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McLay L, Hunter J, Ballam K, Marie Emerson L, Day AS, Vandeleur M, Dalton S, Radcliffe Z, Woodford E. An evaluation of psychosocial sleep interventions for children with chronic health conditions: A systematic review. Sleep Med Rev 2024; 77:101962. [PMID: 38870551 DOI: 10.1016/j.smrv.2024.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
Chronic health conditions (CHC; e.g., cystic fibrosis, type 1 diabetes) in children are associated with disease-specific physical symptoms that contribute to a high prevalence of sleep problems. Sleep problems exacerbate other health-related sequelae and can impede therapeutic response to health treatments, increasing the overall complexity of symptom management. Psychosocial sleep interventions (PSI) improve sleep in children with typical development and neurodevelopmental conditions. Yet, the effectiveness of PSI for children with CHC has scarcely been investigated. This systematic review appraises the literature examining the effectiveness and acceptability of PSI for children with CHC. A search identified 20 studies that met inclusion criteria. Data related to participant characteristics, sleep targets, research design and methods, measures, sleep outcomes and collateral effects were extracted. Study rigor was then evaluated. Most studies evaluated youth-directed Cognitive Behavioral Therapy for Insomnia or parent-implemented behavioral sleep interventions. Twelve studies demonstrated positive sleep treatment effects and four demonstrated mixed effects. Collateral improvements were reported in child mental health and parental health and well-being, though physical health benefits for children were not consistently reported. One, five and 14 studies were rated as having strong, adequate, and weak methodological rigor respectively. Recommendations for clinical practice and future research are made.
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Affiliation(s)
- Laurie McLay
- The Child Well-being Research Institute and Faculty of Health, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, New Zealand.
| | - Jolene Hunter
- Faculty of Health, Te Whare Wānanga o Waitaha University of Canterbury, Christchurch, New Zealand
| | - Kimberly Ballam
- Faculty of Health, Te Whare Wānanga o Waitaha University of Canterbury, Christchurch, New Zealand
| | - Lisa Marie Emerson
- Faculty of Health, Te Whare Wānanga o Waitaha University of Canterbury, Christchurch, New Zealand
| | - Andrew S Day
- Department of Pediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Moya Vandeleur
- The Royal Children's Hospital, Melbourne, Murdoch Children's Research Institute (MCRI), Australia
| | - Samuel Dalton
- Child Health Services, Waitaha Canterbury, Health New Zealand Te Whatu Ora, Christchurch, New Zealand
| | - Zoe Radcliffe
- Faculty of Health, Te Whare Wānanga o Waitaha University of Canterbury, Christchurch, New Zealand
| | - Emma Woodford
- Faculty of Health, Te Whare Wānanga o Waitaha University of Canterbury, Christchurch, New Zealand
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Chen YC, Huang YT, Pan WH, Lee YL. Mediators linking obesity to childhood asthma. Pediatr Allergy Immunol 2022; 33:e13859. [PMID: 36282127 DOI: 10.1111/pai.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity and asthma are highly associated, but the mechanisms underlying the association remain unknown. We examined five mediators linking obesity with childhood asthma: (1) pulmonary function impairment, (2) airway inflammation, (3) physical fitness, (4) sleep-disordered breathing (SDB), and (5) early puberty. METHODS A Mendelian randomization (MR) study with mediation analysis of data obtained from 5965 children as part of the Taiwan Children Health Study. Observational analysis, MR two-stage least-squares method, and MR sensitivity analysis were carried out to investigate each causal pathway. Prospective cohort analyses were used to strengthen the findings. RESULTS The increased asthma risk associated with obesity was found to be mostly mediated through impaired pulmonary function, low physical fitness, and early puberty. In the MR analysis, body mass index was negatively associated with FEV1/FVC and physical fitness index (β = -2.17 and -0.71; 95% CI, -3.92 to -0.42 and -1.30 to -0.13, respectively) and positively associated with early puberty (OR, 1.09; 95% CI, 1.02-1.17). High FEV1/FVC and physical fitness index reduced asthma risk (OR, 0.98 and 0.93; 95% CI, 0.97-0.99 and 0.88-0.98, respectively), whereas SDB and early puberty increased the risk of asthma (OR, 1.03 and 1.22; 95% CI, 1.01-1.05 and 1.05-1.42, respectively). Temporal causality was strengthened in prospective cohort analyses. The three main mediators were low physical fitness, impaired pulmonary function, and early puberty, with mediation proportions of 73.76%, 61.63%, and 27.66%, respectively. CONCLUSIONS Interventions promoting physical fitness and pulmonary function might effectively reduce obesity-induced asthma risk.
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Affiliation(s)
- Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yungling L Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan
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Suzer Gamli I, Keceli Basaran M. The Effect of a Gluten-Free Diet on Sleep Disturbances in Children with Celiac Disease. Nat Sci Sleep 2022; 14:449-456. [PMID: 35321357 PMCID: PMC8937616 DOI: 10.2147/nss.s354811] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Sleep disturbances are common in patients with celiac disease (CD), but their response to a gluten-free diet (GFD) treatment remains scarce. This study investigated the alteration in sleep disturbances within 6 months of starting a GFD in children with CD. PATIENTS AND METHODS A total of 103 children initially diagnosed with CD, with no psychiatric diagnosis and not receiving psychotropic medication, were included in this study. Sociodemographic data were collected, and the Children's Sleep Habits Questionnaire (CSHQ) was completed both before and after six months of initiating a GFD. RESULTS Overall, the total average CSHQ score was 46; after starting the GFD, this decreased to 40, which was under the clinically significant cutoff level for sleep disturbance (p < 0.001). A total of 74 patients (71.8%) had a CSHQ score above the clinically significant cutoff before treatment, which decreased to 40 patients (38.8%) six months after GFD (p < 0.001). A significant improvement was detected in all CSHQ subscale scores and in the total CSHQ score after starting the GFD (p < 0.001). Parasomnia and the total CSHQ score were higher in children who were diagnosed incidentally compared to symptomatic children but did not differ after GFD (p < 0.005). In 39 patients (37.8%), the total CSHQ score remained high 6 months after starting the GFD. Maternal and paternal ages were significantly higher in children whose scores remained high (p < 0.05). CONCLUSION A significant improvement in sleep scores was detected after starting a GFD, regardless of initial age, sex, and symptom status. With a GFD, children may fall asleep more easily and sleep for longer with less interruptions. GFD may help to reduce sleep disturbances in CD, but future studies should investigate the certain conditions in patients who do not respond to a GFD.
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Affiliation(s)
- Ipek Suzer Gamli
- Istanbul Erenkoy Mental and Neurological Diseases Training and Research Hospital Child and Adolescent Psychiatry Unit, Istanbul, Turkey
| | - Meryem Keceli Basaran
- Basaksehir Cam and Sakura State Hospital, Department of Pediatrics, Division of Pediatric Gastroenterology, Istanbul, Turkey
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Jagpal SK, Jobanputra AM, Ahmed OH, Santiago TV, Ramagopal M. Sleep-disordered breathing in cystic fibrosis. Pediatr Pulmonol 2021; 56 Suppl 1:S23-S31. [PMID: 33263201 DOI: 10.1002/ppul.25028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 08/08/2020] [Indexed: 11/10/2022]
Abstract
Sleep-disordered breathing (SBD) is an under recognized comorbidity in the cystic fibrosis (CF) population across the lifespan. Nocturnal hypoxemia, obstructive sleep apnea, and nocturnal hypoventilation are respiratory abnormalities that occur commonly during sleep in patients with lung disease, and have deleterious consequences to the quality of life in people with CF. Effective screening for these abnormalities is needed to allow for timely initiation of treatment, which has been reported to be efficacious. Lack of treatment leads to worsened pulmonary, cardiovascular, and metabolic outcomes in patients. In this review, we give an overview of SBD for the CF clinician, including prevalence, treatment, and suggestions for future research. We strongly encourage the CF community to incorporate evaluation for SBD in CF clinical care so that outcomes for the subset of the CF patients with comorbid SBD improve.
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Affiliation(s)
- Sugeet K Jagpal
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aesha M Jobanputra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Teodoro V Santiago
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maya Ramagopal
- Division of Pediatric Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Jiang Y, Chen W, Spruyt K, Sun W, Wang Y, Li S, Shen X, Wang G, Jiang F. Bed-sharing and related factors in early adolescents. Sleep Med 2015; 17:75-80. [PMID: 26847978 DOI: 10.1016/j.sleep.2015.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/31/2015] [Accepted: 08/02/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the prevalence of bed-sharing and examine correlates of bed-sharing habits in early adolescents. METHODS Participants were 1452 early adolescents from 10 primary schools in Shanghai, China. Children's health status and past history, family environment and parents' attitude towards bed-sharing, and children's sleep arrangements were surveyed. Sleep was assessed by the Children's Sleep Habit Questionnaire. Tanner stage was determined by the endocrinologist. RESULTS The median of age was 10.83 years (range: 9.42-12.92; 95% confidence interval [CI]: 10.79-10.83) and boys accounted for 51.17%. The prevalence of bed-sharing was 16.8%. Positive parental attitude toward bed-sharing (OR: 9.87; 95% CI: 6.57-14.83), asthma (OR: 2.15; 95% CI: 1.16-3.98), smaller residential space (OR: 1.90; 95% CI: 1.17-3.09), extended family (OR: 1.59; 95% CI: 1.16-2.18), and being physically less mature (OR: 2.39; 95% CI: 1.16-4.91) increased the likelihood of bed-sharing. Bed-sharers were more likely to have bedtime resistance (OR: 12.20; 95% CI: 8.59-17.33), sleep anxiety (OR: 3.76; 95% CI: 2.74-5.15), and poor sleep quality (OR: 3.21; 95% CI: 2.28-4.81) compared to non-bed-sharers. Furthermore, bed-sharing was associated with daytime sleepiness (OR: 1.53; 95% CI: 1.10-2.13) but not with sleep duration. CONCLUSIONS Bed-sharing is highly prevalent among Chinese early adolescents and is significantly related to sleep quality. Parental positive attitude toward bed-sharing was the most determining factor.
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Affiliation(s)
- Yanrui Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Wenjuan Chen
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Karen Spruyt
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Wanqi Sun
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Yan Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Shenghui Li
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China; Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoming Shen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China; Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.
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Herbert AR, de Lima J, Fitzgerald DA, Seton C, Waters KA, Collins JJ. Exploratory study of sleeping patterns in children admitted to hospital. J Paediatr Child Health 2014; 50:632-8. [PMID: 24893889 DOI: 10.1111/jpc.12617] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
AIMS Sleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses. METHODS Parents of children admitted to the hospital, aged between 1 and 18 years, were asked to complete a sleep diary during one night of their child's hospital stay. Children older than 12 years were asked to complete a diary independently. Descriptive statistics were used to summarise the data. RESULTS Overall, 107 children were surveyed for one hospital inpatient night. The overall prevalence of poor sleep was 52.3%. The wide age range and variety of diagnosis limited further detailed analysis of specific causes of this problem. Poor sleep prior to admission was the strongest predictor of poor sleep in hospital suggesting that these children already had an underlying sleep problem. Unprompted awakenings were predominantly due to toileting (17.8%) or were spontaneous (17.8%). Factors specific to the hospital environment that woke children were nursing cares (25.2%), alarms (12.1%) and pain (12.1%). CONCLUSIONS Children admitted to hospital have a higher prevalence of poor sleep compared with healthy children in the community. Children were woken frequently by both external noise and attention provided by hospital staff. Education of hospital staff about the importance of sleep for children and factors that affect children's sleep may reduce the negative impact of hospitalisation on children's sleep.
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Affiliation(s)
- Anthony R Herbert
- Paediatric Palliative Care Service, Division of Oncology, Royal Children's Hospital, Brisbane, Queensland, Australia; Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Pain Medicine and Palliative Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Sleep and emotional and behavioral symptoms in adolescents with inflammatory bowel disease. SLEEP DISORDERS 2014; 2014:379450. [PMID: 24876973 PMCID: PMC4026992 DOI: 10.1155/2014/379450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/11/2014] [Accepted: 04/25/2014] [Indexed: 12/12/2022]
Abstract
The current study assessed the associations between sleep and psychosocial symptoms in 157 Finnish adolescents with inflammatory bowel disease (IBD). Sleep trouble was self-rated in Sleep Self-Report (SSR) and in Youth Self-Report (YSR). Psychosocial symptoms of the adolescents were assessed by the YSR and Child Behavior Checklist (CBCL). Patients reporting sleep trouble had significantly more psychosocial symptoms than their counterparts without sleep trouble. This was shown in the CBCL and YSR scales of total problems (P < 0.01), anxious/depressed mood (P < 0.05), and aggressive behavior (P < 0.01). Additionally, SSR sleep problem subscale scores indicating lower sleep quality (bedtime, sleep behavior) associated significantly with attention problems (P < 0.05). These results point out that sleep trouble should be recognized and treated in adolescents with IBD to possibly avoid the emerging of psychosocial symptoms.
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Beebe DW. A brief primer on sleep for pediatric and child clinical neuropsychologists. Child Neuropsychol 2011; 18:313-38. [PMID: 21954988 DOI: 10.1080/09297049.2011.602014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sleep problems are common in the children seen by pediatric and child clinical neuropsychologists, and these problems have the potential to significantly impact the child and his or her family. All are treatable to some degree, and some respond extremely well to existing treatments. This article provides a brief overview of the impact, nature, screening, and treatment for childhood sleep problems, with a particular emphasis on issues relevant to practicing neuropsychologists.
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Affiliation(s)
- Dean W Beebe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Erdem E, Ersu R, Karadag B, Karakoc F, Gokdemir Y, Ay P, Akpinar IN, Dagli E. Effect of night symptoms and disease severity on subjective sleep quality in children with non-cystic-fibrosis bronchiectasis. Pediatr Pulmonol 2011; 46:919-26. [PMID: 21462360 DOI: 10.1002/ppul.21454] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/07/2011] [Accepted: 01/12/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Night-time symptoms and hypoxemia during sleep may affect sleep quality in children with chronic lung disease such as bronchiectasis. Poor sleep quality may impair growth, learning, and emotional development of children. Our aim was to assess the sleep quality and associated factors in children with non-cystic fibrosis bronchiectasis. METHODS Fifty-four patients with bronchiectasis and age-matched controls were included to the study. Pittsburgh Sleep Quality Index (PSQI) and Pediatric Sleep Questionnaire (PSQ) were used to evaluate sleep quality and presence of sleep disordered breathing. A global sum of 5 or more according to PSQI indicated a poor sleep quality. A cut-off value of 0.33 in PSQ was used to identify pediatric sleep disordered breathing. Association between PSQI, pulmonary function tests, symptoms and HRCT scores were evaluated. RESULTS Thirty-seven percent of patients with bronchiectasis and 17% of patients in the control group had poor sleep quality (P < 0.05). Patients with sputum and wheezing had poorer sleep scores (P = 0.003 and P = 0.005). The association of wheezing and breathlessness during night time with sleep quality tended to be significant (P = 0.05). Twenty-two percent of patients with bronchiectasis and 9% of controls had sleep disordered breathing (P = 0.003). Bronchiectasis patients who snored had poorer sleep quality (P < 0.001) and patients with wheezing had significantly higher rate of snoring (P = 0.04). Children with worse HRCT scores also had worse sleep quality (r = 0.28, P = 0.04). CONCLUSIONS Patients with bronchiectasis have disturbed sleep associated with severity of disease. Night symptoms increase the risk of poor sleep quality. Sleep disordered breathing and sleep quality should be assessed in these patients.
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Affiliation(s)
- Ela Erdem
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey.
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Hollway JA, Aman MG. Sleep correlates of pervasive developmental disorders: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1399-1421. [PMID: 21570809 DOI: 10.1016/j.ridd.2011.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/01/2011] [Accepted: 04/02/2011] [Indexed: 05/30/2023]
Abstract
Sleep disturbance is a significant problem in the general pediatric population, and it occurs even more frequently in children with pervasive developmental disorders (PDDs). Much time and energy have been spent examining the characteristics that predispose children to insomnia and it is likely that equivalent factors influence sleep in PDDs. Though similarly affected, it is the unique set of characteristics incumbent in a diagnosis of PDD that has additive effects and increases the likelihood for developing other predisposing factors and subsequent sleep loss. This review summarized research that has explored the behavioral, cognitive, and emotional correlates of sleep disturbance in children with PDDs. The literature provided 38 sleep studies that used either subjective or objective sleep measures. Of these, 17 met criteria for inclusion. Studies were evaluated for their attempts at matching their study samples and adjusting for possible confounding variables. The results revealed that the combined effects of autism symptom severity, internalizing behavior, and externalizing behavior, were the main predisposing factors for the development of insomnia. Other factors included medical conditions, epilepsy, and medication use (likely a proxy for behavior difficulty and even sleep disorder). A bidirectional theoretical framework for sleep disturbance in children with PDDs has been posited as a conceptual guide for future study. Recommendations for future study designs are included.
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Affiliation(s)
- Jill A Hollway
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, United States.
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Daniel LC, Grant M, Kothare SV, Dampier C, Barakat LP. Sleep patterns in pediatric sickle cell disease. Pediatr Blood Cancer 2010; 55:501-7. [PMID: 20658622 DOI: 10.1002/pbc.22564] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research examining sleep in children with sickle cell disease (SCD) has focused on the increased occurrence of specific sleep disorders (i.e., sleep-disordered breathing, hypoxemia, nocturnal enuresis), but no research exists describing general sleep behaviors of children with SCD. The purpose of the current study was to compare sleep patterns and sleep behaviors in children with SCD and healthy controls and examine the associations of demographic and disease factors with sleep in the SCD group. PROCEDURE The Children's Sleep Habits Questionnaire was completed by parents of 4- to 10-year-old children with SCD (n = 54) and children attending well-care clinics in the same urban hospital (n = 52). Within the SCD group, demographic and disease factors [i.e., genotype, healthcare utilization, SCD complications, and socioeconomic status (SES)] were determined by medical chart review. RESULTS Parents of children with SCD reported significantly more behaviors associated with night waking and sleep-disordered breathing than the control group. Within the SCD group, parasomnias were related to SES, enuresis, more severe genotypes, SCD complications, and healthcare utilization. Sleep-disordered breathing was also related to SES, enuresis, and SCD complications. CONCLUSIONS Results indicate the importance of routinely assessing sleep in children with SCD as they are more likely to exhibit disrupted sleep than children with similar demographic backgrounds. Given significantly higher rates of parent reported sleep-disordered breathing and night waking in this population, it is important to consider interventions to minimize disruptions to overnight sleep and improve daytime functioning for quality of life in children with SCD.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania 19104, USA.
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Boergers J, Koinis-Mitchell D. Sleep and culture in children with medical conditions. J Pediatr Psychol 2010; 35:915-26. [PMID: 20332222 DOI: 10.1093/jpepsy/jsq016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To provide an integrative review of the existing literature on the interrelationships among sleep, culture, and medical conditions in children. METHODS A comprehensive literature search was conducted using PubMed, Medline, and PsychINFO computerized databases and bibliographies of relevant articles. RESULTS Children with chronic illnesses experience more sleep problems than healthy children. Cultural beliefs and practices are likely to impact the sleep of children with chronic illnesses. Few studies have examined cultural factors affecting the relationship between sleep and illness, but existing evidence suggests the relationship between sleep and illness is exacerbated for diverse groups. CONCLUSIONS Sleep is of critical importance to children with chronic illnesses. Cultural factors can predispose children both to sleep problems and to certain medical conditions. Additional research is needed to address the limitations of the existing literature, and to develop culturally sensitive interventions to treat sleep problems in children with chronic illnesses.
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Affiliation(s)
- Julie Boergers
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley-Hasbro Children's Research Center, Providence, RI 02903, USA.
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Turbyville JC. Applying principles of physics to the airway to help explain the relationship between asthma and gastroesophageal reflux. Med Hypotheses 2010; 74:1075-80. [PMID: 20080360 DOI: 10.1016/j.mehy.2009.12.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
Abstract
Gastroesophageal reflux (GER) and asthma have been linked, but the true nature of this relationship is incompletely understood. Most of the literature examining this association has implicated GER as the factor contributing to asthma. GER has also been linked to conditions of the upper airway like sinusitis and obstructive sleep apnea (OSA), and once again, usually presumed to be the causative factor. While GER seems to be capable of exacerbating airway disease, mounting evidence suggests that airway obstruction is a risk factor for developing GER. This article examines the principles of physics that predict what should occur given the anatomy of the airway and the esophagus, and provides multiple examples of disease associations that appear to support the hypothesis that airway obstruction is a significant risk factor for development of gastroesophageal reflux.
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Affiliation(s)
- Joseph C Turbyville
- Department of Allergy and Immunology, Walter Reed Army Medical Center, Washington, DC, USA.
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Mayes SD, Calhoun S, Bixler EO, Vgontzas AN. Sleep Problems in Children with Autism, ADHD, Anxiety, Depression, Acquired Brain Injury, and Typical Development. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2008.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
PURPOSE OF REVIEW Insomnia is a major public health problem and is the most common sleep disturbance in both adults and children. The causes of sleeplessness are age-dependent and have potentially enormous effects on cognitive development, behavior, family dynamics, and the metabolic health of children. Here we review the epidemiology, cause, pathophysiology, and clinical approach to pediatric insomnia. RECENT FINDINGS Normal sleep is crucial for brain function, behavior, and normal metabolism. Consistently, sleep loss has been linked to behavioral and attention problems, impaired learning and memory, obesity, and psychiatric disorders. The neurological mechanisms that govern sleep initiation and maintenance are poorly understood. The types of insomnia are age-dependent and can occur as primary disorders, or in the context of another primary sleep disorder such as restless legs syndrome, or secondary to another underlying medical condition. Children with chronic diseases and especially children with neurodevelopmental disorders are at particular risk of insomnia. SUMMARY Pediatric insomnia is common and is a source of potential psychophysiological stress to both children and their caregivers. The causes of insomnia are various. Pediatricians should have a working knowledge of the causes of sleeplessness in order to promptly curtail the chronic effects of sleep loss and effectively screen for underlying, potentially treatable disorders.
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Ng BY, Lee TS. Hypnotherapy for Sleep Disorders. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n8p683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hypnosis can be defined as a procedure during which changes in sensations, perceptions, thoughts, feelings or behaviour are suggested. Hypnosis can be used to amplify whatever it is about therapy that makes it therapeutic. It permits a wide range of choices regarding where and how to intervene in the patient’s problems. In this paper, we set out to examine the rationale of using hypnotherapy to manage various types of sleep disorders, and to explore the techniques, strategies and hypnotic scripts employed by various hypnotherapists. We also examine the research data available on the efficacy of hypnosis in the treatment of sleep disorders. Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions. Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking. Hypnosis is a specialised technique, not a therapy itself, and should be used as an adjunctive intervention within a complete psychological and medical treatment package. Most of the literature is limited to case reports or studies with such a small sample that at times it is very difficult to interpret the results. There is a major placebo effect, so uncontrolled trials are of limited value. It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.
Key words: Insomnia, Nightmares, Nocturnal enuresis, Parasomnias
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Souza LCNAD, Viegas CADA. Quality of sleep and pulmonary function in clinically stable adolescents with sickle cell anemia. J Bras Pneumol 2008; 33:275-81. [PMID: 17906788 DOI: 10.1590/s1806-37132007000300008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 08/22/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate quality of sleep and pulmonary function in clinically stable adolescents with sickle cell anemia (SCA). METHODS A cross-sectional descriptive study involving 50 patients with SCA submitted to nocturnal polysomnography and spirometry at the Brasília University Hospital. Anthropometric, polysomnographic and pulmonary function data were analyzed. Patients were divided into two groups according to oxygen saturation by pulse oximetry (SpO2) during rapid eye movement (REM) sleep: SpO2 < 93%; and SpO2 > 93%. Descriptive statistics, Student's t-test, chi-square test and Pearson's correlation coefficient were used. RESULTS Mean age was 13.9 +/- 2.5 years. Total sleep time and REM sleep percentage were lower, whereas REM sleep latency, the number of awakenings, movement during sleep, changes in sleep stage, sleep-disordered breathing index and obstructive apnea index were higher. Two patients (4%) did not present REM. There were statistically significant differences between the groups in most of the polysomnographic variables. The SpO2 in REM sleep presented a strong positive correlation with waking SpO2 and with SpO2 in non-REM sleep, whereas it presented a strong negative correlation with the percentage of total sleep time during which SPO2 was < 90%. Mean spirometric values were within normal ranges. Residual volume and the residual volume/total lung capacity/functional residual capacity ratio were elevated. CONCLUSION Sleep impairment in clinically stable patients with SCA is probably due to hemoglobin desaturation and not to individual alterations in pulmonary function.
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Long AC, Krishnamurthy V, Palermo TM. Sleep disturbances in school-age children with chronic pain. J Pediatr Psychol 2007; 33:258-68. [PMID: 18079168 DOI: 10.1093/jpepsy/jsm129] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine associations between pain, functional outcomes, and sleep disturbances in children with chronic pain, specifically juvenile idiopathic arthritis (JIA), sickle cell disease (SCD), and headache (HA). Sleep disturbances were tested as a risk factor for increased functional disability and decreased health-related quality of life (HRQOL). METHODS One hundred children (JIA n = 30, SCD n = 26, HA n = 44; 8-12 years; 56% female) and their caregivers participated. Children completed questionnaires regarding pain, depression, and functional disability. Caregivers completed questionnaires regarding sociodemographics, child sleep habits, functional disability, and HRQOL. RESULTS Levels of overall sleep disturbances were above the clinical cutoff for 53% of children with chronic pain. Sleep disturbances predicted lower physical HRQOL and higher functional disability, according to parent report. CONCLUSIONS Sleep disturbances are common and associated with daytime functioning in school-age children with chronic pain, suggesting that assessment and treatment of sleep problems is clinically relevant.
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Yuksel H, Sogut A, Yilmaz O, Demet M, Ergin D, Kirmaz C. Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers. Respir Med 2007; 101:2550-4. [PMID: 17869080 DOI: 10.1016/j.rmed.2007.07.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/17/2007] [Accepted: 07/11/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Having a child with a chronic disease may cause anxiety and depression and impair the sleep quality in the mothers. The aim of this study was to evaluate sleep quality in asthmatic children and their mothers as well as the status of anxiety-depression in the mothers. METHODS Study group consisted of 75 asthmatic children aged between 7 and 16 years (mean+/-SD 8.4+/-2.9) and the control group consisted of 46 healthy children aged between 7 and 15 years (mean+/-SD 9.1+/-3.6). Pittsburgh Sleep Quality Index (PSQI) was administered to both the children and their mothers while Hospital Anxiety and Depression Scale (HADS) was administered only to the mothers. RESULTS Total PSQI score of the mothers in the asthmatic group was significantly correlated with asthma severity of the children (r=0.49, p=0.00). There was a significant correlation between asthma symptom score and sleep disturbing factors subscore in children with asthma (r=0.34, p=0.01). Moreover, anxiety and depression subscores of the mothers in the asthma group were significantly higher (p=0.02). CONCLUSION Asthma may be associated with altered sleep quality in children and their mothers. Similarly, mothers of children with asthma may have disorder of anxiety and depression. Therefore, children with and their mothers need to be assessed for the requirement of support regarding sleep quality and anxiety-depression status.
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Affiliation(s)
- Hasan Yuksel
- Department of Pediatric Allergy, School of Medicine, Celal Bayar University, Manisa, Turkey
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Ward TM, Rankin S, Lee KA. Caring for children with sleep problems. J Pediatr Nurs 2007; 22:283-96. [PMID: 17645956 DOI: 10.1016/j.pedn.2007.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/06/2007] [Indexed: 11/18/2022]
Abstract
Sleep disturbances are common in infants and children. Sleep disturbances in children not only disrupt the child and family but also impact parental and child well-being, daytime functioning, and behavior. Pediatric nurses care for the individual child as well as their family members. Understanding the importance of healthy sleep habits and the implications of inadequate sleep on child behavior and family-peer interactions provides nurses an opportunity to decrease family stress and increase positive coping, adaptation, and family function. Common types of sleep problems are presented, and recommendations for screening tools are included to help nurses better assess sleep problems in children and make appropriate referrals.
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Affiliation(s)
- Teresa M Ward
- University of Washington, Seattle, WA 98195-7266, USA.
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Smith GA, Splaingard M, Hayes JR, Xiang H. Comparison of a personalized parent voice smoke alarm with a conventional residential tone smoke alarm for awakening children. Pediatrics 2006; 118:1623-32. [PMID: 17015555 DOI: 10.1542/peds.2006-0125] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Conventional residential tone smoke alarms fail to awaken the majority of children during slow wave sleep. With the objective of identifying a more effective smoke alarm for children, we compared a personalized parent voice smoke alarm with a conventional residential tone smoke alarm, both presented at 100 dB, with respect to their ability to awaken children 6- to 12-years-old from stage 4 sleep and prompt their performance of a simulated self-rescue escape procedure. METHODS Using a randomized, nonblinded, clinical research design, a volunteer sample of healthy children 6- to 12-years-old was enrolled in the study. Children were trained how to perform a simulated self-rescue escape procedure when they heard a smoke alarm. Each child's mother recorded a voice alarm message, "First name! First name! Wake up! Get out of bed! Leave the room!" For each child, either the voice or tone smoke alarm was randomly selected and triggered during the first cycle of stage 4 sleep, and then the other alarm was triggered during the second cycle of stage 4 sleep. Children's sleep stage was monitored by electroencephalography, electro-oculography, and chin electromyography. The 4 main outcome measures included the number of children who awakened, the number of children who escaped, the time to awakening, and the time to escape. RESULTS Twenty-four children were enrolled. The median age was 9 years, and 11 (46%) were boys. One half of the children received the parent voice alarm first, and one half received the tone alarm first; however, the order that the alarm stimuli were presented was not statistically associated with awakening or escaping. Twenty-three (96%) of the 24 subjects awakened to the parent voice alarm compared with 14 (58%) to the tone alarm. One child did not awaken to either stimulus. Nine children awakened to their parent's voice but not to the tone, whereas none awakened to only the tone and not the voice. Twenty (83%) of the subjects in the parent voice alarm group successfully performed the escape procedure within 5 minutes of alarm onset compared with 9 (38%) in the tone alarm group. The median time to awaken was 20 seconds in the voice alarm group compared with 3 minutes in the tone alarm group. The median time to escape was 38 seconds in the voice alarm group compared with the maximum allowed 5 minutes in the tone alarm group. When exposed to the tone alarm, older children were more likely to awaken and were more likely to escape than younger children. There was no association between child's age and awakening or escaping for children exposed to the parent voice alarm. There was no association between child's gender and awakening or escaping for either alarm type. CONCLUSIONS To our knowledge, this study is the first to compare the ability of different types of smoke alarms to awaken children while monitoring sleep stage. The personalized parent voice smoke alarm at 100 dB successfully awakened 96% of children 6- to 12-years-old from stage 4 sleep with 83% successfully performing a simulated self-rescue escape procedure, significantly outperforming the 100-dB conventional residential tone smoke alarm. These findings suggest a clear direction for future research, as well as important fundamental changes in smoke alarm design, that address the unique developmental needs of children. The development of a more effective smoke alarm for use in homes and other locations where children sleep provides an opportunity to reduce fire-related morbidity and mortality among children.
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Affiliation(s)
- Gary A Smith
- Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, 700 Children's Dr, Columbus, OH 43205, USA.
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Moore K, David TJ, Murray CS, Child F, Arkwright PD. Effect of childhood eczema and asthma on parental sleep and well-being: a prospective comparative study. Br J Dermatol 2006; 154:514-8. [PMID: 16445784 DOI: 10.1111/j.1365-2133.2005.07082.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The psychological impact of childhood atopic eczema on parents and carers is poorly quantified. Objectives To compare the impact of caring for a child with atopic eczema vs. asthma on parents' sleep and well-being. METHODS Ninety-two parents of 55 children who had moderate to severe atopic eczema or asthma took part in this prospective, questionnaire-based study. It was conducted at regional eczema and asthma outpatient clinics within a U.K. tertiary paediatric hospital. The main outcome measures were the number and duration of parents' sleep disturbances, as well as their anxiety and depression scores. RESULTS Mothers caring for children with atopic eczema lost a median of 39 min of sleep per night and fathers lost 45 min sleep per night. This compared with a median of 0 min sleep lost by parents who had children with asthma (P < 0.001). These differences were independent of the age of the children, and whether the child came from a single-parent or two-parent family. There was a direct correlation between the severity of sleep disturbance and the level of maternal anxiety (rho = 0.58; P = 0.002) and depression (rho = 0.73; P < 0.001), as well as the level of paternal anxiety (rho = 0.59; P = 0.01). CONCLUSIONS Compared with looking after a child with chronic asthma, caring for a child with chronic atopic eczema was associated with greater parental sleep disturbances. Disruption to parental sleep correlated with anxiety levels and, in the case of mothers, depression scores.
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Affiliation(s)
- K Moore
- Academic Unit of Child Health, University of Manchester, UK
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