. Findings indicated experiences of neglect in childhood were associated with youth-reported mental health symptoms, but this relation was significantly moderated by sleep duration such that the relation was weakened in the presence of high sleep duration. Both effects were statistically significant and of medium size. Caregiver reports supported the buffering effects of sleep; medium or large interactions between sleep and all three adversity variables (abuse, neglect, and household dysfunction) were noted in multivariate analyses. The current study takes an important first step in identifying that short sleep duration is prevalent among Central American immigrant youth. Findings suggest that sleep duration has important public health potential as a means of buffering the effects of childhood adversity on mental health in a vulnerable group.

Convergent validity of the child behavior checklist sleep items in children with moderate to severe traumatic brain injury

AIM

The Child Behavior Checklist (CBCL) includes several sleep items. We aimed to examine the convergent validity of CBCL sleep scores with validated sleep measures, and to explore their functional correlates.

METHODS

This cross-sectional study included 44 children with moderate to severe TBI, aged 6-15 years. Parents completed the CBCL and Sleep Disturbance Scale for Children (SDSC), and children wore actigraphy watches.

RESULTS

We found significant, albeit differential, associations between CBCL and SDSC sleep scores. Specifically: (i) "trouble sleeping" with SDSC total score, (ii) "trouble sleeping" and "nightmares" with SDSC initiating and maintaining sleep, (iii) "talks/walks in sleep" with SDSC arousal, and (iv) "overtired," "sleeps more" and CBCL sleep composite with SDSC excessive somnolence. The CBCL item "sleeps less" was the only significant predictor of functioning; children who slept less had lower social competence. No associations were found between CBCL sleep scores and actigraphy.

CONCLUSIONS

The CBCL does not provide a comprehensive assessment of sleep disturbances in children with moderate to severe TBI. Nevertheless, certain CBCL sleep items demonstrate initial convergent validity with subscales of the SDSC assessing select types of sleep disturbances. The CBCL may be useful in research and clinical situations when administration of more comprehensive assessment sleep tools is not viable.

Implications of Disability Severity on 24-Hour Movement Guideline Adherence Among Children With Neurodevelopmental Disorders in the United States

BACKGROUND

Research has established beneficial associations between 24-hour movement guideline adherence and several health outcomes in typically developing (TD) children, but these relationships are poorly understood in children with neurodevelopmental disorders (NDD). This study examined (1) 24-hour movement guideline adherence, (2) the influence of disability severity, and (3) associations between guideline adherence and health outcomes of TD children and children with NDD.

METHODS

This cross-sectional study used data from the 2018 and 2019 cycles of the US National Survey of Children's Health. Parental/caregiver reports of movement behaviors (physical activity, screen time, and sleep), disability severity (limitations to daily activities), and health outcomes (general health status, anxiety, and depression) were provided for 8554 children with NDD and 19,669 TD children aged 6-17 years.

RESULTS

Children with NDD had significantly lower odds of meeting each movement behavior guideline compared to TD children; these effects were most pronounced for those who experienced consistent limitations to daily activities. Meeting at least 2 guidelines significantly lowered the odds for anxiety and depression, and increased the odds for better general health for children with NDD.

DISCUSSION

These findings suggest that degree of disability severity has a strong influence on adherence to 24-hour movement guidelines among children with NDD.

Impact of high-risk glycemic control on habitual sleep patterns and sleep quality among youth (13-20 years) with type 1 diabetes mellitus compared to controls without diabetes

BACKGROUND

In type 1 diabetes mellitus (T1D), glycemic control and sleep have a bidirectional relationship, with unhealthy glycemic control impacting sleep, and inadequate sleep impacting diabetes management. Youth are at risk for poor quality sleep; however, little is known about sleep among youth with high-risk glycemic control.

OBJECTIVE

To assess differences in habitual sleep timing, duration, and quality among youth with T1D and controls.

SUBJECTS

Two-hundred-thirty youth (13-20 years): 64 with T1D (mean age 16.6 ± 2.1 years, 48% female, diabetes duration 7.5 ± 3.8 years, HbA1c 96 ± 18.0 mmol/mol [10.9 ± 1.7%]), and 166 controls (mean age 15.3 ± 1.5, 58% female).

METHODS

Comparison of data from two concurrent studies (from the same community) using subjective and objective methods to assess sleep in youth: Pittsburgh Sleep Quality Index evaluating sleep timing and quality; 7-day actigraphy measuring habitual sleep patterns. Regression analyses were used to compare groups.

RESULTS

When adjusted for various confounding factors, youth with T1D reported later bedtimes (+36 min; p < 0.05) and shorter sleep duration (-53 min; p < 0.05) than controls, and were more likely to rate subjective sleep duration (OR 3.57; 95% CI 1.41-9.01), efficiency (OR 4.03; 95% CI 1.43-11.40), and quality (OR 2.59; 95% CI 1.16-5.76) as "poor" (p < 0.05). However, objectively measured sleep patterns were similar between the two groups.

CONCLUSIONS

Youth with high-risk T1D experience sleep difficulties, with later bedtimes contributing to sleep deficit. Despite a lack of objective differences, they perceive their sleep quality to be worse than peers without diabetes.

Sleep Assessment for Sleep Problems in Children

The breadth of childhood sleep problems is broad and can be associated with biologic, psychiatric, behavioral, social, and environmental processes. Unrecognized childhood sleep problems may threaten daytime behaviors and negatively impact school and psychosocial functioning. Left unattended, overall child biopsychosocial development may be impaired. Thus, identifying and addressing sleep problems has potential to optimize childhood health, development, and overall well-being. Nurses need to be cognizant of detrimental impacts of child sleep deprivation and advocate for appropriate sleep assessments while offering sleep education to parents and children.

Differences of Craniofacial Characteristics in Oral Breathing and Pediatric Obstructive Sleep Apnea

BACKGROUND

Oral breathing (OB) was considered associated with specific craniofacial structures and same for pediatric obstructive sleep apnea (OSA). This study aimed to investigate the differences of craniofacial structures between OB and OSA.

METHODS

In this retrospective study, 317 children under age 18 years were recruited and divided into OB group, OSA group, and control group. OSA group (15 boys, 4 girls) were referred from qualified sleep center and diagnosed as pediatric OSA with full-night polysomnography. OB group (10 boys, 10 girls) were mostly referral from pediatric or ENT department, some of whom undertook polysomnography and were not OSA. Control group consisted of orthodontic patients within the same period. Lateral cephalograms were obtained in all groups and their parameters were compared with Chinese normal values and each other.

RESULTS

R-PNS of OB group (18.04 ± 2.49 mm) was greater than OSA group (14.27 ± 4.36 mm) and even control group (16.22 ± 3.91 mm) (P < 0.01). U1-NA was also the greatest in OB group (7.15 ± 2.92 mm), followed by OSA group (4.88 ± 2.66 mm), while control group was the smallest (5.71 ± 2.94 mm) (P < 0.05). In addition, OB group presented the smallest adenoids and tonsils among three groups. Bony nasopharynx development, mandibular length and growth direction of mandible of OB group were all better than OSA group.

CONCLUSION

Despite of oral breathing, anatomical morphology (well-developed dentoalveolar structures; mild adenotonsillar hypertrophy) might protect children from developing OSA.

Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents

Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.

Sleep problems in adolescents with CFS: A case-control study nested within a prospective clinical cohort

Sleep problems have a negative impact on a range of outcomes and are very common in adolescents with chronic fatigue syndrome (CFS). We aimed to (a) establish whether adolescents with CFS have more self-reported sleep problems than illness controls as well as healthy controls, (b) investigate changes in sleep problems and (c) explore the extent to which sleep problems at baseline predict fatigue and functioning at follow-up in adolescents with CFS. The Insomnia Scale was completed by 121 adolescents with CFS, 78 healthy adolescents and 27 adolescents with asthma. Eighty (66%) treatment-naïve adolescents with CFS completed questionnaires approximately 3 months later. Adolescents with CFS reported increased sleep problems compared to healthy controls and adolescents with asthma. In CFS, there was no significant change in sleep problems without treatment over a 3-month follow-up. Sleep problems at baseline predicted a significant proportion of the variance in sleep problems at follow-up. Sleep problems should be targeted in treatment. Regulating the 'body clock' via the regulation of sleep could influence outcomes not assessed in this study such as school attainment.

Adolescents' sleep quality in relation to peer, family and school factors: findings from the 2017/2018 HBSC study in Flanders

PURPOSE

While a multitude of studies focused on biological and behavioral determinants of adolescents' sleep quality, a paucity of research examined the impact of social factors. The current study therefore examines the relationship between adolescents' sleep quality and peer, family and school factors.

METHODS

Data of Flemish participants in the 2017/2018 Health Behavior in School-aged Children survey (HBSC) were used, which is representative of the adolescent population (11-18 years) in Flanders. Adolescents' sleep quality was linked to individual-level data on peer relationships (i.e., peer support), family relationships (i.e., family support, perceived family wealth, caregiving responsibilities) and school relationships (i.e., teacher support, school support, school pressure) and contextual-level data on the school culture. Three-level multilevel models were fitted to account for the clustering of individuals (N = 8153) within classes (N = 769) and classes within schools (N = 177).

RESULTS

The individual-level results indicated that adolescents' sleep quality was positively related to family support, teacher support, student support and perceived family wealth. In contrast, adolescents' sleep quality was negatively related to caregiving responsibilities and school pressure. In addition, the contextual-level results pointed out that adolescents tended to report better sleep quality in less-demanding schools.

CONCLUSION

These findings highlight the need to consider social factors in promoting better sleep in adolescence.

Clinical Validity of the PROMIS Pediatric Sleep Measures across Populations of Children with Chronic Illnesses and Neurodevelopment Disorders

OBJECTIVE

To examine the clinical validity of the Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) short forms.

METHODS

Youth (8-17 years) from clinical populations with known SDs (sleep clinic n = 126, autism n = 276, asthma n = 82, asthma + eczema n = 68) and the general population (n = 902) completed the PROMIS Pediatric SD and SRI 8-item short forms, along with established measures of sleep (Children's Report of Sleep Patterns, Sleep Habits Survey), PROMIS Pediatric Fatigue, and parent-reported clinical indicators (does child have sleep problem, use melatonin, use prescription sleep medication).

RESULTS

Confirmatory factor analyses demonstrated factorial invariance for all clinical groups. Significant differences between the general population and clinical groups were found for SD and SRI (medium to large effect sizes). Convergent validity was demonstrated through separate hierarchical regression models that showed significant associations between parent-reported clinical indicators and SD and SRI, above and beyond clinical group, as well as moderate to strong correlations between the PROMIS sleep measures and both established measures of sleep and fatigue.

CONCLUSIONS

The PROMIS Pediatric SD and SRI short forms provide clinicians and researchers a brief, accurate, and valid way to measure patient-reported sleep outcomes in pediatric populations.

Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke

OBJECTIVES

To assess the prevalence of obstructive sleep apnea syndrome (OSAS) in children with arterial ischemic stroke (AIS) and to evaluate its association with neuropsychological outcomes.

METHODS

We conducted a cross-sectional study of sleep health and neuropsychological outcome in children with AIS. A consecutive cohort of children attending a stroke clinic were assessed using a standardized pediatric sleep questionnaire (PSQ) and standardized measures of pediatric stroke outcome and intellectual, executive and adaptive function. High risk for OSAS was defined as PSQ score ≥0.33.

RESULTS

Overall, 102 children were included (55% males, median age: 9 years [interquartile-range [IQR]: 6-14]). The prevalence of OSAS in children with AIS was significantly higher compared to published normative prevalence rate (25.5% vs 5%, p < 0.001). Children with OSAS were more likely to have infarcts affecting both the anterior and posterior circulation (37.5% vs 9.5%, p = 0.021). In addition, children with OSAS had significantly higher median Pediatric Stroke Outcome Measure (PSOM) scores (2 [IQR: 0-2] vs 1 [IQR: 1-3.5], p = 0.01) and were more likely to be prescribed concomitant medications affecting sleep architecture (50% vs 22.4%, p = 0.007). OSAS was associated with significantly lower scores on intellectual, memory, cognitive, behavioral, attention, executive and adaptive function scales. The association between PSQ and intellectual ability and working memory remained statistically significant upon controlling for potential confounding factors including stroke related characteristics (neurologic impairment and arterial territory).

CONCLUSIONS

The prevalence of OSAS in children with AIS compared to healthy controls is significantly elevated and is associated with poor neuropsychological outcomes. We highlight the importance of regular screening for OSAS - a modifiable risk factor - in children with AIS. The specific risk factors for OSAS and the potential benefits of therapeutic interventions in this patient population warrant further investigation.

EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.

Sleep quality is associated with psychosocial functioning and health-related quality of life in pediatric transplant recipients

This study examined patient-reported sleep quality in a single-center cross-sectional sample of adolescents with solid organ transplants and evaluated associations between sleep quality, psychosocial functioning (ie, depression/anxiety symptoms), and HRQOL. Health disparities associated with minority race/ethnicity and socioeconomic variables were also examined. Sixty-nine adolescents (M = 16.51 years; SD = 1.63) who received a solid organ transplant (kidney: n = 25; liver: n = 24; heart: n = 20) completed self-report measures of sleep quality, psychosocial functioning, and HRQOL. Adolescent transplant recipients endorsed significantly lower levels of sleep quality (ie, falling asleep) compared with previously published norms of healthy peers (t = -3.60; P ≤ .001). Higher sleep quality was significantly associated with fewer anxiety and depressive symptoms (r = -.31 to -.40), and higher physical and psychosocial HRQOL (r = .33-.43). Adolescents from minority backgrounds had significantly worse sleep quality compared with non-Hispanic Whites. Adolescent transplant recipients, particularly those from minority backgrounds, may be at increased risk for experiencing poor sleep quality. Suboptimal sleep is a risk factor for higher levels of anxiety and depressive symptoms, as well as lower levels of physical and psychosocial HRQOL. Sleep is an important modifiable factor that, if improved, may contribute to lower anxiety/depressive symptoms and better HRQOL in adolescent transplant recipients.

Behavioral-educational sleep interventions for pediatric epilepsy: a randomized controlled trial

Study Objectives

To evaluate the effect of a clinic-based, behavioral-educational sleep intervention on sleep of children with epilepsy, maternal knowledge about childhood sleep, and maternal sleep quality.

Methods

A total of 100 toddlers and preschool-age children with epilepsy (1.5–6 years, 55% boys) and their parents were randomized to receive sleep intervention (n = 50) or usual care with attention (n = 50). Outcomes were assessed at baseline, 3, 6, and 12 months after intervention with the use of objective actigraphy, Children’s Sleep Habits Questionnaire, Parents’ Sleep Knowledge Inventory, and Pittsburgh Sleep Quality Index. Intervention effects were examined using general linear models for repeated measurements to compare the mean change in outcomes from baseline to 12 months post-intervention between the two groups.

Results

Sleep intervention resulted in children having greater sleep efficiency by 2.03% compared with the usual care group (95% CI = 0.20% to 3.86%; p = .03). Children in the intervention group also had significantly longer total nighttime sleep as objectively assessed by actigraphy than did those in the usual care group, with an adjusted mean difference of 16.13 minutes (95% CI = 0.24% to 32.03%; p = .04). No intervention effects were observed for maternal knowledge about childhood sleep, and maternal sleep quality.

Conclusion

Sleep intervention provided during routine neurologic visits results in significant, measurable, and sustained benefits in sleep quality and quantity in children with epilepsy. Future trials are warranted to evaluate whether improvements in sleep could impact health-related quality of life or other aspects of functioning in children with epilepsy.

Clinical Trial

This trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).

Course and Predictors of Sleep and Co-occurring Problems in Children with Autism Spectrum Disorder

The chronicity of sleep disturbance and its relation to co-occurring symptoms in children with autism spectrum disorder (ASD) are not well understood. The current study examined longitudinal relations among sleep and co-occurring symptoms in a large well-characterized sample of 437 children with ASD assessed at baseline and follow-up (M = 3.8 years later). Twenty-three percent experienced worsening sleep problems over time, while 31.5% showed improvement. Path analysis indicated that sleep problems at baseline predicted later development of ADHD symptoms in younger children and somatic complaints in older children. For younger children, sensory over-responsivity predicted future sleep problems. Findings suggest that sensory over-reactivity may contribute to sleep problems in some children with ASD, and that sleep problems may result in poor daytime functioning.

A preliminary investigation of sleep quality and patient-reported outcomes in pediatric solid organ transplant candidates

The current cross-sectional, single-center study aimed to examine sleep quality in a sample of adolescents awaiting solid organ transplantation and to explore associations between sleep quality and both health-related quality of life and barriers to adherence. Thirty adolescents between the ages of 12 and 18 years (M age = 15.26, SD = 1.89) who were awaiting transplantation participated in this study. Participants completed measures of sleep quality, health-related quality of life, and barriers to adherence. T test and correlational analyses were performed to examine study aims. Adolescents awaiting transplantation had significantly lower levels of overall sleep quality compared to published norms of healthy peers. Domains of sleep quality were positively related to emotional and psychosocial health-related quality of life. Sleep quality domains were also negatively related to adherence barriers. This study provides preliminary evidence demonstrating that sleep quality among transplant candidates is compromised, and that poor sleep quality is related to adolescents' functioning across a number of domains during the pretransplant period. Results highlight the clinical importance of assessing and targeting sleep functioning in adolescents awaiting transplantation in order to reduce the negative influence of suboptimal sleep on functioning during this vulnerable period.

Sleep hygiene in adolescents with asthma

Objective: Youth with asthma are at-risk for sleep difficulties due to nocturnal asthma symptoms. Sleep hygiene, or the ability to practice consistent sleep behaviors and habits, impacts youth sleep quality and may, as a result, influence daytime cognitive functioning. The current study sought to examine the impact sleep hygiene has on sleep quality, health-related quality of life (HRQL) and sustained attention among adolescents with asthma. It was hypothesized that worse sleep hygiene would be associated with poorer sleep quality, lower school-related and overall HRQL and worse sustained attention. Methods: Participants included 41 adolescents with persistent asthma (M_age = 14.83, SD = 1.28; 51.2% male) recruited from a pediatric pulmonology clinic. Participants completed the adolescent sleep hygiene scale (ASHS), Adolescent Sleep Wake Scale (ASWS) and the Pediatric Quality of Life Index 4.0 generic core scales (PedsQL). Participants also completed the psychomotor vigilance task (PVT), an objective test of sustained attention. Results: Higher sleep hygiene scores were related to higher reported sleep quality (β = 0.377, p = 0.015, f² = 0.166), higher reported school-related HRQL (β = 0.321, p = 0.040, f² = 0.115) and better sustained attention (β = 0.327, p = 0.045, f² = 0.120). Conclusions: Sleep hygiene may be an important factor in sleep quality and deficits in daytime dysfunction including sustained attention and school-related quality of life. As adolescents with asthma are at heightened risk for these outcomes associated with disturbed sleep, sleep hygiene may serve as an important domain for clinical intervention.

A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future

Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population.

Smartphone Applications to Support Sleep Self-Management: Review and Evaluation

STUDY OBJECTIVES

Mobile health (mHealth) tools such as smartphone applications (apps) have potential to support sleep self-management. The objective of this review was to identify the status of available consumer mHealth apps targeted toward supporting sleep self-management and assess their functionalities.

METHODS

We searched four mobile app stores (iTunes Appstore, Android Google Play, Amazon Appstore, and Microsoft Appstore) using the terms "sleep", "sleep management," "sleep monitoring," and "sleep tracking." Apps were evaluated using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scores.

RESULTS

We identified 2,431 potentially relevant apps, of which 73 met inclusion criteria. Most apps were excluded because they were unrelated to sleep self-management, simply provided alarm service, or solely played relaxation sounds in an attempt to improve sleep. The median overall MARS score was 3.1 out of 5, and more than half of apps (42/73, 58%) had a minimum acceptability score of 3.0. The apps had on average 7 functions based on the IMS functionality criteria (range 2 to 11). A record function was present in all apps but only eight had the function to intervene. About half of the apps (33/73, 45%) collected data automatically using embedded sensors, 27 apps allowed the user to manually enter sleep data, and 14 apps supported both types of data recording.

CONCLUSIONS

The findings suggest that few apps meet prespecified criteria for quality, content, and functionality for sleep self-management. Despite the rapid evolution of sleep self-management apps, lack of validation studies is a significant concern that limits the clinical value of these apps.

Risk factors for psychological and psychosomatic symptoms among children with malignancies

AIM

With increasing survival rates in paediatric malignancies, the quality-of-life of children during hospitalisation should be given more attention. We aimed to identify factors associated with psychological and psychosomatic symptoms (PPS) that required medication among children hospitalised for treatment of malignancies.

METHODS

We retrospectively analysed data of 190 patients aged 2-18 years old. They were diagnosed with malignant diseases and admitted for treatment at St. Luke's International Hospital between 2003 and 2013. Patients were considered as having PPS if they were prescribed psychotropic agents during hospitalisation.

RESULTS

Of the 190 patients, 56 (30%) were prescribed psychotropic agents for PPS. Types of PPS included insomnia in 21 (38%), anxiety in 11 (20%), and others conditions (psychogenetic nausea, agitation, delirium, depression). The most prescribed psychotropic agents were etizolam for 34 cases (61%), followed by diazepam and risperidone. The multivariable analyses confirmed statistically significant independent associations for haematopoietic stem cell transplantation (HSCT) (odds ratio (OR), 5.21; 95% confidence interval (CI), 1.77-15.35), older age (12-18 years vs. 2-5 years, OR, 3.74; 95% CI, 1.04-10.00), and opioid use (OR, 7.15; 95% CI, 2.36-21.69).

CONCLUSIONS

Older age at admission, undergoing HSCT, and those given opioids were found to be risk factors for PPS among children with malignancies. Appropriate preventive measures against PPS may be warranted for patients with these risk factors.

Sleep in adolescents and young adults

Sleep has an important role in maintaining health and wellbeing; this relationship is becoming increasingly recognised for adolescents and young adults. Many physicians will encounter young people who present with complaints or conditions that have some relation to poor sleep. This review article looks at why sleep matters within this population group, how it can impact on longer term health consequences and discusses some tools to help enable the clinician to evaluate and address sleep within clinical practice.

Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator?

Sleep problems have been identified as a potential antecedent of chronic pain and pain-related disability in pediatric populations. In adult studies, affect has been implicated in these relationships. This study sought to better understand the relationships between sleep quality, negative and positive affect, and pain and functioning in children with chronic pain. Participants included 213 children and adolescents (aged 7-17 years) presenting to a tertiary pain clinic with chronic pain. Children completed questionnaires measuring sleep quality, positive and negative affect, pain intensity, and functional disability. Results indicated that 74% of children reported disordered sleeping and that poor sleep quality was significantly associated with increased pain, disability, negative affect, and decreased positive affect. Our hypotheses were partially supported, with negative affect (but not positive affect) mediating the relationship between poor sleep and increased pain; and positive as well as negative affect mediating the relationship between poor sleep and increased functional disability. There was no evidence for affect as a moderator. This study adds to the growing literature demonstrating the effect of poor sleep quality on children's pain and functioning, highlighting the need to develop further longitudinal research to confirm the causal roles of these variables.

PERSPECTIVE

This article examines the relationship between poor sleep quality, affect (negative as well as positive), pain, and disability in children with chronic pain. The findings have the potential to better understand the processes involved in how poor sleep may lead to increased pain and pain-related disability.

Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment

Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.

Understanding the Relationship Between Asthma and Sleep in the Pediatric Population

The Centers for Disease Control and Prevention reports that 9.5% of children have been diagnosed with asthma. Sleep disturbances affect 20% to 30% of the pediatric population. The prevalence of nocturnal symptoms of asthma is high, and most children regularly experience nighttime symptoms. Sleep is important for growth and development, and untreated sleep disturbances have adverse effects on school performance, mental health, physical health, and functioning. This review will explore the relationship between asthma and sleep disturbances. Clinicians need to assess children with asthma for sleep disturbance.

Sleep and Pain in Pediatric Illness: A Conceptual Review

BACKGROUND

Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented.

AIMS

This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs).

RESULTS

Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes.

CONCLUSION

It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.

Sleep Architecture Relates to Daytime Affect and Somatic Complaints in Clinically Anxious but Not Healthy Children

It is increasingly clear that seminal sleep-affective relationships begin to take root in childhood, yet studies exploring how nighttime sleep characteristics relate to daytime affective symptoms, both in clinical and healthy populations of children, are lacking. The current study sought to explore these relationships by investigating whether trait-like and/or daily reports of affective and somatic symptoms of children with generalized anxiety disorder and matched controls relate to sleep architecture. Sixty-six children (ages 7-11; 54.4% female; 56.1% Caucasian; 18.2% biracial; 6.1% African American; 3% Asian; 16.7% Hispanic) participated including 29 with primary generalized anxiety disorder (without comorbid depression) and 37 healthy controls matched on age and race/ethnicity. Participants underwent structured diagnostic assessments including child-report measures and subsequently reported on their negative affect and somatic symptoms over the course of 1 week. Children also completed 1 night of polysomnography. Among children with generalized anxiety disorder only, greater amounts of slow wave sleep corresponded with less negative affect, and greater amounts of rapid eye movement sleep was related to more somatic complaints across the week. Similarly, for trait-like measures, more rapid eye movement sleep and shorter latency to rapid eye movement sleep were related to greater depressive symptoms in the anxious group only. The current findings suggest that physiologic sleep characteristics may contribute in direct ways to the symptom profiles of clinically anxious children. The functional relevance of such findings (e.g., how specific sleep characteristics serve to either increase or reduce long-term risk) is a vital direction for future research.

Objective assessment of sleep status and its correlates in hospitalized children with cancer: Exploratory study

BACKGROUND

Children with cancer are known to have sleep problems. Although hospitalization and psychosocial factors are considered to be the factors affecting children's sleep, few studies have confirmed these effects. The aims of this study were to describe the sleep status of hospitalized children with cancer and to explore the correlates.

METHODS

The sleep status of 11 hospitalized children (aged 2-12 years) with cancer was measured using actigraph and sleep diary during hospitalization and a short home stay. Possible correlates were assessed using a questionnaire.

RESULTS

The participants had significantly longer sleep onset latency, earlier bedtime, and poorer self-evaluated sleep quality during hospitalization than the short home stay. They had shorter total sleep time, longer wake time after sleep onset, and less sleep efficiency at home, compared with healthy historical controls. Children's age, symptoms, hospitalization period, Cognitive Fatigue, Procedural Anxiety, Treatment Anxiety, Social Anxiety, and Separation Anxiety, as well as caregiver anxiety, Receptive and Focused Attitude, and Regimented Attitude were significantly correlated with sleep variables.

CONCLUSIONS

Hospitalization decreased self-evaluated sleep quality, and difficulty falling asleep. The sleep of the participants at home was disturbed compared with that of healthy children. Hospitalization, patient characteristics, disease-related, and some psychosocial factors were associated with sleep variables. Medical professionals should develop a favorable environment for falling asleep in hospital for individual children. Children with cancer in the early period of hospitalization need increased care to facilitate good sleep.

Influence of asthma status on sleep variability in overweight/obese youth

OBJECTIVE

Pediatric asthma and overweight/obesity (OV/OB) frequently co-occur and youth with both conditions exhibit poor sleep/bedtime habits. This study assessed differences in week-to-weekend bedtime/wake time variability among OV/OB youth with/without comorbid asthma, and tested whether variability predicted weekday sleep.

METHODS

OV/OB youth (n = 142; 28% comorbid asthma; 7-12 years) wore an Accelerometer for 5 days (2 weekend days), providing estimates of week-to-weekend bedtime/wake-time variability, weekday Total Sleep Time (TST), weekday time in bed (TIB), and weekday wake after sleep onset (WASO).

RESULTS

There were no demographic differences between groups beyond lower family income for the OV/OB+asthma group. The OV/OB+asthma group exhibited later weekday (mean OV/OB+asthma = 10:39 pm, mean OV/OB only = 10:30pm) and weekend (mean OV/OB+asthma = 11:41 pm, mean OV/OB only = 11:17pm) bedtimes, earlier weekday waketimes (mean OV/OB+asthma = 6:40 am, mean OV/OB only = 6:51 am), and similar weekend waketimes (mean OV/OB+asthma = 7:54 pm, mean OV/OB only = 7:52 pm. Univariate MANOVA follow-ups indicated a main effect of asthma group for week-to-weekend bedtime and waketime variability, with the OV/OB+asthma group evidencing approximately 30 minutes greater bedtime (OV/OB+asthma mean = 90 minutes) and waketime (OV/OB+asthma mean = 108 minutes) variability. Within the OV/OB+asthma group, greater waketime variability predicted fewer minutes of weekday TIB and WASO. Within the OV/OB only group, wake time variability predicted fewer minutes of weekday TIB.

CONCLUSION

Findings suggest that asthma status confers risk for more week-to-weekend variability among currently OV/OB youth, and that greater variability shortens the weekday sleep period. Further research on reasons for greater week-to-weekend sleep variability in asthma is needed.

Sleep disorders in pediatric chronic kidney disease patients

The prevalence of sleep disorders during childhood has been estimated to range from 25 to 43 %. The aim of this review is to determine the prevalence of sleep disorders and possible associations with chronic kidney disease (CKD)-related factors and health-related quality of life (HRQOL) in children with CKD. An electronic systematic literature search for sleep disorders in children with CKD in Pubmed, Embase and the Cochrane Library Databases identified seven relevant articles for review, all of which reported an increased prevalence of sleep disorders in children with CKD. Five studies included children with CKD undergoing dialysis, and two studies included only non-dialysis patients. In all studies the presence of sleep disturbances was assessed by questionnaires; only one study compared the results of a validated questionnaire with laboratory-based polysomnography. The prevalence of any sleep disorder ranged from 77 to 85 % in dialysis patients, to 32-50 % in transplanted patients and 40-50 % in non-dialysis patients. The most commonly studied disorder was restless legs syndrome, which presented at a prevalence of 10-35 %. Three studies showed significant associations between presence of sleep disorders and HRQOL. We found consistent evidence of an increased prevalence of sleep disturbances in children with CKD, and these seemed to play a critical role in HRQOL.

Developmental Course and Determinants of Sleep Disturbances in Adolescents With Spina Bifida

OBJECTIVES

To examine (1) trajectories of sleep disturbances in adolescents with spina bifida (SB) compared with a typically developing (TD) group over a 10-year period and (2) individual, family, and socioeconomic determinants of changes in sleep disturbances.

METHODS

Participants were 68 families of youth with SB and 68 families of TD youth. Parent-report of adolescent sleep was collected every 2 years at 6 time points (T1: ages 8-9; T6: ages 18-19). Multiple informants and measures were used to examine internalizing, externalizing, and inattention symptoms, dyadic/family conflict, socioeconomic status (SES), and family income.

RESULTS

Sleep disturbances increased over the 10-year period. Youth with SB had greater sleep disturbances during early adolescence. Greater preadolescent externalizing symptoms, greater parent-child and marital conflict, and lower SES predicted increased sleep disturbances.

CONCLUSIONS

Sleep disturbances are common and persistent in adolescents with SB. Sleep assessment and management are important clinical and research priorities in this population.

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.