Experimental sleep restriction increases somatic complaints in healthy adolescents

Clinical Characterization of Juvenile Fibromyalgia in a Multicenter Cohort of Adolescents Enrolled in a Randomized Clinical Trial

OBJECTIVE

Juvenile fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference.

METHODS

Participants were 203 adolescents (ages 12-17 years) who completed baseline assessments for the multisite Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool, which includes a Widespread Pain Index (WPI; 0-18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0-12) based on the 2010 American College of Rheumatology criteria for fibromyalgia. Participants also completed self-report measures of pain intensity, functional impairment, and psychological functioning.

RESULTS

Participants endorsed a median of 11 painful body sites (WPI score) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterologic, and psychological symptoms were frequently endorsed. The WPI score was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment.

CONCLUSION

JFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors, highlighting the need for a broader approach to the assessment and treatment of JFM.

Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study

BACKGROUND

Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers.

OBJECTIVES

Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs.

METHOD

Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed.

RESULTS

Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity.

CONCLUSION

This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.

The complexities of the sleep-pain relationship in adolescents: A critical review

Chronic pain is a common and disabling condition in adolescents. Disturbed sleep is associated with many detrimental effects in adolescents with acute and chronic pain. While sleep and pain are known to share a reciprocal relationship, the sleep-pain relationship in adolescence warrants further contextualization within normally occurring maturation of several biopsychological processes. Since sleep and pain disorders begin to emerge in early adolescence and are often comorbid, there is a need for a comprehensive picture of their interrelation especially related to temporal relationships and mechanistic drivers. While existing reviews provide a solid foundation for the interaction between disturbed sleep and pain in youth, we will extend this review by highlighting current methodological challenges for both sleep and pain assessments, exploring the recent evidence for directionality in the sleep-pain relationship, reviewing potential mechanisms and factors underlying the relationship, and providing direction for future investigations. We will also highlight the potential role of digital technologies in advancing the understanding of the sleep and pain relationship. Ultimately, we anticipate this information will facilitate further research and inform the management of pain and poor sleep, which will ultimately improve the quality of life in adolescents and reduce the risk of pain persisting into adulthood.

Prevalence of somatic and pain complaints and associations with sleep disturbance in adolescents with insomnia presenting to a behavioral sleep medicine clinic

STUDY OBJECTIVES

Sleep problems are highly comorbid with pediatric pain, yet there is a dearth of research on how pain and somatic complaints impact adolescent insomnia presentation and response to cognitive-behavioral therapy for insomnia (CBT-I). This study aims to (1) determine the prevalence of parent-reported somatic/pain complaints in adolescents with insomnia presenting to a behavioral sleep clinic, (2) assess the impact of somatic/pain complaints on initial sleep presentation, and (3) assess the impact of baseline somatic/pain complaints on response to CBT-I.

METHODS

Participants included adolescents (n = 375) presenting to a behavioral sleep medicine center with a primary diagnosis of insomnia. As a part of clinical care, pre-evaluation measures were completed including the Pediatric Insomnia Severity Index, Adolescent Sleep Hygiene Scale, Adolescent Sleep Wake Scale, and Child Behavior Checklist. The Somatic Syndrome Scale of the Child Behavior Checklist measured somatic complaints and teens were categorized as endorsing pain if reported to experience aches/pains, headaches, or stomachaches. Adolescents completed the Pediatric Insomnia Severity Index at end of treatment.

RESULTS

Most adolescents had parent-reported somatic (61.1%) and/or pain complaints: headaches (66.6%), stomachaches (48.5%), and aches/pains (45.1%). Greater somatic and pain complaints predicted a worse sleep presentation at intake (all P < .05). After controlling for insomnia severity at intake, neither end-of-treatment insomnia severity nor treatment status were predicted by somatic and pain complaints at intake.

CONCLUSIONS

Results suggest that parent-reported somatic/pain complaints are prevalent in > 50% of adolescents seeking behavioral insomnia treatment. Although complaints are associated with more severe insomnia at intake, they do not appear to interfere with treatment response.

CITATION

Van Dyk TR, Krietsch KN, King CD, Byars KC. Prevalence of somatic and pain complaints and associations with sleep disturbance in adolescents with insomnia presenting to a behavioral sleep medicine clinic. J Clin Sleep Med. 2022;18(1):151-160.

The Current Status of Insufficient Sleep Duration and Its Influencing Factors Among Children and Adolescents: A Household Based Cross-Sectional Study in Zhejiang Province, China

PURPOSE

Insufficient sleep duration is common among children and adolescents worldwide, and the decline of sleep duration during the recent years is troubling. This study aimed to learn the status of insufficient sleep duration and to explore its influencing factors among children and adolescents in Zhejiang Province, China.

DESIGN AND METHODS

A stratified sampling technique was employed in the present cross-sectional study. Demographic characteristics, sports time as well as sedentary behavior were investigated.

RESULTS

A greater proportion of children than adolescents reported insufficient sleep duration (36.4% versus 19.2%, p = 0.001). For children, insufficient sleep duration was associated with age (OR = 1.290, 95%CI: 1.069-1.557), watching movies or TV shows with smartphones after school (OR = 3.098, 95%CI: 1.293-7.420), surf the internet after school (OR = 0.113, 95%CI: 0.013-0.969), walk to school (OR = 0.289, 95%CI: 0.105-0.793). For adolescents, insufficient sleep duration was associated with watch TV after school (OR = 0.379, 95%CI: 0.148-0.970), watching movies or TV shows with smartphones after school (OR = 4.744, 95%CI: 1.799-12.507), do homework after school (OR = 0.265, 95%CI: 0.086-0.813).

CONCLUSIONS

An unhealthy sedentary screen lifestyle profile may have influence on insufficient sleep duration. Urgent actions are needed to improve sleep duration among children and adolescents.

The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth-A Narrative Review

Musculoskeletal pain is common in the general pediatric population and is a challenge to youth, their parents, and society. The majority of children experiencing musculoskeletal pain will recover; however, a small subgroup of youth develops chronic pain. There is limited understanding of the factors that affect the transition from acute to chronic pain in youth. This review introduces sleep deficiency in the acute to chronic pain transition, exploring the potential mediational or mechanistic role and pathways of sleep in this process, including the interaction with sensory, psychological, and social components of pain and highlighting new avenues for treatment. Biological mechanisms include the increased production of inflammatory mediators and the effect on the hypothalamus-pituitary-adrenal (HPA) axis and on the dopaminergic signaling. Psychological and social components include the effect of sleep on the emotional-affective and behavioral components of pain, the negative impact on daily and social activities and coping strategies and on the reward system, increased pain catastrophizing, fear of pain, pain-related anxiety, hypervigilance, and social isolation. Future longitudinal studies are needed to elucidate these mechanistic pathways of the effect of sleep on the transition from acute to chronic pain, which may lead to the development of new treatment targets to prevent this transition.