Validation of the Sleep Disturbance Scale for Children and prevalence of parent-reported sleep disorder symptoms in Chinese children

Long-term exposure to ozone and sleep disorders in children: A multicity study in China

Evidence regarding the link between long-term ambient ozone (O3) exposure and childhood sleep disorders is little. This study aims to examine the associations between long-term exposure to O3 and sleep disorders in children. We conducted a population-based cross-sectional survey, including 185,428 children aged 6-18 years in 173 schools across 14 Chinese cities during 2012 and 2018. Parents or guardians completed a checklist using Sleep Disturbance Scale for Children, and O3 exposure at residential and school addresses was estimated using a satellite-based spatiotemporal model. We used generalized linear mixed models to test the associations with adjustment for factors including socio-demographic variables, lifestyle, meteorology and multiple pollutants. Mean concentrations of O3, particulate matter with diameters ≤2.5 mm (PM2.5) and nitrogen dioxide (NO2) were 89.0 μg/m3, 42.5 μg/m3 and 34.4 μg/m3, respectively. O3 and NO2 concentrations were similar among provinces, while PM2.5 concentration varied significantly among provinces. Overall, 19.4% of children had at least one sleep disorder. Long-term exposure to O3 was positively associated with odds of sleep disorders for all subtypes. For example, each interquartile increment in home-school O3 concentrations was associated with a higher odds ratio for global sleep disorder, at 1.22 (95% confidence interval: 1.18, 1.26). Similar associations were observed for sleep disorder subtypes. The associations remained similar after adjustment for PM2.5 and NO2. Moreover, these associations were heterogeneous regionally, with more prominent associations among children residing in southeast region than in northeast and northwest regions in China. We concluded that long-term exposure to O3 is positively associated with risks of childhood sleep disorders. These associations varied by geographical region of China.

Exposures to particulate matters and childhood sleep disorders-A large study in three provinces in China

OBJECTIVES

Evidence on the link between long-term ambient particulate matter (PM) exposures and childhood sleep disorders were scarce. We examined the associations between long-term exposures to PM2.5 and PM1 (PM with an aerodynamic equivalent diameter <2.5 μm and <1 μm, respectively) with sleep disorders in children.

METHODS

We performed a population-based cross-sectional survey in 177,263 children aged 6 to 18 years in 14 Chinese cities during 2012-2018. A satellite-based spatiotemporal model was employed to estimate four-year annual average PM2.5 and PM1 exposures at residential and school addresses. Parents or guardians completed a checklist using the Sleep Disturbance Scale for Children. We estimated the associations using generalized linear mixed models with adjustment for characteristics of children, parents, and indoor environments.

RESULTS

Long-term PM2.5 and PM1 exposures were positively associated with odds of sleep disorders for almost all domains. For example, increments in PM2.5 and PM1 per 10 μg/m3 were associated with odds ratios of global sleep disorder of 1.24 (95 % confidence interval [CI]: 1.14, 1.35) and 1.31 (95 %CI: 1.18, 1.46), respectively. Similar results were observed for subtypes of sleep disorder. These associations were heterogeneous regionally, with stronger associations among children residing in southeast region than in northeast and northwest regions. Moreover, larger estimates of PM1 were found than that of PM2.5 in southeast region.

CONCLUSION

Long-term PM2.5 and PM1 exposures are independently associated with higher risks of childhood sleep disorders, and these associations vary by geographical region.

Effects of transcranial magnetic stimulation on sleep structure and quality in children with autism

Introduction

Sleep disorders are common in children with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) can influence the excitability of neuronal cells in stimulated areas, leading to improvements in sleep and other autistic symptoms. However, studies on clinical mechanisms of TMS in treating sleep disorders associated with ASD are limited. Therefore, we aimed to explore the effects of TMS on sleep structure and quality in children with ASD.

Methods

Between January 2020 and December 2021, recruitment was advertised through child and adolescent outpatient clinics and online platforms by the Hangzhou Seventh People's Hospital and Lishui Second People's Hospital. Sixty children with ASD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were selected and randomly divided into the active TMS and sham TMS treatment groups. Thirty healthy children of the same age were recruited as controls. The active TMS group received bilateral low-frequency (0.5 Hz) TMS targeting the dorsolateral prefrontal cortex on both sides in children with ASD, whereas the sham TMS group received sham stimulation with the same stimulation time and location as the experimental group. Both groups were treated for 6 weeks, and the participants were assessed using the Sleep Disturbance Scale for Children (SDSC) before treatment, at 3 weeks, and at 6 weeks of intervention. Independent sample t-tests and difference t-tests were used for statistical analysis of the data.

Results

No significant differences were observed in general demographic variables, such as age and sex, between the ASD and control groups (P>0.05). Independent sample t-test analysis showed that the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis scores were significantly higher in the ASD group than in the control group (P<0.05). Before treatment, no significant differences were observed in the factor or total SDSC scores between the sham TMS group and the active TMS group (P>0.05). After 15 and 30 treatment sessions, the total SDSC score, difficulty falling asleep, sleep maintenance, sleep-wake transition disorders, and excessive daytime sleepiness scores were significantly higher in the sham TMS group than in the active TMS group (P<0.05). The difference t-test analysis showed that after 30 treatment sessions, the reduction rates of the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis dimensions were significantly higher in the active TMS group than in the sham TMS group (P<0.05).

Conclusion

Low-frequency TMS targeting the dorsolateral prefrontal cortex in children with ASD can effectively improve their sleep status, and significant improvement can be achieved after 6 weeks (30 sessions) of treatment.

Association Between Home Renovation and Sleeping Problems Among Children Aged 6-18 Years: A Nationwide Survey in China

BACKGROUND

Although the indoor environment has been proposed to be associated with childhood sleep health, to our knowledge no study has investigated the association between home renovation and childhood sleep problems.

METHODS

The study included 186,470 children aged 6-18 years from the National Chinese Children Health Study (2012-2018). We measured childhood sleeping problems via the Chinese version of the Sleep Disturbance Scale for Children (C-SDSC). Information on home renovation exposure within the recent 2 years was collected via parent report. We estimated associations between home renovation and various sleeping problems, defined using both continuous and categorized (binary) C-SDSC t-scores, using generalized mixed models. We fitted models with city as a random effect variable, and other covariates as fixed effects.

RESULTS

Out of the overall participants, 89,732 (48%) were exposed to recent home renovations. Compared to the unexposed group, children exposed to home renovations had higher odds of total sleep disorder (odd ratios [OR] = 1.3; 95% confidence interval [CI] = 1.2, 1.4). Associations varied when we considered different types of home renovation materials. Children exposed to multiple types of home renovation had higher odds of sleeping problems. We observed similar findings when considering continuous C-SDSC t-scores. Additionally, sex and age of children modified the associations of home renovation exposure with some of the sleeping problem subtypes.

CONCLUSIONS

We found that home renovation was associated with higher odds of having sleeping problems and that they varied when considering the type of renovation, cumulative exposure, sex, and age differences.

July 14th 2016 Nice Terrorist Attack Court Trial: A Protocol on Sleep Quality and Somatic Symptoms as Markers of Risk for Traumatic Reactivation in Adolescents Exposed to This Attack

The court trial of the 14th of July 2016 terrorist attack in Nice (France) opened in September 2022 and ended in December 2022. Engaging in court proceedings, whether as a victim or a witness, can lead to a significant risk of traumatic reactivation (i.e., the re-emergence of post-traumatic stress symptoms). The present protocol aimed to improve knowledge of the pathophysiology of traumatic reactivation due to the media coverage of the trial by assessing sleep disturbances and somatic symptoms that could reappear if there is a traumatic reactivation. Method and Analysis: This is a monocentric longitudinal study, with recruitment solely planned at the Nice Pediatric Psychotrauma Center (NPPC). We intended to include 100 adolescents aged 12 to 17 years who were directly or indirectly exposed to the attack and included in the "14-7" program). Assessments began one month before the trial, in August 2022, and were scheduled once a month until the end of the trial. A smartwatch recorded sleep activity. Somatic and PTSD symptoms and sleep were assessed through validated questionnaires. The main analyses comprised the variance and regression analyses of predictors of clinical evolution over time. Ethics and Dissemination: The National Ethics Committee "NORD OUEST III" approved the "14-7" program protocol (number 2017-A02212-51). The specific amendment for this research was approved in April 2022 by the same national ethical committee. Inclusions started in August 2022.

The association between childhood adiposity in northeast China and anthropogenic heat flux: A new insight into the comprehensive impact of human activities

Anthropogenic heat has been reported to have significant health impacts, but research on its association with childhood adiposity is still lacking. In this study, we matched the 2008-2012 average anthropogenic heat flux, as simulated by a grid estimation model using inventory methods, with questionnaire and measurement data of 49,938 children randomly recruited from seven cities in Northeast China in 2012. After adjusting for social demographic and behavioral factors, we used generalized linear mixed-effect models to assess the association between anthropogenic heat flux and adiposity among children. We also examined the effect modification of various social demographic and behavioral confounders. We found that each 10 W/m2 increase in total anthropogenic heat flux and that from the industry source was associated with an increase of 5.82% (95% CI = 0.84%-11.05%) and 6.62% (95% CI = 0.87%-12.70%) in the odds of childhood adiposity. Similarly, the excess rate of adiposity among children were 5.26% (95% CI = -1.33%-12.29%) and 8.51% (95% CI = 2.24%-15.17%) per 1 W/m2 increase in the anthropogenic heat flux from transportation and buildings, and was 7.94% (95% CI = 2.28%-13.91%) per 0.001 W/m2 increase in the anthropogenic heat flux from human metabolism. We also found generally greater effect estimates among female children and children who were exposed to passive smoking during pregnancy, born by caesarean section, non-breastfed/mixed-fed, or lived within 20 m adjacent to the main road. The potential deleterious effect of anthropogenic heat exposure on adiposity among children may make it a new but major threat to be targeted by future mitigation strategies.

Associations between sleep, reading, and mathematics in Taiwanese children

BACKGROUND

Some research shows a link between sleep behaviours and school achievement in English-speaking children and adolescents.

AIMS

The current study aimed to examine the relationship between children's sleep behaviours and aspects of their school achievement in Mandarin-speaking children who are living in Taiwan.

SAMPLE

The present study reports on 69 second-grade children (age range = 6.84-8.4 years) recruited in Taipei City, Taiwan.

METHODS

Children's sleep behaviours were assessed through two standardized parent self-report questionnaires: the Children's Sleep Habits Questionnaire (CSHQ) and the Sleep Disturbance Scale for Children (SDSC). Children undertook three standardized tests of word reading, reading comprehension and math.

RESULTS

Key findings include: (i) sleep disturbances are more prevalent when using the CSHQ scale than the SDSC scale, (ii) around half of second graders struggle with general sleep disturbances as observed by the CSHQ scale, (iii) children who go to bed before 22:00 and have at least 9-h sleep tend to exhibit fewer sleep disturbances, (iv) parasomnias as measured by the CSHQ are negatively correlated with reading comprehension after controlling age and nonverbal IQ, and (v) the amount of sleep (naps) during daytime is negatively correlated with Chinese character recognition, reading comprehension and math after controlling age and nonverbal IQ.

CONCLUSIONS

There is growing awareness of the value of research that spans culturally and linguistically diverse populations. Our study contributes to ongoing discussions about the relationship between sleep, and skills in reading and math in school-aged children in Taiwan.

Cognitive Disengagement Syndrome and Child Sleep Problems in ADHD, Anxiety and Depression

The main objective of this study was to analyse the relationship and differential contribution of Cognitive Disengagement Syndrome (CDS) and sleep problems in children in different psychopathological measures. A total of 1133 participants (612 fathers/mothers and 521 children aged 7-13 years in Years 3-6 of Primary Education) completed the scales on CDS, sleep problems, depression (DEP), anxiety (ANX) and attention deficit and hyperactivity disorder (ADHD). Similar and significant correlations were identified in the measures of CDS and sleep problems between fathers and mothers, obtaining a high coefficient between the two parents. However, weak correlations were found between fathers/mothers and children. The scores of CDS and the sleep disturbance scale for children (SDSC) significantly predicted the internalising measures and ADHD, especially between SDSC and DEP. It was confirmed that sleep problems had a greater presence in the group of children with the highest ADHD scores, and especially in CDS and ADHD jointly. To conclude, the data indicate the importance of sleep problems in understanding CDS and its relationship with other psychopathological measures, especially ADHD, although to a greater extent with internalising symptoms, especially DEP.

The Sleep Disturbance Scale for Children: psychometric properties and prevalence of sleep disorders in Spanish children aged 6-16 years

The present research aimed to investigate, for the first time, the validity and reliability of the Sleep Disturbance Scale for Children (SDSC) in a sample of 2733 Spanish children aged 6-16 years. We also described the prevalence and sociodemographic correlates of sleep disorder symptoms among young people, which had never been studied in Spain. Confirmatory factor analysis supported the original six-factor model and Cronbach's alpha for the total questionnaire was 0.82, which indicated good reliability. Moreover, all the SDSC subscales correlated positively and significantly with the total score (range = 0.41-0.70), thus showing convergent validity. Considering T-scores >70 as pathological, we identified at least one sleep disorder in 116 participants (4.24%), including disorders of excessive somnolence (DOES; 5.82%), sleep-wake transition disorders (SWTD; 5.27%), and disorders of initiating and maintaining sleep (DIMS; 5.09%) among the most common problems. Students in secondary education and those from families with a low socioeconomic status were more likely to have DIMS, disorders of arousal, and DOES. Subjects with clinically elevated levels of sleep breathing disorders were more frequently of foreign origin and from disadvantaged families. Boys and primary school students were more prone to sleep hyperhidrosis, while SWTD were overrepresented among children with a low socioeconomic status. According to our results, the Spanish version of the SDSC seems to be a good instrument for assessing sleep disturbances in school-age children and adolescents, which is essential to prevent the significant implications of poor sleeping on the overall welfare of young people.

Validation of the sleep disturbance scale for children (SDSC) in infants and toddlers from mainland China

The sleep disturbance scale for children (SDSC) has been validated in the population of Chinese children (aged 5-16 years) and has good psychometric properties. However, valid assessment tools for sleep problems in the population of infants and young children from mainland China are relatively scarce, and rates of screening and management for pediatric sleep problems are low.

Objective

This study is to evaluate the reliability and validity of SDSC among infants (aged 6-36 months), and to provide a reference for expanding the application of the SDSC for Chinese infants (SDSC-I).

Materials and methods

From April to November 2021, parents of infants from Fuzhou, Quanzhou, Longyan, Sanming, and Nanping cities in Fujian Province, China completed the SDSC-I. Several factor analyses were performed to evaluate the reliability and validity of the scale.

Results

Of note, 432 out of 469 samples were valid. After item selections and exploratory factor analyses, the SDSC-I concluded six dimensions (disorders of initiating sleep, disorders of maintaining sleep, sleep hyperhidrosis, sleep breathing disorders, parasomnias, and non-restorative sleep and excessive somnolence) with 23 items. The Cronbach's α coefficient of the scale was 0.863, and those for the six dimensions were within 0.576-0.835. The values of parameters for content validity of the scale were: IR = 0.87, I-CVI > 0.78, Kappa value > 0.74, S-CVI/UA = 0.87, S-CVI/Ave = 0.98. Principal component analysis revealed that the Kaiser-Meyer-Olkin (KMO) value was 0.84, and the factor loading of items ranged from 0.328 to 0.849, with six factors of eigenvalue more than one, which could explain 58.274% of the total variance. The confirmatory factor analysis results showed that χ2/DF was 3.556, root-mean-square error of approximation (RMSEA) was 0.077, comparative fit index (CFI) was 0.809, and standardized RMR (SRMR) was 0.070.

Conclusion

Our study provides evidence that the SDSC-I is reliable and valid, and it is effective for the screening and management of sleep disturbances among infants (aged 6-36 months). Compared with other questionnaires such as the Brief Infant Sleep Questionnaire (BISQ), it is worthy of popularization and application in pediatric primary care.

Respiratory sleep disorders, nasal obstruction and enuresis in children with non-syndromic Pierre Robin sequence

INTRODUCTION

Obstructive sleep apnea is highly prevalent in non-syndromic Pierre Robin sequence patients. Studies have found a probable relationship between obstructive sleep apnea and nasal obstruction and between obstructive sleep apnea and enuresis. Assessment of the relationship between these variables in non-syndromic Pierre Robin sequence patients is scarce.

OBJECTIVE

The present study aims to evaluate the relationship between symptoms of obstructive sleep apnea, nasal obstruction and enuresis, determining the prevalence of symptoms suggestive of these conditions, in schoolchildren with non-syndromic Pierre Robin sequence, and describe the prevalence of excessive daytime sleepiness habitual snoring and voiding dysfunction symptoms associated with enuresis.

METHODS

This was a prospective analytical cross-sectional study developed at a reference center. Anthropometric measurements and a structured clinical interview were carried out in a sample of 48 patients. The instruments "sleep disorders scale in children" "nasal congestion index questionnaire" (CQ-5), and the "voiding dysfunction symptom score questionnaire" were used. Statistical analysis was performed for p < 0.05.

RESULTS

Positive "sleep disorders scale in children" scores for obstructive sleep apnea and CQ-5 for nasal obstruction were observed in 38.78% and 16.33%, respectively. Enuresis was reported in 16.33% of children, being characterized as primary in 71.43% and polysymptomatic in 55.55%; according to the "voiding dysfunction symptom score questionnaire". There was a significant relationship between nasal obstruction and obstructive sleep apnea symptoms (p < 0.05), but no significance was found between obstructive sleep apnea symptoms and enuresis, and between nasal obstruction and enuresis. The prevalence of excessive daytime sleepiness was 12.24% and of habitual snoring, 48.98%. A family history of enuresis, younger age in years and a positive "voiding dysfunction symptom score questionnaire" score were associated with a higher prevalence of enuresis (p < 0.05).

CONCLUSION

Children with non-syndromic Pierre Robin sequence are at high risk for obstructive sleep apnea symptoms and habitual snoring, with a correlation being observed between nasal obstruction and obstructive sleep apnea symptoms. In addition, the study showed that non-syndromic Pierre Robin sequence, obstructive sleep apnea and nasal obstruction symptoms were not risk factors for enuresis in these patients.

Sleep Disturbance Scale for Children: Italian Validation in Autism Spectrum Disorder Population

Sleep disorders in children with autism spectrum disorders (ASDs) are well-described. However, there is a lack of specific assessment tools to investigate sleep disturbance in this target population. The present investigation reports the Italian validation of the Sleep Disturbance Scale for Children (SDSC) in the ASD population, also investigating the correlation between sleep disorders In both children and parents. Internal consistency and test−retest reliability were investigated using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Concurrent validity was analyzed by comparing the score of the SDSC with the Pittsburgh Sleep Quality Index (PSQI), while the correlation between the SDCS score and the General Sleep Disturbance Scale (GSDS) was used to analyze the correlation between sleep disorders in children and sleep disorders in their parents. In total, 99 children with a diagnosis of ASD participated in the study. Cronbach’s alpha revealed satisfactory value (0.853), as well as reliability (ICC 0.972) and concurrent validity (0.745). Our results also revealed a significant linear correlation between children’s and parents’ sleep disorders (p < 0.05). In conclusion, we found the SDSC to be a useful tool for measuring sleep disorders in ASD children. Our findings offer concrete inputs to achieve adequate pathways for taking care of children with ASDs and their parents.

Sleep health and its related influencing factors in primary and middle school students in Fuzhou: A large multi-center cross-sectional study

Background

This current study set out to investigate the status of sleep health in 7–20-year-old students in Fuzhou and explore the related influencing factors of sleep health.

Methods

A total of 38,467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May to June 2019, in 18 primary schools and 18 middle schools from nine districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill out a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, sleep-related lifestyle behaviors, and electronic-products usage). Multiple linear regression was carried out to analyze data.

Results

Of the total 40,888 questionnaires we released, 38,467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85 ± 3.1, including 20,013 boys and 18,454 girls. The multiple linear regression analysis identified factors associated with sleep health (p < 0.05): Boy (coef = 0.073, 95% CI: 0.030–0.115), age (coef = 1.797, 95% CI: 0.224–0.243), key school (coef = 2.069, 95% CI: 0.105–0.193), urban (coef = 0.096, 95% CI: 0.054–0.139), excessive daytime sleepiness (coef = 0.535, 95% CI: 0.432–0.639), unhealthy sleep habits (coef = 0.363, 95% CI: 0.307–0.419), eating before sleep (coef = 0.578, 95% CI: 0.527–0.630), using electronic products in bedroom (coef = 0.074, 95% CI: 0.028–0.121), screen time per day during school (coef = 0.260, 95% CI: 0.235–0.284), frequency of using electronics 30 min before bedtime (coef = 0.150, 95% CI: 0.134–0.166), strained relationship with parents (coef = 0.361, 95% CI: 0.270–0.452), strained relationship with peers (coef = 0.267, 95% CI: 0.171–0.363), excessive homework or learning (coef = 0.189, 95% CI: 0.141–0.237), time for doing homework (coef = 0.266, 95% CI: 0.245–0.287), and mood swings frequently (coef = 1.174, 95% CI: 1.127–1.221) negatively impact sleep health. Sleep alone (coef = −0.204, 95% CI: −0.262–0.147) were the risk factors for sleep health. Furthermore, frequent mood swings was considered the most influential factor on overall variables.

Conclusions

Sleep health is associated with factors covered sociodemographic characteristics, family sleep habits, and routine activities before bedtime. Multiple measures should be taken to improve sleep quality in a targeted manner.

Outdoor light at night, overweight, and obesity in school-aged children and adolescents

Previous studies have indicated that outdoor light at night (LAN) is associated with a higher prevalence of overweight or obesity in adults. However, the association of LAN levels with overweight or obesity in children is still unknown. This study utilized data from the Seven Northeastern Cities study, which included 47,990 school-aged children and adolescents (ages 6-18 years). Outdoor LAN levels were measured using satellite imaging data. Weight and height were used to calculate age-sex-specific body mass index (BMI) Z-scores based on the World Health Organization (WHO) growth standards. Overweight status and obesity were defined using the Chinese standard. Information regarding socioeconomic status, sleep-related characteristics, and obesogenic factors were obtained using a questionnaire. A generalized linear mixed model examined the associations of outdoor LAN levels (in quartiles) with the outcomes of interest. Compared to children in the lowest quartile of outdoor LAN levels, children exposed to higher outdoor LAN levels had larger BMI Z-scores and higher odds of being overweight (including obesity) or obese, with the largest estimates in the third quartile [BMI Z-score: β = 0.26, 95% CI: 0.18-0.33; overweight (including obesity): OR = 1.40, 95% CI: 1.25-1.56; obesity: OR = 1.46, 95% CI: 1.29-1.65]. There was a significant sex difference (P_interaction<0.001) in the association of outdoor LAN levels with BMI Z-scores, and the association was stronger in males. Results remained robust following multiple sensitivity analyses and the adjustment of sleep-related characteristics, obesogenic factors, and environmental exposures. Our findings suggest that higher outdoor LAN levels are associated with larger BMI Z-scores and greater odds of overweight (including obesity) and obesity in school-aged children and adolescents. Further, the association between outdoor LAN levels and BMI Z-scores is stronger in males. Future studies with exposure assessments that consider both outdoor and indoor LAN exposures are needed.

Effects of Washed Fecal Bacteria Transplantation in Sleep Quality, Stool Features and Autism Symptomatology: A Chinese Preliminary Observational Study

Purpose

Autism spectrum disorder is a highly complex neurological and psychosocial disorder characterized by social dysfunction, severe reduction in speech, and a single stereotyped behavior. The treatment methods are currently limited, and children with autism generally suffer from constipation and sleep disorders. It is urgent to find an alternative psychotropic drug, given the drug dependence and adverse reactions that may occur with long-term medication.

Patients and Methods

This retrospective study included 49 children with autism at the first affiliated Hospital of Guangdong Pharmaceutical University, who received washed fecal microbiota transplantation (WMT) treatment between June 2019 and July 2021 and compared the sleep disorder scores between the constipation group, control group and blank group.

Results

Second WMT could significantly improve the sleep disorder scores in the constipation group (p=0.026) and the decrease in sleep disturbance scale for children (SDSC) score was synchronized with the increase in Bristol stool form scale (BSFS) score. However, there was no significant difference between patients without constipation (p=0.54), and the behavior of autism improved in both groups.

Conclusion

WMT could relieve constipation and improve sleep disorders in children with autism, with no deterioration in stool morphology and sleep disorders in other children. Moreover, there were no obvious serious adverse clinical events after WMT.

Associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers

The aim of this study was to examine the associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers. This cross-sectional survey was conducted in Guangzhou, China. Children aged 3–6 years were recruited from 32 kindergartens in 7 administrative districts. Asthma, allergic rhinitis and sleep problems were evaluated using a valid questionnaire. Binary logistic regression models were employed to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations of asthma and allergic rhinitis with short sleep duration, late bedtime and frequent nocturnal awakening. We included 4876 preschool children in the current analysis. Of these, 182 (3.7%) diagnosed as asthma, and 511 (10.5%) diagnosed as allergic rhinitis. Frequent nocturnal awakening was associated with asthma and allergic rhinitis, with adjusted OR were 1.49 (95% CI 1.05–2.13) and 1.59 (95% CI 1.27–1.99), respectively. Subgroup analysis showed the OR for frequent nocturnal awakening with asthma was higher in girls (1.68; 95% CI 1.02–2.78) than in boys (1.35; 95% CI 0.81–2.24), but the OR for frequent nocturnal awakening with allergic rhinitis were similar in girls (1.73; 95% CI 1.15–2.30) and boys (1.57; 95% CI 1.17–2.12). No significant associations of short sleep duration and late bedtime with asthma or allergic rhinitis were identified. Our data suggested that frequent nocturnal awakening was associated with asthma and allergic rhinitis among preschoolers, and the association of frequent nocturnal awakening with asthma differed by gender. Further studies are warranted to address the causal relationship between nocturnal awakening and asthma and allergic rhinitis.

Association Between Exposure to Outdoor Artificial Light at Night and Sleep Disorders Among Children in China

IMPORTANCE

Healthy sleep has an important role in the physical and mental health of children. However, few studies have investigated the association between outdoor artificial light at night (ALAN) and sleep disorders in children.

OBJECTIVE

To explore the associations between outdoor ALAN exposure and sleep disorders in children.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study, part of the National Chinese Children Health Study, was conducted from April 1, 2012, to June 30, 2013, in the first stage and from May 1, 2016, to May 31, 2018, in the second stage in 55 districts of 14 cities in China. This analysis included 201 994 children and adolescents aged 2 to 18 years. Data were analyzed from February 20 to March 21, 2022.

EXPOSURES

Outdoor ALAN exposure (in nanowatts per centimeters squared per steradian) within 500 m of each participant's residential address obtained from the satellite imagery data, with a resolution of approximately 500 m.

MAIN OUTCOMES AND MEASURES

Sleep disorders were measured by the Chinese version of the Sleep Disturbance Scale for Children. Generalized linear mixed models were used to estimate the associations of outdoor ALAN with sleep scores and sleep disorders.

RESULTS

The study included 201 994 children and adolescents (mean [SD] age, 11.3 [3.2] years; 106 378 boys [52.7%]), 7166 (3.5%) of whom had sleep disorder symptoms. Outdoor ALAN exposure of study participants ranged from 0.02 to 113.48 nW/cm2/sr. Compared with the lowest quintile (Q1) of outdoor ALAN exposure, higher quintiles of exposure (Q2-Q5) were associated with an increase in total sleep scores of 0.81 (95% CI, 0.66-0.96) in Q2, 0.83 (95% CI, 0.68-0.97) in Q3, 0.62 (95% CI, 0.46-0.77) in Q4, and 0.53 (95% CI, 0.36-0.70) in Q5. Higher quintiles of exposure were also associated with odds ratios for sleep disorder of 1.34 (95% CI, 1.23-1.45) in Q2, 1.43 (95% CI, 1.32-1.55) in Q3, 1.31 (95% CI, 1.21-1.43) in Q4, and 1.25 (95% CI, 1.14-1.38) in Q5. Similar associations were observed for sleep disorder subtypes. In addition, greater effect estimates were found among children younger than 12 years.

CONCLUSIONS AND RELEVANCE

The findings of this cross-sectional study suggest that sleep disorders are more prevalent among children residing in areas with high levels of outdoor ALAN and the associations are generally stronger in children younger than 12 years. These findings further suggest that effective control of outdoor ALAN may be an important measure for improving the quality of children's sleep.

Relationship between sleep disorders and attention-deficit-hyperactivity disorder in children

OBJECTIVE

To explore the correlation between sleep disorders and attention-deficit-hyperactivity disorder (ADHD) in children.

METHODS

We studied 100 Chinese children (70 boys and 30 girls; mean age, 8.77 ± 2.39 years). Parents completed the Children's Sleep Disturbance Scale (SDSC) and the Swanson Nolan and Pelham Version IV Scale (SNAP-IV) questionnaires. SNAP-IV and SDSC scores were compared in children with and without sleep disorders and ADHD.

RESULTS

There were significant differences in SDSC scores, Arousal Disorder (AD) scores, and Sleep Breathing Disorder (SBD) scores between children with and without ADHD (P < 0.05). The sleep disorder group had higher SNAP-IV scores than the non-sleep disorder group (P < 0.05). Children with sleep disorders showed higher ADHD symptom values (inattention, hyperactivity/impulsivity, and oppositional defiance) than children without sleep disorders (P < 0.01). There was a moderate correlation between SDSC scores and SNAP-IV scores (r = 0.486, P < 0.05). Using SNAP-IV scores as the dependent variable, multiple linear regression analysis was applied, and a statistically significant effect of AD and Sleep-Wake Transition Disorder (SWTD) scores on SNAP-IV scores was found (P < 0.05). The area under the curve (95% CI) of the SDSC score for predicting sleep disorders with ADHD was 0.714 (0.606, 0.821; P = 0.0005).

CONCLUSION

Children with ADHD are prone to sleep disorders. The higher the ADHD symptom score, the more sleeping problems. Sleep disorders can also cause or exacerbate ADHD symptoms, and the ADHD symptom score correlates with sleep disorder severity. We can reduce the severity of attention-deficit-hyperactivity in children with ADHD by improving their sleep with behavioral sleep interventions.

Exposure to second-hand smoke during early life and subsequent sleep problems in children: a population-based cross-sectional study

BACKGROUND

Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children.

METHODS

In this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems.

RESULTS

We included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (β = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses.

CONCLUSIONS

Early-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6-18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.

The Interaction between Lockdown-Specific Conditions and Family-Specific Variables Explains the Presence of Child Insomnia during COVID-19: A Key Response to the Current Debate

It is still debated whether lockdown conditions in response to the coronavirus disease 2019 (COVID-19) health crisis seriously affected children’s sleep. For young children, some studies identified more insomnia, while others only transient disturbances, or even no effect. Based on the premise of mother–child synchrony, a well-known dynamic established in child development research, we hypothesized that principally, the children whose mothers perceived the lockdown as stressful and/or responded maladaptively, suffered sleep disturbances. The main objective of this study was to identify the family profiles, variables, and lockdown responses most linked to insomnia in young children. The sample consisted of 165 mothers, French vs. Swiss origin (accounting for different lockdown severities), of children 6 months to 5 years old. Validated sleep, stress, and behavior scales were used. Multiple regression, age-matched clustering, and structural equation modeling analyses provided evidence that insomnia in young children is indeed strongly linked to the mother’s reaction to the pandemic and lockdown. Specifically, reactions such as COVID-19 fear/anxiety and obsessive COVID-19 information seeking coincide with heightened vigilance, cascading into reduced child social contact, outings, and increased screen viewing, ultimately culminating in child insomnia and behavioral problems. Mother education level and child day care quality (e.g., home-schooling) were also identified as strong insomnia predictors.

Evaluation of the effect of the COVID-19 pandemic on sleep disorders and nutrition in children

AIMS

The aim of the study was to evaluate the possible changes in sleep behavior and nutrition in children during the pandemic period.

METHODS

One hundred fourteen parents who accepted to participate in the study aged 18 and over and who had children between the ages of 6 and 16 were included in the study. A questionnaire was carried out after written consents were obtained. In the first part of the questionnaire, there were a total of 9 questions including socio-demographic information and nutritional characteristics, and the second part included the "Sleep Disturbance Scale for Children" (SDSC). The data were analyzed with the SPSS 20 statistical program.

RESULTS

The total number of participants was 114 parents; 64 (56%) of the children were girls and 50 (43.9%) were boys. Among the participants, the number of children who had COVID-19 was 38 (33.3%). There was no statistically significant relationship between going through COVID-19 status and the variables examined in general. The proportion of participants who stated that if the pandemic period was prolonged, COVID-19 would not change their diet was found to be statistically significant (P = .038). The SDSC score was found to be significantly high in girls (P < .05).

CONCLUSION

Sleep and nutritional disorders affect the quality of life for all ages for both genders, and their importance increases even more in extraordinary periods such as pandemic. Sleep problems increasing especially with an accompanying anxiety state may lead to developmental problems as well as deepening psychological disorders.

Validity and reliability of the Turkish version of Sleep Disturbance Scale for Children

OBJECT

This study examines the validity and reliability of the Sleep Disturbance Scale for Children (SDSC) in the Turkish language.

METHOD

This scale was translated into the Turkish language by applying the translation-back translation method and content validity analysis. A total of 1903 participants aged 5-15 years were included in the study. A sociodemographic data form, SDSC, and the Children's Sleep Habits Questionnaire (CSHQ) were filled by the parents. Internal consistency analysis, correlation analysis, test-retest analysis, and confirmatory factor analysis were applied to evaluate the reliability and validity of the applied scale.

RESULTS

The internal consistency of the scale was high (Cronbach α = 0.84). Test-retest reliability was found to be high as well. According to the confirmatory factor analysis, the Turkish version of the scale was compatible with the model of the original scale. According to the T-score evaluation, the frequency of sleep disorders was determined to be 4.15%, and the most common sleep disorder was sleep hyperhidrosis. Correlations between the scores of the SDSC and CSHQ were at a satisfactory level.

CONCLUSIONS

These results revealed that the SDSC is a valid and reliable scale that can be used in children aged 5-14 years in Turkey to question sleep disorder symptoms.

The role of house dust mite immunotherapy in Indonesian children with chronic rhinosinusitis allergy: A randomized control trial

Background

Chronic rhinosinusitis allergy (CRA) is a disease that is commonly found in children and is mostly caused by allergy to house dust mites (HDM). The use of HDM immunotherapy can be considered in children with allergies.

Objectives

Analyzing the impact of mite immunotherapy on disease burden in Indonesian children with CRA.

Methods

A randomized control trial study was conducted to participants in 2 groups, namely the immunotherapy group (n = 25) and the non-immunotherapy group (n = 25). Participants were given HDM immunotherapy for 14 weeks, which was given once per week. Participants during therapy were evaluated for rhinosinusitis symptoms and measured their immunity status (specific IgE), sleep quality (SDSC), quality of life (SN5), and family coping (F-COPES) pre-post therapy. Statistical analysis used in this study included paired t-test, Wilcoxon test, independent t-test, or Mann Whitney test with p < 0.05.

Results

The value of specific IgE in the immunotherapy group was 4.12 ± 7.75 kU/l (pre-test) and 1.52 ± 2.42 kU/l (post-test; p < 0.001), while in the non-immunotherapy group was 1.47 ± 3.28 kU/l (pre-test) and 1.18 ± 2.81 kU/l (post-test; p = 0.317). The SDSC value in the immunotherapy group was 42.16 ± 2.75 (pre-test) and 30.32 ± 3.22 (post-test; p < 0.001), while in the non-immunotherapy group was 41.92 ± 2.75 (pre-test) and 41.84 ± 2.87 (post-test; p = 0.987). The F-COPES value in the immunotherapy group was 101.56 ± 5.78 (pre-test) and 105.20 ± 4.31 (post-test; p = 0.015), while in the non-immunotherapy group was 100.36 ± 9.63 (pre-test) and 99.96 ± 9.98 (post-test; p = 0.224). The SN-5 value in the immunotherapy group was 30.04 ± 2.78 (pre-test) and 11.00 ± 2.33 (post-test; p < 0.001), while in the non-immunotherapy group was 30.04 ± 2.78 (pre-test) and 30.04 ± 2.78 (post-test; p = 0.767). There was a significant comparison between the immunotherapy group and the non-immunotherapy group on the specific IgE (p = 0.013), SDSC (p < 0.001), and SN-5 (p < 0.001) values. Meanwhile, there was no significant difference in the F-COPES value (p = 0.129).

Conclusions

The administration of HDM immunotherapy can improve the participant's immunity, quality of life, and sleep disorder.

Mental Health in Children in the Context of COVID-19: Focus on Discharged Children

Introduction: To date, the mental health consequences of children hospitalized with COVID-19 remain unclear. We aimed to assess mental health status in children in the context of COVID-19, with a focus on discharged children. Methods: We recruited discharged children who recovered from COVID-19 and healthy controls between July and September 2020 in Wuhan Children's Hospital. Post-traumatic stress disorder (PTSD), anxiety, depression, and sleep problems were assessed in these children using questionnaires. Univariable and multivariable logistic and linear regressions were conducted to identify risk factors. Results: Totally, there were 152 children (61 discharged children and 91 healthy controls) aged 7-18 years old in our study. An increasing trend in the prevalence of PTSD, anxiety, and depression was observed in the discharged children compared with healthy controls (PTSD: 8.20 vs. 2.20%, anxiety: 22.95 vs. 13.19%; depression: 47.54 vs. 32.97%). Discharged children tended to report more depressive symptoms (β = 0.39) and less sleep problems (β = -0.37). Discharged children who lived in nuclear families and had longer hospital stays were more likely to report depression [odds ratio (OR) = 3.68 and 1.14, respectively]. Anxiety symptoms and the severity of sleep problems of discharged children were positively associated with caregivers' depression and PTSD symptoms (OR = 21.88 and 31.09, respectively). Conclusion: In conclusion, PTSD, anxiety, and depression symptoms were common among recovered children 4 months after COVID-19 hospitalization. Children from nuclear family and those had longer hospital stays need special attention. In addition, parental mental health had a significant impact on their children's mental resilience and recovery.

Evidence Base Update on Assessing Sleep in Youth

BACKGROUND

Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.

METHOD

We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).

RESULTS

Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.

CONCLUSION

Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.

Screen time and sleep disorder in preschool children: identifying the safe threshold in a digital world

OBJECTIVES

Sleep disorder is a common problem in children that can jeopardize their health and well-being. With the popularity of electronic devices such as portable tablets and smartphones in the 21st century, children are spending much more time on screen, but the impact of such change on children's sleep disorder has been less investigated so far. This study aims to examine the dose-response association between time spent on different electronic devices and children's sleep disorder.

STUDY DESIGN

The design of this study is a cross-sectional study.

METHODS

We randomly selected 2278 children aged 3-6 years from 15 kindergartens in Tongling, China. The potentially non-linear association between screen-viewing time (i.e. television [TV], computer, iPad, Phone) and the risk of sleep disorder was examined using a logistic generalized additive model.

RESULTS

We observed a J-shaped association between TV viewing time and the risk of sleep disorder, with a threshold of 1 h/day. For each 1 h/day increment in TV viewing time over the threshold, the risk of sleep disorder increased by 12.35% (95% confidence interval: 1.87-23.92%). This association seemed to be greater for girls than boys and for TV viewing at weekend than on weekdays, but the difference was not statistically significant (P-value>0.05). We did not find adequate evidence of an adverse effect of more time spent on computer, iPad and Phone.

CONCLUSIONS

This study suggests a positive but non-linear relationship between time spent on watching TV and sleep disorder in Chinese preschool children. Setting the TV viewing time limit less than 1 h/day may help reduce the risk of developing sleep disorder. Further investigation is also needed to examine and compare the effects of heavy use of other electronic devices on sleep disorder.

Evaluation of Chronotype Among Children and Associations With BMI, Sleep, Anxiety, and Depression

Objectives: To evaluate possible associations between chronotype, weight, sleep problems, anxiety, and depression among children from 6 to 12 years of age.

Method: One-hundred children aged between 6 and 12 years were randomly recruited in five pediatrician clinics in the capital city of Beirut, Lebanon. The protocol was approved by the ethics committee of Saint-Joseph University and Hotel-Dieu Hospital and an informed written formal consent was obtained from one of the parents. The Sleep Disturbance Scale for Children (CCTQ), the Revised Child Anxiety and Depression Scale (RCADS)-Parent version, and the Children's Chronotype Questionnaire (CCTQ) were used.

Results: The majority of the sample (47%) presented an intermediate chronotype. There was a shift toward evening chronotype with increased age and a significant association between electronic devices use and an evening chronotype. Higher sleep disturbances were also observed among children with an evening chronotype. In particular, disorders of initiating and maintaining sleep, non-restorative sleep, excessive somnolence, and total SDSC were significantly higher among evening type children in our study. Finally, major depression domain scores were significantly higher among children with an evening chronotype.

Conclusions: Several findings of this study are important and explain factors associated to chronotype in children. Two important future perspectives can be highlighted: limiting electronic devices use among children in an effort to reduce circadian rhythm disturbances and identifying and treating sleep problems associated with eveningness, taking into account the possible presence of major depression among this population.

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

Factor structure of the Sleep Disturbance Scale for Children (SDSC) in those with Attention Deficit and Hyperactivity Disorder (ADHD)

Objective

Method

Results

Conclusion

•

The original SDSC factor structure could not be replicated in an ADHD sample.

•

The fit of competing factor structures was evaluated.

•

An optimal structure including six-specific and a general factor was identified.

•

The alternative structure reported adequate psychometric properties.

•

The SDSC may be used to yield a total sleep difficulties score in ADHD samples.

Parent-reported sleep disorders in children with motor disabilities: a comparison with the Sleep Disturbance Scale for Children's new norms

OBJECTIVE

Children with motor disabilities such as cerebral palsy or neuromuscular diseases present more sleep disorders than their typically developing (TD) peers. However, research on these populations has always been performed using historical normative datasets or controls such as siblings. Therefore, we assessed the sleep quality of children with motor disabilities in comparison with a large, contemporary, general population sample.

METHODS

Demographic, medical, and the Sleep Disturbance Scale for Children (SDSC) questionnaires were sent to parents of children aged 4-18 years and followed by our tertiary pediatric neurorehabilitation clinic, and to those of school-aged children in regional primary and secondary schools. TD participant data allowed us to set pathological sleep score thresholds (T score ≥70).

RESULTS

We collected 245 responses for children with motor disabilities and 2891 for those from the general population (37% and 26% response rates, respectively). Cerebral palsy was the most frequent diagnosis (N = 109, 44.5%). Children with motor disabilities had significantly more frequent pathological sleep reported in their total SDSC score (7% vs 1.9%, odds ratio (OR) 3.98, 95% confidence interval (CI) 2.17-7.27, p < 0.001) and in five subscores. Single-parent households and drug-resistant epilepsy showed significant positive associations with pathological sleep among children with motor disabilities. For TD peers, parental unemployment and parental nationality were positively associated with pathological sleep.

CONCLUSION

This population-based study robustly estimated the prevalence of sleep disorders in children with motor disabilities. Sleep disorders were significantly more frequent in children with motor disabilities, but at a lower frequency than previously reported.

Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study

OBJECTIVE

To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate.

DESIGN

Prospective cross-sectional study.

SETTING

Referral care center.

PARTICIPANTS

One hundred seventy-four children aged 6 to 12 years of both genders.

INTERVENTIONS

Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance.

RESULTS

Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis.

CONCLUSIONS

Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.

Psychometric properties of parent and child reported sleep assessment tools in children with cerebral palsy: a systematic review

AIM

To determine whether any parent and child report sleep measure tools have been validated in children aged 0-18 years with cerebral palsy (CP).

METHOD

A systematic search of five databases was performed up to June 2017. Studies were included if a sleep measure tool was used to evaluate sleep in children 0-18 years with CP based on international classifications of sleep. Sleep measures were assessed for psychometric data in children with CP.

RESULTS

Only one paper which used the Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen (SNAKE) questionnaire met the study criteria. The four other measures frequently used in children with CP had no psychometric data available for their use in children with CP. The SNAKE questionnaire has been validated only in children with CP in Gross Motor Function Classification System level V. The Sleep Disturbance Scale for Children and the Pediatric Sleep Questionnaire had the strongest psychometric properties in typically developing children, but has not yet been validated in children with CP.

INTERPRETATION

Current sleep measures being administered in typically developing children are also often used in children with CP, but have not been well validated in this group of children.

WHAT THIS PAPER ADDS

There are no condition specific measures of sleep in children with cerebral palsy (CP). The Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen (SNAKE) questionnaire is validated for children with CP in Gross Motor Function Classification System level V. A framework to design a CP specific sleep questionnaire is provided.