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Lee WY, Lau MN, Soh EX, Yuen SW, Ashari A, Radzi Z. Validation of the Malay version of Epworth sleepiness scale for children and adolescents (MESS-CHAD). BMC Oral Health 2023; 23:1015. [PMID: 38115099 PMCID: PMC10729393 DOI: 10.1186/s12903-023-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) is a valid and reliable eight-item self-administered questionnaire for the assessment of excessive daytime sleepiness and is commonly used to screen sleep-disordered breathing for children and adolescents. The cross-sectional study aimed to translate and cross-culturally adapt ESS-CHAD into a Malay version of Epworth Sleepiness Scale for Children and Adolescents (MESS-CHAD) for the Malaysian population, and to assess the validity and reliability of MESS-CHAD. METHODS Forward-backward translation method was used to translate and cross-culturally adapt ESS-CHAD. Three linguistic experts and two paediatricians content validated the translated version. Face validity was conducted through audio-recorded semi-structured in-depth interviews with 14 native Malay-speaking children and adolescents followed by thematic analysis. The revised questionnaire was then proofread by a linguistic expert. A total of 40 subjects answered the MESS-CHAD twice, 2 weeks apart, for test-retest reliability and internal consistency. For criterion validity, 148 eligible subjects and their parents answered MESS-CHAD and the Malay version of Sleep-Related Breathing Disorder scale extracted from the Paediatric Sleep Questionnaire (M-PSQ:SRBD) concurrently. Variance Inflation Factor (VIF) and P values of the model's outer weight and outer loading were analysed using SmartPLS software to assess the indicator's multicollinearity and significance for formative construct validity. RESULTS Intraclass Correlation Coefficient (ICC) ranging from 0.798 to 0.932 and Cronbach's alpha ranging from 0.813 to 0.932 confirmed good to excellent test-retest reliability and internal consistency, respectively. Spearman Correlation Coefficient value of 0.789 suggested a very strong positive correlation between MESS-CHAD and M-PSQ:SRBD. VIF ranging from 1.109 to 1.455 indicated no collinearity problem. All questionnaire items in MESS-CHAD were retained as the P value of either outer model weight or outer model loading was significant (P < 0.05). CONCLUSION ESS-CHAD has been translated and cross-culturally adapted into Malay version for the Malaysian population, and found to be valid and reliable.
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Affiliation(s)
- Wan Ying Lee
- Lanang Dental Clinic, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - May Nak Lau
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Eunice Xinwei Soh
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sze Wan Yuen
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Asma Ashari
- Centre for Family Oral Health, Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia.
| | - Zamri Radzi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
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Gustin MP, Putois B, Guyon A, Lecendreux M, Challamel MJ, Plancoulaine S, Bioulac-Rogier S, Schroder C, Royant-Parola S, Huguelet S, Franco P. French Sleepiness Scale for Adolescents-8 items: A discriminant and diagnostic validation. L'ENCEPHALE 2023; 49:109-116. [PMID: 36253180 DOI: 10.1016/j.encep.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Abstract
The objective of the present study was to validate the Short Version of French Sleepiness Scale for Adolescents (FSSA) with eight items (FSSA8). METHODS A total of 384 adolescents, aged between 12 and 18 years, completed the FSSA8. These included 269 nonclinical adolescents and 115 adolescents admitted for overnight polysomnography and Multiple Sleep Latency Test (MSLT) because of suspected hypersomnia (85 patients with narcolepsy and 30 with other sleep disorders). Item response theory (IRT) assumptions were tested and psychometric properties were analysed. Matching on sex ratio and age was conducted to estimate concurrent criterion, diagnostic validity and cut-offs. RESULTS IRT assumptions were validated confirming the one-dimensionality of the FSSA8. The latent continuum sleepiness for which the scale and its items are reliable encompassed most of the clinical subjects. FSSA8 is weakly correlated with MSLT. Distribution of scores for the nonclinical group and the clinical group differed significantly; the FSSA8 had very good screening validity in sleep disorders. The cut-off was seven points. CONCLUSION The FSSA8 appeared to be more reliable for patients than for nonclinical participants and to be a good tool for screening excessive daytime sleepiness in sleep disorders.
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Affiliation(s)
- M-P Gustin
- Emerging Pathogens Laboratory-Fondation Mérieux, International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France; Institute of Pharmaceutic and Biological Sciences, Public Health department, Biostatistics, University Claude-Bernard Lyon 1, Villeurbanne, France
| | - B Putois
- Faculty of Psychology, Swiss Distance Learning University, Brig 3900, Switzerland
| | - A Guyon
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Lyon Neuroscience Research Centre, CNRS UMR 5292-INSERM U1028-Lyon 1 University, Bron 69005, France
| | - M Lecendreux
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Centre pédiatrique des pathologies du sommeil, Hôpital Robert Debré, Paris, France
| | - M-J Challamel
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France
| | - S Plancoulaine
- Université de Paris Cité, Inserm, INRAE, CRESS, 75004 Paris, France
| | - S Bioulac-Rogier
- Service de Psychiatrie de l'enfant et l'adolescent, Hôpital Couple enfant, CHU Grenoble Alpes CHU CS 10217, 38046 Grenoble, France
| | - C Schroder
- University of Strasbourg; CNRS UPR 3212, Institute of Cellular and Integrative Neurosciences
| | | | - S Huguelet
- Faculty of Psychology, Swiss Distance Learning University, Brig 3900, Switzerland
| | - P Franco
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Lyon Neuroscience Research Centre, CNRS UMR 5292-INSERM U1028-Lyon 1 University, Bron 69005, France.
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Kotagal S. A small but important advance for sleep health in children. Lancet Neurol 2023; 22:284-285. [PMID: 36931790 DOI: 10.1016/s1474-4422(23)00073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Suresh Kotagal
- Emeritus Professor, Department of Neurology, The Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
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Dye TJ, Simakajornboon N. Narcolepsy in Children: Sleep disorders in children, A rapidly evolving field seeking consensus. Pediatr Pulmonol 2022; 57:1952-1962. [PMID: 34021733 DOI: 10.1002/ppul.25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Narcolepsy is a life-long sleep disorder with two distinct subtypes, narcolepsy type I and narcolepsy type II. It is now well recognized that the loss of hypocretin neurons underlies the pathogenesis of narcolepsy type I, however, the pathogenesis of narcolepsy type II is currently unknown. Both genetic and environmental factors play an important role in the pathogenesis of narcolepsy. There is increasing evidence that autoimmune processes may play a critical role in the loss of hypocretin neurons. Infections especially streptococcus and influenza have been proposed as a potential trigger for the autoimmune-mediated mechanism. Several recent studies have shown increased cases of pediatric narcolepsy following the 2009 H1N1 pandemic. The increased cases in Europe seem to be related to a specific type of H1N1 influenza vaccination (Pandemrix), while the increased cases in China are related to influenza infection. Children with narcolepsy can have an unusual presentation at disease onset including complex motor movements which may lead to delayed diagnosis. All classic narcolepsy tetrads are present in only a small proportion of children. The diagnosis of narcolepsy is confirmed by either obtaining cerebrospinal fluid hypocretin or overnight sleep study with the multiple sleep latency test (MSLT). There are limitations of using MSLT in young children such that a negative MSLT test cannot exclude narcolepsy. HLA markers have limited utility in narcolepsy, but it may be useful in young children with clinical suspicion of narcolepsy. For management, both pharmacologic and non-pharmacologic treatments are important in the management of narcolepsy. Pharmacotherapy is primarily aimed to address excessive daytime sleepiness and REM-related symptoms such as cataplexy. In addition to pharmacotherapy, routine screening of behavioral and psychosocial issues is warranted to identify patients who would benefit from bio-behavior intervention.
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Affiliation(s)
- Thomas J Dye
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Maski K, Worhach J, Steinhart E, Boduch M, Morse AM, Strunc M, Scammell T, Owens J, Jesteadt L, Crisp C, Williams D, Sideridis G. Development and Validation of the Pediatric Hypersomnolence Survey. Neurology 2022; 98:e1964-e1975. [PMID: 35314496 PMCID: PMC9141629 DOI: 10.1212/wnl.0000000000200187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Narcolepsy and idiopathic hypersomnia usually begin in early adolescence, but diagnostic delays ranging from 5 to 10 years are common, affecting disease burden. To improve early identification of these treatable conditions, we developed and validated the Pediatric Hypersomnolence Survey (PHS). METHODS Content was developed through literature review, patient focus groups, interviews with experts in the field, and field testing. We then validated the 14-item self-reported survey across 3 hospitals and web recruitment from patient groups. In the validation phase, we recruited a total of 331 participants (patients with narcolepsy type 1 [n = 64], narcolepsy type 2 [n = 34], idiopathic hypersomnia [n = 36], and other sleep disorders [n = 97] and healthy controls [n = 100], ages 8-18 years) to complete the survey. We assessed a range of psychometric properties, including discriminant diagnostic validity for CNS disorders of hypersomnolence using receiver operating characteristic curve analysis and reliability across a 1-week period. RESULTS Confirmatory factor analysis indicated a 4-domain solution with good reliability expressed by satisfactory omega values. Across groups, the PHS total score showed appropriate positive correlations with other validated surveys of sleepiness (r = 0.65-0.78, p < 0.001) and negative correlations with multiple sleep latency test measures (mean sleep latency: r = -0.27, p = 0.006; number of sleep-onset REM periods: r = 0.26, p = 0.007). Compared to controls and patients with other sleep disorders, the area under the curve for participants with narcolepsy or idiopathic hypersomnia was 0.87 (standard error 0.02, 95% CI 0.83-0.91) with high sensitivity (81.3, 95% CI 73.7%-87.5%) and specificity (81.2%, 95 CI 75.1%-86.4%). Test-retest reliability was r = 0.87. DISCUSSION The PHS is a valid and reliable tool for clinicians to identify pediatric patients with narcolepsy and idiopathic hypersomnia. Implemented in clinical practice, the PHS will potentially decrease diagnostic delays and time to treatment, ultimately reducing disease burden for these debilitating conditions. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the PHS accurately identifies patients with central disorders of hypersomnolence.
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Affiliation(s)
- Kiran Maski
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Jennifer Worhach
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Erin Steinhart
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Madeline Boduch
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Anne Marie Morse
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Michael Strunc
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Thomas Scammell
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Judith Owens
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Lindsay Jesteadt
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Claire Crisp
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - David Williams
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Georgios Sideridis
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
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Current Understanding of Narcolepsy 1 and its Comorbidities: What Clinicians Need to Know. Adv Ther 2022; 39:221-243. [PMID: 34894325 PMCID: PMC8799537 DOI: 10.1007/s12325-021-01992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Narcolepsy is a chronic neurologic disorder associated with the dysregulation of the sleep–wake cycle that often leads to a decreased quality of life and results in a considerable health burden. There is often a delay to diagnosis of narcolepsy, mainly due to the lack of recognition of this disorder. One of the main factors hindering the diagnosis of narcolepsy is the association of comorbidities, which include other sleep disorders, psychiatric disorders, cardiovascular disorders, and metabolic disorders. The signs and symptoms of these comorbidities often overlap with those of narcolepsy, and some of the medications used for their treatment may obscure the symptoms of narcolepsy, leading to a delay in diagnosis. This review is targeted to clinicians unaccustomed to working with sleep disorders and aims to increase recognition and improve the management of narcolepsy.
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Uygun SD, Bilbay NT. Psychometric evaluation of the Turkish adaptation of the Epworth sleepiness scale for children and adolescents. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.2000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sabide Duygu Uygun
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Nedime Tuğçe Bilbay
- Department of Neurology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Salah NY, Abido AY, Rashed HR. Relationship of glycaemic derangement using continuous glucose monitoring system with sleep pattern among children with type 1 diabetes. Diabetes Metab Res Rev 2021; 37:e3407. [PMID: 32935448 DOI: 10.1002/dmrr.3407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Glycaemic derangement has been linked to sleep disruption. However, the impact of glycaemic derangement on sleep pattern among children with type 1 diabetes (C-T1D) remains unraveled. AIM To assess the effect of nocturnal hyperglycaemia and clinically significant (CS) hypoglycaemia on sleep pattern among C-T1D. METHODOLOGY Thirty C-T1D were compared to 30 age and sex matched healthy siblings. Patients having other organ disease that might cause sleep disorders or on medications causing sleep disturbance were excluded. History included diabetes-duration, type and dose of insulin therapy, chronic diabetic-complications, and manifestations of sleep disorders. Epworth Sleepiness Scale-Child Adolescent was used. Continuous glucose monitoring system (CGMS) and overnight polysomnography were done and analysed. RESULTS C-T1D had significantly lower sleep efficiency and significantly higher arousal index (AI), periodic limb movement index and apnoea-hypopnoea index compared to controls. Moreover, they had significantly longer sleep-onset latency, light sleep percentage, and shorter rapid eye movement percentage than controls. According to nocturnal CGMS readings, 15 C-T1D had nocturnal hyperglycaemia (50%), six experienced CS hypoglycaemia (20%), two had level-1 hypoglycaemia (6.7%), and seven were within the normoglycaemic range (23.3%). C-T1D experiencing nocturnal CS hypoglycaemia had significantly higher stage 3 sleep (P = 0.004) than controls. On the other hand, C- T1D experiencing nocturnal hyperglycaemia had significantly higher sleep onset latency (P = 0.013), light sleep percentage (P < 0.001), and AI (P < 0.001) than controls. Nocturnal CS hypoglycaemia was positively correlated to deep sleep duration, while hyperglycaemia was correlated to number of awakenings, sleep-onset latency, and light sleep duration. CONCLUSION In children with T1D CS hypoglycaemia is associated with sleep deepening, while hyperglycaemia is associated with increased light sleep, sleep onset latency.
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Affiliation(s)
- Nouran Y Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal Y Abido
- General Practitioner, Health Insurance Hospital, Giza, Egypt
| | - Hebatallah R Rashed
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
PURPOSE OF REVIEW This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences. RECENT FINDINGS Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and glutamate play a role in sleep disordered breathing (SDB). SUMMARY Untreated sleep disordered breathing (obstructive sleep apnea and/or central sleep apnea) are an important cause of medical mortality and morbidity. OSA is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep followed by hypoxia and sympathetic activation. Apneic events are terminated by arousal, followed by increases in pulse and blood pressure, and re-oxygenation and the release of inflammatory factors. Individuals with OSA have an increased risk of developing atrial fibrillation. Hypoxemia and poor sleep quality because of OSA increase the risk of cognitive decline in the elderly.
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Abstract
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.
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Affiliation(s)
- Tabitha Sen
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen Spruyt
- Lyon Neuroscience Research Center, INSERM U1028-CNRS UMR 5292, University Claude Bernard, School of Medicine, Lyon, France
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Bioulac S, Taillard J, Philip P, Sagaspe P. Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry 2020; 11:3. [PMID: 32174847 PMCID: PMC7055535 DOI: 10.3389/fpsyt.2020.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.
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Affiliation(s)
- Stéphanie Bioulac
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Jacques Taillard
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Pierre Philip
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Patricia Sagaspe
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
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Wang YG, Benmedjahed K, Lambert J, Evans CJ, Hwang S, Black J, Johns MW. Assessing narcolepsy with cataplexy in children and adolescents: development of a cataplexy diary and the ESS-CHAD. Nat Sci Sleep 2017; 9:201-211. [PMID: 28860883 PMCID: PMC5565379 DOI: 10.2147/nss.s140143] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to qualitatively evaluate concepts for incorporation into a daily diary to capture cataplexy frequency and to assess the content validity of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) in pediatric patients with narcolepsy. PATIENTS AND METHODS Face-to-face concept elicitation and cognitive interviews were conducted with children (7-9 years; n=13) and adolescents (10-17 years; n=16) who have narcolepsy with cataplexy, and their parents/caregivers. RESULTS Similarities and differences were noted between narcolepsy concepts described by children and their parents/caregivers, suggesting some different but complementary perspectives; parents may not recognize cataplexy symptoms/triggers as well as children, but parents have greater recognition of the circumstances of falling asleep. Cataplexy diary modifications included changes in definitions and examples of cataplexy, using child-friendly terminology, adding a quantitative question to determine daily frequency, and standardizing the questionnaire for evening administration with self-completion by the child. Modifications were made to ESS-CHAD for child-friendly wording and to ensure that items reflect activities (eating, watching TV/video) and environments (school, bus/car transport) in which children are likely to participate. Two ESS-CHAD versions were proposed: one with a 1-month recall period, for general use, and the other with a recall period of "since your last study visit," for research, which could be shorter or longer than 1 month (as short as 1 week). CONCLUSION The cataplexy diary and ESS-CHAD were modified for the assessment of children and adolescents. Further psychometric validation is recommended. These measures are being used in a Phase III, placebo-controlled clinical trial of sodium oxybate in children and adolescents with narcolepsy.
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Affiliation(s)
- Y Grace Wang
- Clinical Development, Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | | | | | | | - Jed Black
- Clinical Development, Jazz Pharmaceuticals, Palo Alto, CA, USA.,Sleep Medicine, Stanford Sleep Medicine Center, Redwood City, CA, USA
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