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Koinis-Mitchell D, Marshall GD, Kopel SJ, Belanger NMS, Ayala-Figueroa J, Echevarria S, Millman R, Zheng T, Weathers J, Gredvig CA, Carskadon MA. Experimental methods to study sleep disruption and immune balance in urban children with asthma. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac003. [PMID: 35355783 PMCID: PMC8947185 DOI: 10.1093/sleepadvances/zpac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/08/2021] [Indexed: 11/13/2022]
Abstract
Study Objectives We describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illustrate effects of experimentally disrupted sleep on the immune balance profile (Th1/Th2 cytokines), key sleep variables from polysomnography data, and lung function in our sample. Methods Children follow an individualized structured sleep schedule consistent with their habitual sleep need (≥9.5 hours' time in bed) for six days before a laboratory-based experimental sleep protocol. Children then spend two successive nights in the sleep lab monitored by polysomnography: a baseline night consisting of uninterrupted sleep, and a disruption night, during which they are awoken for 2 minutes between 20-minute intervals of uninterrupted sleep. Evening and morning blood draws bracket baseline and disruption nights for immune biomarker assessment. Results A shift towards immune imbalance following the sleep disruption protocol was observed in these illustrative cases. Conclusions Data from these case examples provide evidence that the experimental protocol caused disruptions in sleep as observed on polysomnography and had the hypothesized downstream effects on immune balance associated with clinical asthma control. Documenting the effects of sleep disruption on immune function in children with persistent asthma is a crucial step towards understanding associations between sleep, immune balance, and asthma outcomes and provides important information for developing novel interventions for youth with asthma and suboptimal sleep. Clinical Trials Not applicable.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gailen D Marshall
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sheryl J Kopel
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole M S Belanger
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jesús Ayala-Figueroa
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Sofia Echevarria
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Bradley-Hasbro Children’s Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Richard Millman
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tao Zheng
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica Weathers
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
| | - Caroline A Gredvig
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
| | - Mary A Carskadon
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- EP Bradley Hospital Sleep and Chronobiology Research Laboratory, Providence, RI, USA
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Dai Y, Liu J. Parental perceived child sleep problems: A concept analysis. J SPEC PEDIATR NURS 2021; 26:e12327. [PMID: 33493387 DOI: 10.1111/jspn.12327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This paper aims to delineate a conceptual analysis of parental perceived child sleep problems. DESIGN AND METHODS Rodger's evolutionary approach to concept analysis was employed. A systematic literature search of PubMed, CINAHL, Medline, and PsycINFO was conducted from inception to June 2020. Peer-reviewed papers written in English focusing on parental perception of their children's sleep problems were included. RESULTS A total of 47 papers were included for analysis. Parental perceived child sleep problems can be defined as parental reliance on their observations and beliefs, and perceived locus of control to appraise an array of children's sleep-related signs and behaviors, which may contain bias but still reflects certain aspects of children's sleep health status. A wide range of physiological, psychosocial, familial, environmental, and cultural factors may contribute to parental perceived child sleep problems, which may further contribute to parent-child dyads' physical and mental health as well as the whole family's general wellness. PRACTICE IMPLICATIONS Defining the concept of parental perceived child sleep problems facilitate health professionals a foundation for consistent use, understanding, and evaluation of parent-reported child sleep outcome. Future research on the standard conceptual and operational definition of parental perceived child sleep problem, and its potential antecedents and consequences is warranted. The characteristic of parental perceived sleep problems, together with child sleep history and objective sleep measures should be integrated to evaluate child sleep health.
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Affiliation(s)
- Ying Dai
- Schools of Nursing, Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jianghong Liu
- Schools of Nursing and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Maternal emotions during the first three postnatal months: Gaining an hermeneutic understanding. Women Birth 2018; 32:579-585. [PMID: 30477964 DOI: 10.1016/j.wombi.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Maternal emotions in the first three postnatal months are rarely explored yet in the German context despite it is known that they play an important role in the complexity of maternal health and well-being. AIM Gaining understanding of maternal emotions and how the developmental process of the infant circadian rhythm influences them during the first three months of the postnatal period. METHODS A Gadamerian-based research method was used to explore the experiences of 15 mothers in Germany. FINDINGS 'Being needed' and 'being in need' emerged as the first two themes and were further explored hermeneutically. This resulted in the findings of 'emotional balance and conflicting emotions' as underlying maternal emotions during the first three months following birth. DISCUSSION Understanding maternal emotions during the first three months of the postnatal period has the potential of opening new pathways for improving maternal health and well-being. CONCLUSION A spectrum of maternal emotions, maternal uncertainties and maternal needs exists in the first three months of the postnatal period.
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Zhang J, Zhang Y, Jiang Y, Sun W, Zhu Q, Ip P, Zhang D, Liu S, Chen C, Chen J, Zhang L, Zhang H, Tang M, Dong W, Wu Y, Yin Y, Jiang F. Effect of Sleep Duration, Diet, and Physical Activity on Obesity and Overweight Elementary School Students in Shanghai. THE JOURNAL OF SCHOOL HEALTH 2018; 88:112-121. [PMID: 29333647 DOI: 10.1111/josh.12583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/11/2017] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND This was a cross-sectional survey to investigate the relationship of age, parent education, sleep duration, physical activity, and dietary habits with overweight or obesity in school-age children in Shanghai. METHODS The survey gathered information from 13,001 children in grades 1 through 5 (age 6 to 10 years) among 26 elementary schools in 7 districts. Activity level was evaluated using the International Children's Leisure Activities Study Survey Questionnaire (CLASS-C). The definitions of normal, overweight, and obese were adjusted for each age. RESULTS Logistic regression analysis indicated that age, being male, having ≤10 hours of sleep on non-school days, eating ≥1 vegetable/day, or drinking ≥1 sugar-sweetened drink/day increased the risk for a child being overweight or obese compared with having >10 hours of sleep or ≤3 vegetables or ≤3 sugar-sweetened drinks/month (p ≤ .008). Having >2 hours of outdoor activities on non-school days reduced the risk of being overweight or obese compared with ≤2 hours of outdoor activities on non-school days (p < .001). CONCLUSIONS We found that age, sex, sleep, and some dietary habits impacted weight, and suggests that specific cultural and economic factors may impact risk of a child being overweight or obese.
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Affiliation(s)
- Jing Zhang
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - YunTing Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YanRui Jiang
- Developmental-Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - WanQi Sun
- Developmental-Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qi Zhu
- Developmental-Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Patrick Ip
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China
| | - DongLan Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ShiJian Liu
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Public Health and School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chang Chen
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Public Health and School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie Chen
- Sleep Disorders Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhang
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - MingYu Tang
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - WenFang Dong
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - YuFeng Wu
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Pulmonary Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No 1678, DongFang Road, Shanghai, China
| | - Fan Jiang
- Sleep Disorders Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children. J Autism Dev Disord 2018; 47:2067-2079. [PMID: 28434058 PMCID: PMC5487747 DOI: 10.1007/s10803-017-3130-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest associations (ORs 2.0–23.3). Moderately strong associations were observed for nutrition, genetic, ear nose and throat, and sleep conditions (ORs 2.1–3.2). Using machine learning methods, we clustered children based on their medical conditions prior to ASD diagnosis and demonstrated ASD risk stratification. Our findings provide new evidence indicating that children with ASD have a disproportionate burden of certain medical conditions preceding ASD diagnosis.
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Cavalheiro MG, Corrêa CDC, Maximino LP, Weber SAT. Sleep quality in children: questionnaires available in Brazil. Sleep Sci 2017; 10:154-160. [PMID: 29410747 PMCID: PMC5760049 DOI: 10.5935/1984-0063.20170027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. MATERIAL AND METHODS A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords "sleep quality" and "children". Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. RESULTS Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6) (1); Inventory of Sleep Habits for Preschool Children (2); the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18) (3), Sleep Questionnaire by Reimão and Lefévre - QRL (4); the Questionnaire on Sleep Behaviour Patterns (5) and the translation of the Sleep Disturbance Scale for Children (6); Brief Infant Sleep Questionnaire - BISQ (7) . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. CONCLUSIONS A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process.
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Affiliation(s)
- Maria Gabriela Cavalheiro
- Hospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP),
Universidade de São Paulo (FOB-USP), Seção de genética e
biologia molecular - Bauru - SP - Brazil
| | - Camila de Castro Corrêa
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
Júlio de Mesquita Filho, Department of Ophthalmology and Otolaryngology -
Botucatu - SP - Brazil
| | - Luciana Paula Maximino
- Faculdade de Odontologia de Bauru, Universidade de São Paulo
(FOB-USP), Department of Speech Therapy and Audiology - Bauru - SP - Brazil
| | - Silke Anna Theresa Weber
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
Júlio de Mesquita Filho, Department of Ophthalmology and Otolaryngology -
Botucatu - SP - Brazil
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Abstract
Insomnia among children and adolescents is ubiquitous and takes a great toll on youth and their families, impacting academic achievement, mood, social functioning, and a variety of developmental outcomes. Unfortunately, however, pediatric insomnia most often remains unidentified and untreated. When treatment is provided, it is most often in the form of medications, which are not FDA approved for that indication in children and adolescents. A comprehensive literature review was employed to establish the recommendations in this report. This article provides a review of sleep physiology and both current and recommended approaches to assessing and treating pediatric insomnia. Comprehensive assessment, accurate diagnosis, and evidence-based treatment of insomnia is imperative to the healthy development of children and adolescents. While clinicians often prescribe a variety of medications to treat pediatric insomnia, there is insufficient data to demonstrate efficacy and endorse their routine use. At this time, behavioral techniques, such as cognitive behavior therapy for insomnia and sleep hygiene education, should remain the first line of treatment. As a second-line consideration, melatonin, a dietary supplement, may be effective. Pediatric insomnia has an enormous impact on children, adolescents, and their families that requires adequate attention from clinicians and parents alike.
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Koinis-Mitchell D, Kopel SJ, Boergers J, McQuaid EL, Esteban CA, Seifer R, Fritz GK, Beltran AJ, Klein RB, LeBourgeois M. Good Sleep Health in Urban Children With Asthma: A Risk and Resilience Approach. J Pediatr Psychol 2015; 40:888-903. [PMID: 25991645 DOI: 10.1093/jpepsy/jsv046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/22/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To identify children demonstrating "good" sleep health in a sample of urban children with persistent asthma; to compare sociocontextual, asthma clinical characteristics, and sleep behaviors in children with "good" versus "poor" sleep health; and to examine protective effects of family-based health behaviors on sleep health. METHODS Participants were 249 Black (33%), Latino (51%) and non-Latino White (16%) children with asthma, ages 7-9 years, and their primary caregivers. RESULTS 32 percent of children had "good" sleep health. Well-controlled asthma and better lung function were more likely in this group. In the context of urban risks, sleep hygiene appeared to be a protective factor associated with better sleep quality. The protective effect of asthma management functioned differently by ethnic group. CONCLUSIONS This study identifies protective processes that may guard against urban risks to optimize sleep health in children with asthma. Intervention programs can be tailored to consider specific supports that enhance sleep health in this high-risk group.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Julie Boergers
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Cynthia A Esteban
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Ronald Seifer
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Alvaro J Beltran
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Robert B Klein
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
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Hart CN, Carskadon MA, Considine RV, Fava JL, Lawton J, Raynor HA, Jelalian E, Owens J, Wing R. Changes in children's sleep duration on food intake, weight, and leptin. Pediatrics 2013; 132:e1473-80. [PMID: 24190680 DOI: 10.1542/peds.2013-1274] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the effect of experimental changes in children's sleep duration on self-reported food intake, food reinforcement, appetite-regulating hormones, and measured weight. METHODS Using a within-subjects, counterbalanced, crossover design, 37 children, 8 to 11 years of age (27% overweight/obese) completed a 3-week study. Children slept their typical amount at home for 1 week and were then randomized to either increase or decrease their time in bed by 1.5 hours per night for 1 week, completing the alternate schedule on the third week. Primary outcomes were dietary intake as assessed by 24-hour dietary recalls, food reinforcement (ie, points earned for a food reward), and fasting leptin and ghrelin. The secondary outcome was child weight. RESULTS Participants achieved a 2 hour, 21 minute difference in the actigraph defined sleep period time between the increase and decrease sleep conditions (P < .001). Compared with the decrease sleep condition, during the increase condition, children reported consuming an average of 134 kcal/day less (P < .05), and exhibited lower fasting morning leptin values (P < .05). Measured weights were 0.22 kg lower during the increase sleep than the decrease sleep condition (P < .001). There were no differences in food reinforcement or in fasting ghrelin. CONCLUSIONS Compared with decreased sleep, increased sleep duration in school-age children resulted in lower reported food intake, lower fasting leptin levels, and lower weight. The potential role of sleep duration in pediatric obesity prevention and treatment warrants further study.
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Affiliation(s)
- Chantelle N Hart
- Center for Obesity Research and Education, Temple University, 3223 N Broad St, Suite 175, Philadelphia, PA 19140.
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Abstract
The purpose of this review is to provide a comprehensive update of epidemiologic studies that have assessed the association between sleep and obesity risk. Data suggest that short sleep is associated with an increased risk for being or becoming overweight/obese or having increased body fat. Late bedtimes are also a risk factor for overweight/obesity. Findings also suggest that changes in eating pathways may lead to increased body fat. Future experimental studies are needed to enhance our understanding of the underlying mechanisms through which sleep may play a role in the development and maintenance of childhood obesity.
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Affiliation(s)
- Chantelle N. Hart
- Corresponding author for proof and reprints: Chantelle Hart, Ph.D., Weight Control & Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903; ; 401-793-9727; 401-793-8944 (fax)
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Paine S, Gradisar M. A randomised controlled trial of cognitive-behaviour therapy for behavioural insomnia of childhood in school-aged children. Behav Res Ther 2011; 49:379-88. [DOI: 10.1016/j.brat.2011.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 03/11/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
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Abstract
Sleep has long been considered as a passive phenomenon, but it is now clear that it is a period of intense brain activity involving higher cortical functions. Overall, sleep affects every aspect of a child's development, particularly higher cognitive functions. Sleep concerns are ranked as the fifth leading concern of parents. Close to one third of all children suffer from sleep disorders, the prevalence of which is increased in certain pediatric populations, such as children with special needs, children with psychiatric or medical diagnoses and children with autism or pervasive developmental disorders. The paper reviews sleep physiology and the impact, classification, and management of sleep disorders in the pediatric age group.
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Affiliation(s)
- Hanan M El Shakankiry
- King Fahd University Hospital, Al Dammam University, Al Khobar, Kingdom of Saudi Arabia
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Abstract
Ever since its original description by Leo Kanner in l943, autism has been generally defined by its clinical characteristics and core symptoms that include impaired social skills, isolated areas of interest, and delayed and disordered language. Over time, it has become apparent that autism is a heterogeneous disorder with regard to its clinical presentation, etiology, underlying neurobiology, and degree of severity. As a result, the termed diagnosis of autism spectrum disorders (ASDs) has come into common usage. With advancements in clinical care, there has come the appreciation that many ASD children, adolescents, and adults may have medically relevant disorders that may negatively impact their developmental progress and behavior, but which frequently go undetected. Many of these medical conditions are treatable, often resulting in improved developmental gains and quality of life for the patient and family. In addition, the possibility exists that some of these medical conditions may suggest the presence of important genetic and/or biologic markers, which, if identified, can refine our ability to be more precise in categorizing clinical and genetic subtypes within the autism spectrum.
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Affiliation(s)
- Margaret L Bauman
- Department of Neurology, and Lurie Center LADDERS program, Massachusetts General Hospital, Boston, MA 02421, USA.
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Affiliation(s)
- Malena Thunström
- Child Health Unit, Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Sweden
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Batista BHB, Nunes ML. Evaluation of sleep habits in children with epilepsy. Epilepsy Behav 2007; 11:60-4. [PMID: 17499554 DOI: 10.1016/j.yebeh.2007.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 03/20/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
Sleep disturbances are a common complaint among patients with epilepsy. Studies assessing the relationship between sleep and epilepsy during childhood are scarce. The purpose of this study was to evaluate sleep habits in children with epilepsy. This cross-sectional study of children with and without epilepsy employed two questionnaires to evaluate sleep habits. Characteristics of both sleep habits and epilepsy (type of seizure, epileptic syndrome, number of seizures, use of anticonvulsant drugs) were collected from parental interviews and medical records. Our results indicate that children with epilepsy have a greater incidence of sleep problems compared with children without epilepsy. In those with epilepsy, we observed that nocturnal seizures, polytherapy, developmental delay, refractory epilepsy, generalized seizures, and epileptic syndromes with an unfavorable outcome are associated with poor sleep habits.
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Affiliation(s)
- Bianca H Brum Batista
- Neuroscience Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Batista BHB, Nunes ML. Validação para língua portuguesa de duas escalas para avaliação de hábitos e qualidade de sono em crianças. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s1676-26492006000500006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Apresentar a validação para língua portuguesa das escalas de avaliação do sono: "Inventário dos hábitos de sono para crianças pré-escolares" e "Questionário sobre o comportamento do sono". MÉTODOS: Inicialmente as escalas foram traduzidas para português, após receberam tradução reversa, em reunião de consenso foi avaliada a melhor versão. As escalas foram aplicadas em dois grupos de crianças (controle e com epilepsia). Os pacientes com epilepsia foram estratificados pela gravidade através da classificação de Engel. Os escores obtidos foram comparados entre si e relacionados com a gravidade da epilepsia. RESULTADOS: A escala "Inventário dos hábitos de sono para crianças pré-escolares" evidenciou maior incidência de alterações na rotina da hora de dormir, na ritmicidade do sono e de separação dos pais no grupo com epilepsia refratária. Crianças com epilepsia controlada apresentaram hábitos do sono mais saudáveis (p < 0,05). A aplicação do "Questionário sobre o comportamento do sono" evidenciou alterações na qualidade do sono no grupo com epilepsia (p < 0,001). Quanto maior a refratariedade da epilepsia pior a qualidade do sono (p < 0,001). CONCLUSÃO: Disponibilizamos através da validação para língua portuguesa questionários para avaliação de distúrbios do sono na infância. A aplicação destes questionários demonstrou a influência exercida pela epilepsia com crises não controladas na qualidade do sono.
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Doran SM, Harvey MT, Horner RH. Sleep and Developmental Disabilities: Assessment, Treatment, and Outcome Measures. ACTA ACUST UNITED AC 2006; 44:13-27. [PMID: 16405384 DOI: 10.1352/0047-6765(2006)44[13:saddat]2.0.co;2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
People with developmental disabilities sleep less and experience higher incidence of clinical sleep disorders than the general population. Exploring the neurophysiology linking sleep with daytime performance in patients with developmental disabilities is now possible using minimally sufficient sleep and sleep-sensitive behavioral assays. Although frequent sampling represents the primary difficulty, it is required to untangle coincident effects of sleep quality amidst circadian variation. Recent evidence finds high quality sleep promotes brain plasticity, improves health measures, and enriches quality of life. Sleep treatments for apnea, insomnia, restless limbs, and conditioned sleep-aversion are available, although not readily provided, for people with developmental disabilities. This population would gain both clinical and behavioral benefits as improved sleep-monitoring, behavioral testing, and sleep-treatment technology is adapted to their needs.
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Affiliation(s)
- Scott M Doran
- Department of Special Education, Box 40, Vanderbilt University, Nashville, TN 37203, USA.
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Spruyt K, O'Brien LM, Cluydts R, Verleye GB, Ferri R. Odds, prevalence and predictors of sleep problems in school-age normal children. J Sleep Res 2005; 14:163-76. [PMID: 15910514 DOI: 10.1111/j.1365-2869.2005.00458.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objectives of the study were to describe the prevalence, odds, and predictors of 36 paediatric sleep behaviours and describe their coexistence in a school-age normal population. The design was community-based questionnaire survey of sleep-wake patterns, sleep environment, and 36 sleep behaviours indicative of six sleep disorder-subscales using the Health-Behaviour Questionnaire. A caregivers' report of 3045 children aged 6-13 years in Belgium constituted the participants. Prevalence of each sleep behaviour was calculated. Log-linear modelling within and between the sleep disorder-subscales was used to screen for coexistence. The effect size of selected night-time parameters to the likelihood of sleep behaviours and disorder-subscale was expressed as odds ratios via logit regression analysis. Significant differences in sleep-wake patterns were found between weekday and weekend. Ranking by odds showed that: (1) sleep problems such as 'tired when waking up', 'repetitive limb movements', 'going to bed reluctantly', and 'sleep paralysis' and; (2) the disorder-subscale 'excessive somnolence' are common in children. Coexistences within and between disorder-subscales of sleep problems are evident in a school-age, normal population. These results suggest that disorders of excessive somnolence (DES) are highly prevalent in a non-clinical sample of school-age children. Furthermore, sleep-onset latency and a noisy, not well-darkened room are predictive towards the odds for exhibiting sleep problems and disorders. It is advocated that more information on the importance of good sleep-wake hygiene should reach parents and children.
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Affiliation(s)
- Karen Spruyt
- Department of Cognitive and Physiological Psychology, Faculty of Psychology and Educational Sciences, Free University of Brussels, Brussels, Belgium.
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Fayle RW. Sleep Disorders. Neurol Clin 2005. [DOI: 10.1016/j.ncl.2005.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Couturier JL, Speechley KN, Steele M, Norman R, Stringer B, Nicolson R. Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: prevalence, severity, and pattern. J Am Acad Child Adolesc Psychiatry 2005; 44:815-22. [PMID: 16034284 DOI: 10.1097/01.chi.0000166377.22651.87] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares parents' perceptions of the prevalence, severity, and pattern of sleep problems in children of normal intelligence with pervasive developmental disorders (PDDs) with a normative comparison group of children. METHOD A survey including the Children's Sleep Habits Questionnaire was mailed to a sample of parents of children (age range 5-12 years) with PDDs (diagnosed by the Autism Diagnostic Interview-Revised) obtained by chart review of the past 7 years and to parents of comparison children matched on age, gender, and postal code. RESULTS The response rate in the PDD group was 82.2% (37/45) and 55.8% (43/77) in the comparison group. By individually matching, 23 pairs were obtained. The prevalence of sleep problems in the PDD group was reported by parents as being significantly higher than in the comparison group (78% and 26%, respectively; p < .002), as was the severity (mean score 48.2 and 39.0, respectively; p < .001). Values for four of eight sleep subscales including sleep onset delay, sleep duration, sleep anxiety, and parasomnias were significantly higher in the PDD group. CONCLUSIONS Parents report that sleep problems are significantly more prevalent and severe in children of normal intelligence with PDDs compared with normally developing children, and the pattern appears diverse. Sleep problems in children with PDDs require further research and clinical attention.
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Affiliation(s)
- Jennifer L Couturier
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.
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Abstract
Approximately 25% of children younger than 5 years experience some type of sleep problem. Whether the problem is acute or chronic, significant disruption to the child's sleep can occur and have a negative impact on the child and family. This article is the second in a two-part series on sleep in infants and young children. The purpose of this article is to provide fundamental information regarding common pediatric sleep problems for the clinician to use when assessing a child's sleep behaviors or addressing parental concerns. The definition, impact, and clinical evaluation of sleep problems are discussed.
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Affiliation(s)
- Katherine Finn Davis
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA 30322, USA.
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Smits MG, van Stel HF, van der Heijden K, Meijer AM, Coenen AML, Kerkhof GA. Melatonin improves health status and sleep in children with idiopathic chronic sleep-onset insomnia: a randomized placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 2003; 42:1286-93. [PMID: 14566165 DOI: 10.1097/01.chi.0000085756.71002.86] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of melatonin treatment on health status and sleep in children with idiopathic sleep-onset insomnia. METHOD A randomized, double-blind, placebo-controlled trial was conducted in a Dutch sleep center, involving 62 children, 6 to 12 years of age, who suffered more than 1 year from idiopathic chronic sleep-onset insomnia. Patients received either 5 mg melatonin or placebo at 7 pm. The study consisted of a 1-week baseline period, followed by a 4-week treatment. Health status was measured with the RAND General Health Rating Index (RAND-GHRI) and Functional Status II (FS-II) questionnaires. Lights-off time, sleep onset, and wake-up time were recorded in a diary, and endogenous dim light melatonin onset was measured in saliva. RESULTS The total scores of the RAND-GHRI and FS-II improved significantly more during melatonin treatment compared to placebo. The magnitude of change was much higher in the melatonin group than in the placebo group, with standardized response means for the RAND-GHRI of 0.69 versus 0.07 and for the FS-II of 1.61 versus 0.64. Melatonin treatment also significantly advanced sleep onset by 57 minutes, sleep offset by 9 minutes, and melatonin onset by 82 minutes, and decreased sleep latency by 17 minutes. Lights-off time and total sleep time did not change. CONCLUSIONS Melatonin improves health status and advances the sleep-wake rhythm in children with idiopathic chronic sleep-onset insomnia.
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Affiliation(s)
- Marcel G Smits
- Sleep Centre, Hospital Gelderse Vallei, Willy Brandtlaan 10, Box 9025, 6710 HN Ede, the Netherlands.
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Thackeray EJ, Richdale AL. The behavioural treatment of sleep difficulties in children with an intellectual disability. BEHAVIORAL INTERVENTIONS 2002. [DOI: 10.1002/bin.123] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Glaze DG, Rosen CL, Owens JA. Toward a practical definition of pediatric insomnia. Curr Ther Res Clin Exp 2002. [DOI: 10.1016/s0011-393x(02)80100-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Smits MG, Nagtegaal EE, van der Heijden J, Coenen AM, Kerkhof GA. Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial. J Child Neurol 2001; 16:86-92. [PMID: 11292231 DOI: 10.1177/088307380101600204] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To establish the efficacy of melatonin treatment in childhood sleep onset insomnia, 40 elementary school children, 6 to 12 years of age, who suffered more than 1 year from chronic sleep onset insomnia, were studied in a double-blind, placebo-controlled study. The children were randomly assigned to receive either 5-mg melatonin or placebo. The study consisted of a 1-week baseline, consecutively followed by a 4-week treatment period. After that period, treatment was continued if the parents wished so. The study's impact was assessed by measurements of lights-off time, sleep onset, and wake-up time, recorded in a diary (n = 33). Sleep onset was also recorded with an actigraph (n = 25). Endogenous dim light melatonin onset was measured in saliva (n = 27). Sustained attention was evaluated with the Bourdon-Vos reaction time test (n = 36). In the melatonin group, mean (95% CI) lights-off time advanced 34 (6-63) minutes, diary sleep onset 63 (32-94) minutes, actigraphic sleep onset 75 (36-114) minutes, and melatonin onset 57 (24 to 89) minutes; total sleep time increased 41 (19-62) minutes. In the placebo group, these parameters did not shift significantly. The change during the 4-week treatment period differed between the treatment groups significantly as to lights-off time, diary and actigraphic sleep onset, sleep duration, and melatonin onset. There were no significant differences between the treatment groups in the change of sleep latency, wake-up time, and sustained attention reaction times. Mild headache occurred in 2 children during the first 2 days of the melatonin treatment. Eighteen months after the start of the trial, in 13 of the 38 children who could be followed up, melatonin treatment was stopped because their sleep problem was solved and in 1 child because sleep was not improved. Twelve children used melatonin 5 mg, the other 1.0 to 2.5 mg. One child developed mild generalized epilepsy 4 months after the start of the trial. The results show that melatonin, 5 mg at 6 PM, was relatively safe to take in the short term and significantly more effective than placebo in advancing sleep onset and dim light melatonin onset and increasing sleep duration in elementary school children with chronic sleep onset insomnia. Sustained attention was not affected.
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Affiliation(s)
- M G Smits
- Department of Neurology and Sleep-Wake Disorders, Hospital De Gelderse Vallei, Ede, The Netherlands.
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Owens LJ, France KG, Wiggs L. REVIEW ARTICLE: Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review. Sleep Med Rev 1999; 3:281-302. [PMID: 12531150 DOI: 10.1053/smrv.1999.0082] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review covers the literature on behavioural and cognitive-behavioural treatments for sleep disturbance in infants, pre-school, and school-age children. Treatment areas are dyssomnias (disorders of initiating, maintaining, or excessive sleep) and parasomnias (behaviours which occur predominantly during sleep). Interventions aimed at preventing sleep disorder through targeting infant sleep patterns are also examined. Controlled experimental studies are the main focus of this review but case studies and clinical reports are also included. It is concluded that, for families willing to undertake behavioural and cognitive-behavioural interventions, some treatments appear effective for some infant and child sleep problems, in the short term at least. The adequacy of current research is discussed, and suggestions for future research are given.
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Affiliation(s)
- Laurence J Owens
- Education Department, University of Canterbury, Christchurch, Aotearoa/New Zealand
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Abstract
Disorders of excessive daytime sleepiness (EDS) constitute a major health hazard, since impaired alertness may lead to accidents and poor quality of life, and some of them are associated with increased cardiovascular morbidity and mortality. Many disorders of EDS are neurological diseases (e.g. narcolepsy and periodic limb movements in sleep, PLMS). The largest group of disorders causing EDS consists of sleep-related disturbances of breathing, where neuroregulatory mechanisms play a major role in pathophysiology. Many patients with neurodegenerative and neuromuscular diseases suffer from sleep disturbances associated with EDS. Therefore, neurologists must be acquainted with the differential diagnosis of EDS and the major categories of sleep disorders causing it. The present update focuses on major sleep disorders causing EDS, and approaches the topic from the neurologist's perspective. Rather than being an extensive review, this update includes recent data on epidemiology, pathophysiology, diagnosis and treatment of obstructive sleep apnea and related conditions (increased upper airway resistance syndrome, central sleep apnea), as well as of narcolepsy and PLMS. Also included are recent data concerning EDS in neurodegenerative (Alzheimer's disease, Parkinson's disease, multiple system atrophy) and neuromuscular disorders.
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Affiliation(s)
- B El-Ad
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel
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