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Becking BE, Verweij JP, Jonkman REG, van Merkesteyn JPR, Van den Akker-Van Marle ME. Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population. Sleep Med 2024; 119:19-26. [PMID: 38636211 DOI: 10.1016/j.sleep.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Pediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. METHODS The translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4-18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. RESULTS The factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. CONCLUSIONS Cultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.
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Affiliation(s)
- Bibi E Becking
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Jop P Verweij
- Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, the Netherlands.
| | | | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
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2
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Williamson AA, Uwah EA, Min J, Zhang X, Griffis H, Cielo CM, Tapia IE, Fiks AG, Mindell JA. Diagnosis of sleep disorders in child healthcare settings. Sleep Med 2024; 119:80-87. [PMID: 38657437 PMCID: PMC11180578 DOI: 10.1016/j.sleep.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Sleep disorders impact at least 10 % of children, pose risks to overall wellbeing, and are key targets of preventive interventions. The objectives of this study were to describe the prevalence of pediatric sleep disorder diagnoses across sociodemographic characteristics and co-occurring conditions, and to explore potential sociodemographic disparities. METHODS Cross-sectional analysis of 12,394,902 children (0-17 years; 50.9 % Medicaid-insured) in the 2017 MarketScan database. Prevalence was assessed utilizing ICD-10 codes, with multivariate logistic regressions examining disparities (insurance coverage; race and ethnicity in Medicaid-insured) for diagnoses in ≥0.10 % of children. RESULTS The prevalence of sleep disorder diagnoses was 2.36 %. The most common diagnoses were obstructive sleep disordered breathing (oSDB, 1.17 %), unspecified sleep disorders (0.64 %), insomnia (0.52 %), and other SDB (0.10 %), with <0.10 % for all other diagnoses. Insomnia and parasomnias diagnoses were much lower than diagnostic estimates. Sleep diagnoses were more prevalent in Medicaid versus commercially insured youth, 2-5-year-olds, and in children with co-occurring medical, neurodevelopmental, or behavioral health conditions. Girls and boys were generally equally likely to be diagnosed with any sleep disorder. In Medicaid-insured children, white children were more likely to have any sleep diagnosis compared to all other racial and ethnic groups. Black/African American children were more likely than white children to have oSDB. CONCLUSIONS Compared to diagnostic estimates, claims data suggest sleep disorders are under-diagnosed, with notable sociodemographic disparities. Findings suggest a need for clinical resources to identify and address sleep disorders and to understand biases potentially driving disparities, given that sleep is a modifiable determinant of child wellbeing.
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Affiliation(s)
- Ariel A Williamson
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; The Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA.
| | - Eberechukwu A Uwah
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jungwon Min
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher M Cielo
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jodi A Mindell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
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3
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Servos Li MM, Hamersley ERS, Baldassari C. Nasal Disorders. Pediatr Rev 2024; 45:188-200. [PMID: 38556515 DOI: 10.1542/pir.2023-006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.
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Affiliation(s)
- Mariah M Servos Li
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Erin R S Hamersley
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
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4
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Kim CY, Reinertsen E, Dang C, Nkutshweu D, Sathekge R, Choi YJ, Cha JY, Alturki G, Jamel A, Suzuki A, Arai K, Amm E, Motro M, Parsi G. Association among craniofacial morphology, ethnicity, and risk of pediatric sleep-related breathing disorders: A multicenter study. Am J Orthod Dentofacial Orthop 2024; 165:414-422. [PMID: 38149956 DOI: 10.1016/j.ajodo.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Craniofacial morphology and ethnicity may be risk factors for sleep-related breathing disorder (SRBD) in children but have not yet been assessed in an international multicenter study. The objectives of this study were to assess the association among craniofacial features, self-reported ethnicity, and risk of SRBD in children undergoing orthodontic treatment. METHODS Children aged 5-18 years who presented for orthodontic evaluation were enrolled in the United States, South Africa, South Korea, Saudi Arabia, and Japan. The risk of SRBD was defined as answering ≥0.33 positive responses to the Pediatric Sleep Questionnaire. Craniofacial features included measurements in sagittal and vertical dimensions to evaluate the cranial base, maxillomandibular and dental relationships, and nasopharyngeal airway dimensions. Logistic regression was performed to assess the association among craniofacial features, ethnicity, age, body mass index, and risk of SRBD. RESULTS Data were obtained from 602 patients from 5 sites. A total of 76 patients (12.6%) had a risk of SRBD. The mean age was 12.5 years. Male gender (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0-3.4; P = 0.041), Middle Eastern ethnicity (OR, 10.2; 95% CI, 4.1-25.4; P = 0.001), body mass index (OR, 1.1; 95% CI, 1.04-1.10; P = 0.001), gonial angle (OR, 0.91; 95% CI, 0.85-0.98; P = 0.011), and inferiorly positioned hyoid (OR, 1.1; 95% CI, 1.0-1.2; P = 0.002) were significantly associated with the risk of SRBD. CONCLUSIONS In an ambidirectional cohort study across 5 sites, male gender, Middle Eastern ethnicity, body mass index, gonial angle, and inferiorly positioned hyoid were associated with the risk of SRBD in children undergoing orthodontic treatment.
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Affiliation(s)
- Chai Yoon Kim
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Erik Reinertsen
- Research Laboratory of Electronics, MIT, Massachusetts Institute of Technology, Cambridge, Mass
| | - Calvin Dang
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Dineo Nkutshweu
- Department of Orthodontics, 1 Military Hospital, Pretoria, South Africa
| | - Rachel Sathekge
- Department of Orthodontics, 1 Military Hospital, Pretoria, South Africa
| | - Yoon Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ghassan Alturki
- Department of Orthodontics, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Ahmad Jamel
- Department of Orthodontics, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Akihiro Suzuki
- Department of Orthodontics, School of Life Dentistry, The Nippon Dental University, Tokyo, Japan
| | - Kazuhito Arai
- Department of Orthodontics, School of Life Dentistry, The Nippon Dental University, Tokyo, Japan
| | - Elie Amm
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Melih Motro
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass
| | - Goli Parsi
- Department of Orthodontics and Dentofacial Orthopedics, Boston University Henry M Goldman School of Dental Medicine, Boston, Mass.
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Asarnow LD, Mirchandaney R. Sleep and Mood Disorders Among Youth. Psychiatr Clin North Am 2024; 47:255-272. [PMID: 38302210 DOI: 10.1016/j.psc.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
This article reviews the literature on mood disorders and sleep disorders among children and adolescents. Research suggests that sleep plays an important role in the development, progression, and maintenance of mood disorder symptoms among children and adolescents. Sleep problems as early as maternal perinatal insomnia may predict and predate depression among youth. Children and adolescents who develop comorbid mood disorders and sleep problems represent a particularly high-risk group with more severe mood episode symptoms, higher rates of self-harm and suicidality, and less responsivity to treatment. Treatment research supports the idea that sleep problems can be improved through behavioral interventions.
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Affiliation(s)
- Lauren D Asarnow
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, RM LP-A307, San Francisco, CA 94143, USA.
| | - Riya Mirchandaney
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, RM LP-A307, San Francisco, CA 94143, USA
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Magnusdottir S, Hill EA. Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: A systematic review. Sleep Med Rev 2024; 73:101871. [PMID: 37976758 DOI: 10.1016/j.smrv.2023.101871] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Untreated pediatric obstructive sleep apnea (OSA) is associated with significant morbidities affecting behavior, neurocognitive development, endocrine and metabolic health. This systematic review evaluated prevalence of OSA reported in population-based studies among preschoolers as early intervention may have positive effects on health and quality of life. Thirty studies were included. High degrees of heterogeneity in methods and definitions were observed between the studies. Seven studies confirmed OSA by implementing objective methods after screening for habitual snoring with only two studies utilizing polysomnography, the reference standard, testing 1.2% of the combined cohorts (n = 82/4575) to confirm disease. Diagnosis of OSA was based on utilizing retired thresholds of the apnea-hypopnea-index (AHI), AHI4%≥5/hour of sleep (hrSleep), reporting prevalence of 1.8% and 6.4%, respectively. The remaining five studies implemented relatively insensitive objective recording methods to confirm disease in a limited number of children (n = 449/2486; 18.0%), estimating prevalence in the range of 0.7%-13.0%. The remaining literature is based on implementing questionnaires only to evaluate OSA. Studies published before 2014 reported 3.3%-9.4% prevalence, while more recent studies published 2016-2023 report higher prevalence, 12.8%-20.4%, when excluding outliers. This trend suggests that prevalence of OSA may possibly have been increasing in preschoolers over the past decade.
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Affiliation(s)
- Solveig Magnusdottir
- MyCardio LLC, SleepImage®, 3200 E Cherry Creek South Drive, Denver, CO, 80209, USA.
| | - Elizabeth A Hill
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Dorothy Crowfoot Hodgkin Building, South Parks Road, Oxford, OX1 3QU, UK
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7
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Benedetto L, Peña F, Rivas M, Ferreira A, Torterolo P. The Integration of the Maternal Care with Sleep During the Postpartum Period. Sleep Med Clin 2023; 18:499-509. [PMID: 38501522 DOI: 10.1016/j.jsmc.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Our entire life occurs in a constant alternation between wakefulness and sleep. The impossibility of living without sleep implies that any behavior must adapt to the need for sleep, and maternal behavior does not escape from this determination. Additionally, maternal behavior in mammals is a highly motivated behavior, essential for the survival of the offspring. Thus, the mother has to adapt her physiology of sleep to the constant demands of the pups, where each species will have different strategies to merge these two physiological needs. However, all studied female mammals will experience sleep disturbances at some point of the postpartum period.
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Affiliation(s)
- Luciana Benedetto
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | - Florencia Peña
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Mayda Rivas
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Annabel Ferreira
- Sección de Fisiología y Nutrición, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Pablo Torterolo
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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8
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Abstract
This article reviews disparities in pediatric sleep health and sleep disorders from early childhood through adolescence (birth to age 18 years). Sleep health is a multidimensional construct including sleep duration, consolidation, and other domains, whereas sleep disorders reflect both behaviorally (eg, insomnia) and medically based (eg, sleep disordered breathing) sleep diagnoses. Using a socioecological framework, we review multilevel (ie, child, family, school, health-care system, neighborhood, and sociocultural) factors linked to sleep health disparities. Mechanistic research and studies using an intersectional lens to understand overlapping marginalized identities are needed to inform multilevel interventions to promote sleep health equity in pediatrics.
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Affiliation(s)
- Francesca Lupini
- Children's National Hospital, 111 Michigan Avenue Northwest, 6 Floor CTR Suite, Room M7658, Washington, DC 20010, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street Boulevard, Room 8202, Philadelphia, PA 19146, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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9
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Williamson AA, Johnson TJ, Tapia IE. Health disparities in pediatric sleep-disordered breathing. Paediatr Respir Rev 2023; 45:2-7. [PMID: 35277358 PMCID: PMC9329494 DOI: 10.1016/j.prrv.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.
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Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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10
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Wellham A, Kim C, Kwok SS, Lee R, Naoum S, Razza JM, Goonewardene MS. Sleep-disordered breathing in children seeking orthodontic care-an Australian perspective. Aust Dent J 2023; 68:26-34. [PMID: 36346173 DOI: 10.1111/adj.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of sleep-disordered breathing in children is underestimated due to impediments in detection and diagnosis. Consequently, delayed management may affect the quality of life and the growth and development of a child. Due to their patient demographic, orthodontists are optimally positioned to identify those at risk of sleep-disordered breathing and make referrals for investigation and management. This study aims to determine the prevalence of children at risk of sleep-disordered breathing in an Australian orthodontic population. METHODS A 1-year retrospective study was conducted in an urban Western Australian private orthodontic practice with two branches in similar socioeconomic demographics. The responses of new patients to a modified paediatric sleep questionnaire and standard medical history form were recorded. RESULTS In 1209 patients (4-18 years), 7.3% were at risk of sleep-disordered breathing. An association between sex and the potential risk of sleep-disordered breathing was found with 11% of males at risk of sleep-disordered breathing compared to 7% of females (P = 0.012). CONCLUSIONS The relatively high prevalence of children at risk of sleep-disordered breathing presenting for orthodontic care presents an opportunity to identify at-risk individuals through routine use of the paediatric sleep questionnaire. This would facilitate early referral for diagnosis and management of sleep-disordered breathing.
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Affiliation(s)
- A Wellham
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - C Kim
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - S S Kwok
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rjh Lee
- School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia
| | - S Naoum
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - J M Razza
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - M S Goonewardene
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
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11
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Hammond L, Joly V, Kapasi A, Kryska K, Andrew G, Oberlander TF, Pei J, Rasmussen C. Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104366. [PMID: 36279676 DOI: 10.1016/j.ridd.2022.104366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions. AIMS In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population. METHODS AND PROCEDURES Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity. OUTCOMES AND RESULTS Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior. CONCLUSIONS AND IMPLICATIONS Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.
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Affiliation(s)
- Leah Hammond
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Aamena Kapasi
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Kryska
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Tim F Oberlander
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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Mignolli E, Scialpi A, Valente D, Berardi A, Galeoto G, Tofani M. Sleep Disturbance Scale for Children: Italian Validation in Autism Spectrum Disorder Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10163. [PMID: 36011798 PMCID: PMC9407824 DOI: 10.3390/ijerph191610163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Sleep disorders in children with autism spectrum disorders (ASDs) are well-described. However, there is a lack of specific assessment tools to investigate sleep disturbance in this target population. The present investigation reports the Italian validation of the Sleep Disturbance Scale for Children (SDSC) in the ASD population, also investigating the correlation between sleep disorders In both children and parents. Internal consistency and test−retest reliability were investigated using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Concurrent validity was analyzed by comparing the score of the SDSC with the Pittsburgh Sleep Quality Index (PSQI), while the correlation between the SDCS score and the General Sleep Disturbance Scale (GSDS) was used to analyze the correlation between sleep disorders in children and sleep disorders in their parents. In total, 99 children with a diagnosis of ASD participated in the study. Cronbach’s alpha revealed satisfactory value (0.853), as well as reliability (ICC 0.972) and concurrent validity (0.745). Our results also revealed a significant linear correlation between children’s and parents’ sleep disorders (p < 0.05). In conclusion, we found the SDSC to be a useful tool for measuring sleep disorders in ASD children. Our findings offer concrete inputs to achieve adequate pathways for taking care of children with ASDs and their parents.
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Affiliation(s)
- Ester Mignolli
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessia Scialpi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed—Istituto Neurologico Mediterraneo, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 86077 Pozzilli, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed—Istituto Neurologico Mediterraneo, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 86077 Pozzilli, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 00165 Rome, Italy
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13
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Adavadkar PA, Pappalardo AA, Glassgow AE, Zhang C, Schwartz A, Brooks LJ, Martin MA. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med 2022; 18:2001-2007. [PMID: 35621126 PMCID: PMC9340607 DOI: 10.5664/jcsm.10064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. METHODS Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least one CMC from a large metropolitan area. The study population (N=16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. RESULTS Fourteen percent of the population (mean age of 9.1 years [SD= 5.2]; 35.8% African American (AA); 56.4% male; 77 with more than one CMC) received a sleep disorder diagnosis. The most frequent diagnosis was SDB (11.2%), followed by nocturnal enuresis (1.2%), and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with one CMC (19.7% vs. 5.8%; p <0.001). Insomnia rates in Hispanic/Latinx (1.2%) and AA (0.8%) children and adolescents were significantly lower (both p<0.001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. CONCLUSIONS Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests under-diagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Under-recognition of sleep disorders have short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs.
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Affiliation(s)
- Pranshu A Adavadkar
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
| | - Christina Zhang
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.,Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois
| | - Lee J Brooks
- Department of Pediatrics, Rowan SOM, Stratford, NJ
| | - Molly A Martin
- Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois
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14
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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050748. [PMID: 35626925 PMCID: PMC9139390 DOI: 10.3390/children9050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
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15
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Gupta G, Dang LT, O'Brien LM, Shellhaas RA. Parent-Reported Sleep Profile of Children With Early-Life Epilepsies. Pediatr Neurol 2022; 128:9-15. [PMID: 34992036 PMCID: PMC8857052 DOI: 10.1016/j.pediatrneurol.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep comorbidities are common, and sometimes severe, for children with early-life epilepsies (ELEs). Yet, there is a paucity of data regarding the profile of these sleep disturbances and their complications. METHODS Participants registered with the Rare Epilepsy Network (REN) were queried about sleep via online questionnaires. Descriptive statistics and logistic regression were performed. RESULTS Median age of the 356 children was 56 months (interquartile range 30 to 99), 56% were female, and 53% (188/356) endorsed a sleep concern. Frequent nighttime awakenings (157 of 350; 45%), difficulty falling asleep (133 of 350; 38%), and very restless sleep (118 of 345; 34%) were most endorsed. Nocturnal seizures were associated with sleep concerns and were reported in 75% (268 of 356) of children. Of the children with nocturnal seizures, 56% (118 of 268) had sleep concerns. Of the children without nocturnal seizures, 43% (38 of 88) had sleep concerns. Sleep concerns were most common in dup15q syndrome (16 of 19; 84%). Children aged 4 to ≤10 years (adjusted odds ratio [aOR] 16.1; 95% confidence interval [CI] 2.0, 131.0) and 10 to <13 years (aOR 22.2; 95% CI 2.6, 188.6) had a greater odds of having a sleep concern compared with children aged ≤6 months. Female sex appeared protective for sleep concerns (aOR 0.6; 95% CI 0.4, 0.9). The association between sleep concerns and nocturnal seizures was weaker when adjusted for sex and age category in a logistic regression model. CONCLUSIONS Reported sleep concerns are highly prevalent in children with ELEs and persist with age, in contrast to what is expected in healthy children. There may be unmet sleep-related clinical needs in children with ELEs.
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Affiliation(s)
- Gita Gupta
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Louis T Dang
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Louise M O'Brien
- Departments of Neurology, Obstetrics and Gynecology and Oral and Maxillofacial Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Renée A Shellhaas
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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16
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Niu X, Yung AKC, Strickertsson TIB, Stoustrup P, Cornelis MA, Cattaneo PM. Translation and cross-cultural adaptation of the sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire into Danish language. Acta Odontol Scand 2022; 80:411-418. [PMID: 35044870 DOI: 10.1080/00016357.2021.2023755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep-disordered breathing (SDB) is common but often underestimated in children. The gold standard for assessing SDB is polysomnography, but it is expensive and time-consuming. The Paediatric Sleep Questionnaire (PSQ/SRDB) is a validated screening tool for SDB, which represents an efficient and alternative tool for screening SDB among children. However, a translated and validated Danish version of the PSQ/SRDB is not available yet. Our aim was to cross-culturally translate the PSQ/SRDB into Danish language for use in clinical and research settings. PATIENTS/METHODS The translation was carried out through forward-backward translation techniques performed by a panel of experts, and the cross-cultural adaptation was achieved by pretesting of the pre-final version. Internal consistency of the Danish PSQ/SRDB version was measured by Cronbach's alpha coefficients, while Cohen's kappa was used to evaluate test-retest reliability. Construct validity was assessed by factor analysis of the principal components. RESULTS The Danish PSQ/SRDB was administered to the caregivers of 348 children. An overall Cronbach's alpha of 0.72 was found, confirming the survey's consistency, with the results for the domains ranging 0.52-0.70. The Danish PSQ/SRDB showed moderate to perfect reliability for all items, except for one question (C14). Factor analysis performed on the Danish PSQ/SRDB showed that the predetermined four factors were similar with the original version of the PSQ/SRDB. CONCLUSIONS The Danish version of the PSQ/SRDB has been successfully translated and cross-culturally adapted, suggesting that it can be used as an appropriate paediatric screening tool for SDB in Denmark.
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Affiliation(s)
- Xiaowen Niu
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Augustine K. C. Yung
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | | | - Peter Stoustrup
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Marie A. Cornelis
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Paolo M. Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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17
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Insomnia. Sleep Med Clin 2022; 17:67-76. [DOI: 10.1016/j.jsmc.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Chiba Y, Phillips OR, Takenoshita S, Ollila HM, Hallmayer JF, Nishino S, Singh MK. Genetic and demographic predisposing factors associated with pediatric sleepwalking in the Philadelphia Neurodevelopmental Cohort. J Neurol Sci 2021; 430:119997. [PMID: 34563919 DOI: 10.1016/j.jns.2021.119997] [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: 06/01/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Sleepwalking is a parasomnia associated with non-rapid eye movement (NREM) sleep and is formally diagnosed using polysomnography (PSG). However, PSG are difficult to perform on children or adolescents due to needed compliance. To understand this condition in youth, few studies have been conducted on a large cohort of youths with a diverse distribution of ages and races to characterize it better in the absence of PSG. The present study aimed to evaluate the prevalence of sleepwalking in youth, as well as associated demographic and genetic characteristics, using questionnaires in a large pediatric cohort. METHODS Data from the Philadelphia Neurodevelopmental Cohort (PNC) of 7515 youths aged between 8 and 22 years were used in analyses. Demographic and clinical data, including age, sex, and race, and genetic data from 2753 African American (AA) and 4762 European American (EA) subjects were investigated. The age-wise prevalence of sleepwalking in AA and EA subjects was evaluated. Finally, race-specific genome-wide association (GWAS) analyses of sleepwalking were also performed (N = 155 AA cases and 2598 AA controls; N = 512 EA cases and 4250 EA controls). RESULTS Lifetime history of sleepwalking correlated with male sex and EA race. A genetic risk locus that reached genome-wide significance was detected at rs73450744 on chromosome 18 in AA, but not EA youth. CONCLUSION The present results suggest that male sex, EA race, and genetic factors may be associated with higher rates of sleepwalking among youth. Future studies should consider these variables to advance understanding of the complex pathogenesis of sleepwalking.
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Affiliation(s)
- Yuhei Chiba
- Sleep and Circadian Neurobiology laboratory, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA; Department of Psychiatry, Sekiaikai Yokohama Maioka Hospital, Yokohama, Kanagawa, Japan; Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan; YUAD, Yokohama, Kanagawa, Japan.
| | - Owen R Phillips
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA; Brain Key Inc., San Francisco, California, USA
| | - Shinichi Takenoshita
- Sleep and Circadian Neurobiology laboratory, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA; Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Hanna M Ollila
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Joachim F Hallmayer
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Seiji Nishino
- Sleep and Circadian Neurobiology laboratory, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Manpreet K Singh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA.
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19
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Ong ZL, Chaturvedi N, Tillin T, Dale C, Garfield V. Association between sleep quality and type 2 diabetes at 20-year follow-up in the Southall and Brent REvisited (SABRE) cohort: a triethnic analysis. J Epidemiol Community Health 2021; 75:1117-1122. [PMID: 34117111 PMCID: PMC8515117 DOI: 10.1136/jech-2020-215796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/17/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022]
Abstract
Background The risk of developing type 2 diabetes associated with poor sleep quality is comparable to other lifestyle factors (eg, overweight, physical inactivity). In the UK, these risk factors could not explain the two to three-fold excess risks in South-Asian and African-Caribbean men compared with Europeans. This study investigates (1) the association between mid-life sleep quality and later-life type 2 diabetes risk and (2) the potential modifying effect of ethnicity. Methods The Southall and Brent REvisited cohort is composed of Europeans, South-Asians and African-Caribbeans (median follow-up 19 years). Complete-case analysis was performed on 2189 participants without diabetes at baseline (age=51.7±7 SD). Competing risks regressions were used to estimate the HRs of developing diabetes associated with self-reported baseline sleep (difficulty falling asleep, early morning waking, waking up tired, snoring and a composite sleep score), adjusting for confounders. Modifying effects of ethnicity were analysed by conducting interaction tests and ethnicity-stratified analyses. Results There were 484 occurrences of incident type 2 diabetes (22%). Overall, there were no associations between sleep exposures and diabetes risk. Interaction tests suggested a possible modifying effect for South-Asians compared with Europeans for snoring only (p=0.056). The ethnicity-stratified analysis found an association with snoring among South-Asians (HR 1.41, 95% CI 1.08 to 1.85), comparing those who snored often/always versus occasionally/never. There were no elevated risks for the other sleep exposures. Conclusion The association between snoring and type 2 diabetes appeared to be modified by ethnicity, and was strongest in South-Asians.
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Affiliation(s)
- Zhen Ling Ong
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Caroline Dale
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK.,Institute of Health Informatics, University College London, London, UK
| | - Victoria Garfield
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
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20
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Kang EK, Kim SS. Behavioral insomnia in infants and young children. Clin Exp Pediatr 2021; 64:111-116. [PMID: 32683806 PMCID: PMC7940085 DOI: 10.3345/cep.2020.00052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022] Open
Abstract
In infants and young children, bedtime problems and night waking are common and the main presentations of insomnia. Poor sleep may critically impact the daytime functioning and mood of the child and their caregivers. A comprehensive sleep history, a sleep diary/log, and the BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) sleep screen are useful for diagnosing sleep problems in young children. Behavioral therapies for this type of insomnia include extinction, bedtime fading with positive routines, and scheduled awakening. Previous studies of behavioral interventions for young children showed significant improvements in sleep-onset latency, night waking frequency, and night waking duration. Parent education about their child's sleep, bedtime routines, and sleep hygiene is essential for treatment.
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Affiliation(s)
- Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seung Soo Kim
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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21
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Giannakopoulos G, Kolaitis G. Sleep problems in children and adolescents following traumatic life events. World J Psychiatry 2021; 11:27-34. [PMID: 33643859 PMCID: PMC7896245 DOI: 10.5498/wjp.v11.i2.27] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.
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Affiliation(s)
- George Giannakopoulos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
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22
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Abstract
This article reviews the literature on mood disorders and sleep disorders among children and adolescents. Research suggests that sleep plays an important role in the development, progression, and maintenance of mood disorder symptoms among children and adolescents. Sleep problems as early as maternal perinatal insomnia may predict and predate depression among youth. Children and adolescents who develop comorbid mood disorders and sleep problems represent a particularly high-risk group with more severe mood episode symptoms, higher rates of self-harm and suicidality, and less responsivity to treatment. Treatment research supports the idea that sleep problems can be improved through behavioral interventions.
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Affiliation(s)
- Lauren D Asarnow
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, RM LP-A307, San Francisco, CA 94143, USA.
| | - Riya Mirchandaney
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, RM LP-A307, San Francisco, CA 94143, USA
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23
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Sleep Disordered Breathing: An Epidemiological Study among Albanian Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228586. [PMID: 33227965 PMCID: PMC7699164 DOI: 10.3390/ijerph17228586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
Sleep Disordered Breathing (SDB) comprises a group of diseases characterized by alterations in the frequency and/or depth of breathing during sleep. The aim of this study was to investigate the frequency of SDB in a group of Albanian children and adolescents and to describe its social, physiological, psychological, sleep-related, and anthropometric risk factors, in relation to the sociodemographic situation. A total of 6087 participants (mean age: 10.42 years, range: 6 to 15 years, 52.3% females and 47.7% males) attending public schools all over Albania took part in the cross-sectional study. On a sample of 6087 questionnaires distributed, 4702 (77.25% of the original sample) were returned and included in the study. High risk status for SDB was assessed using the Paediatric Sleep Questionnaire (PSQ). The prevalence of SDB was 7.9%. No statistically significant difference was found for gender at high risk for SBD. Compared to participants living in urban aeras (7.3%), participants living in rural areas (10.4%) reported significantly higher SDB prevalence rates. No other significant correlations were detected between the high-risk subjects and the age. The prevalence of the subjects at high risk of SBD obese participants (20.8%) was statistically higher than among nonobese ones (6.3%). SDB is highly prevalent in Albanian growing population and further prevalence studies are recommended.
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24
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Abtahi S, Witmans M, Alsufyani NA, Major MP, Major PW. Pediatric sleep-disordered breathing in the orthodontic population: Prevalence of positive risk and associations. Am J Orthod Dentofacial Orthop 2020; 157:466-473.e1. [PMID: 32241353 DOI: 10.1016/j.ajodo.2019.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pediatric sleep-disordered breathing (SDB) describes a spectrum of disease ranging from snoring to upper airway resistance syndrome and obstructive sleep apnea (OSA). Anatomical features assessed during orthodontic exams are often associated with symptoms of SDB in children. Hence, we need to determine the prevalence of positive risk for SDB in the pediatric orthodontic population compared with a general pediatric population and understand comorbidities associated with SDB risk among orthodontic patients. METHODS Responses from Pediatric Sleep Questionnaires were collected from 390 patients between the ages of 5 and 16 years, seeking orthodontic treatment. Prevalence of overall SDB risk, habitual snoring, and sleepiness were determined in the orthodontic population and compared with those previously reported by identical methods in the general pediatric population. Additional health history information was used to assess comorbidities associated with SDB risk in 130 of the patients. RESULTS At 10.8%, the prevalence of positive SDB risk was found to be significantly higher in the general pediatric orthodontic population than in a healthy pediatric population (5%). The prevalence of snoring and sleepiness in the orthodontic population was 13.3% and 17.9%, respectively. Among the comorbidities, nocturnal enuresis (13.6%), overweight (18.2%), and attention deficit hyperactivity disorder (31.8%) had a higher prevalence in orthodontic patients with higher SDB risk (P < 0.05). CONCLUSIONS There is a higher pediatric SDB risk prevalence in the orthodontic population compared with a healthy pediatric population. Orthodontic practitioners should make SDB screening a routine part of their clinical practice.
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Affiliation(s)
- Sahar Abtahi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manisha Witmans
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Noura A Alsufyani
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Michael P Major
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Major
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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25
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Garmroudinezhad Rostami E, Touchette É, Huynh N, Montplaisir J, Tremblay RE, Battaglia M, Boivin M. High separation anxiety trajectory in early childhood is a risk factor for sleep bruxism at age 7. Sleep 2020; 43:zsz317. [PMID: 31894243 PMCID: PMC7355392 DOI: 10.1093/sleep/zsz317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/18/2019] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES The evolution of sleep bruxism manifestations and their co-occurrence with separation anxiety in early childhood remain unclear. Our threefold aim was to: (1) describe developmental sleep bruxism trajectories in early childhood, (2) investigate co-occurrences between trajectories of sleep bruxism and separation anxiety, and (3) determine whether distinct trajectories of separation anxiety increase the risk of presenting sleep bruxism during the first year of elementary school. METHODS This study is part of the Québec Longitudinal Study of Child Development. Sleep bruxism scores were assessed from age 1.5 to 7 years with the Self-Administered Questionnaire for Mother (n = 1946). Separation anxiety scores were measured from age 1.5 to 6 years with the Interviewer-Completed Computerized Questionnaire (n = 2045). RESULTS We identified four sleep bruxism trajectories from age 1.5 to 6 years: High-Increasing sleep bruxism at age 1.5 (14.1%), High-Increasing sleep bruxism at age 4 (18.3%), Low-Persistent sleep bruxism (12.1%), and Never-Persistent sleep bruxism (55.5%); and four separation anxiety trajectories from age 1.5 to 6 years: Low-Persistent separation anxiety (60.2%), High-Increasing separation anxiety (6.9%), High-Decreasing separation anxiety (10.8%), and Low-Increasing separation anxiety (22.1%). Sleep bruxism and separation anxiety trajectories were weakly associated (X2 = 37.84, p < 0.001). Compared with preschoolers belonging to the Low-Persistent separation anxiety trajectory, preschoolers in the High-Increasing separation anxiety trajectory had almost double the risk of presenting sleep bruxism at age 7 (95% CI = 1.25-3.22, p = 0.04). CONCLUSION When separation anxiety issues are detected in early childhood, it would be useful to target sleep bruxism during the first year of elementary school.
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Affiliation(s)
- Elham Garmroudinezhad Rostami
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Évelyne Touchette
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Nelly Huynh
- Faculty of Dental Medicine, University of Montréal, Montréal, Québec, Canada
- Research Centre, CHU Ste-Justine, Montreal, Québec, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Departments of Pediatrics and Psychology, University of Montréal, Montréal, Québec, Canada
| | - Richard E Tremblay
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- Research Centre, CHU Ste-Justine, Montreal, Québec, Canada
- Departments of Pediatrics and Psychology, University of Montréal, Montréal, Québec, Canada
- Geary Institute for Public Policy, UCD School of Economics and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Child, Youth, & Emerging Adulthood Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michel Boivin
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
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Narasimhan U, Anitha FS, Anbu C, Abdul Hameed MF. The Spectrum of Sleep Disorders Among Children: A Cross-sectional Study at a South Indian Tertiary Care Hospital. Cureus 2020; 12:e7535. [PMID: 32377483 PMCID: PMC7198097 DOI: 10.7759/cureus.7535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Sleep problems during infancy and early childhood are fairly common and rarely recognized in pediatric practice. These are mostly related to the initiation and maintenance of night-time sleep. Understanding sleep patterns and disorders associated with sleep is challenging, especially in the pediatric age group. This study was done to estimate the magnitude of sleep disorders in children and to evaluate the associated risk factors. Methods This cross-sectional study was carried out among 450 children visiting the pediatric outpatient department of Sri Ramachandra Institute of Higher Education and Research, Chennai, India between November 2018 and June 2019. Children with chronic illnesses and a history of physical or mental trauma in the past six months were excluded. The Sleep Disturbance Scale for Children (SDSC) was used to gather information regarding sleep disorders. Results It was observed that a majority of the participants (72.2%) slept 9-11 hours per day. Among 46.2% of the participants, the time lag between bedtime and sleep time was less than 15 minutes. Overall, sleep problems were present in 34% of the participants. History of sleep problems in infancy, absence of siblings, and parental presence while sleeping emerged as statistically significant risk factors for childhood sleep disorders (p: <0.05). Conclusion We believe our study provides a basis for exploring the pattern and problems associated with sleep behavior among children. There is a need for setting up routine screening measures in pediatric outpatient departments to facilitate early detection of sleep disorders in order to avoid complications.
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Affiliation(s)
- Udayakumar Narasimhan
- Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Fatima Shirly Anitha
- Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Chamelee Anbu
- Psychiatry, Saveetha Medical College and Hospital, Chennai, IND
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Siriwat R, Gurbani N, Xu Y, Hossain MM, Simakajornboon N. Sleep manifestations, sleep architecture in children with Eosinophilic esophagitis presenting to a sleep clinic. Sleep Med 2020; 68:160-166. [DOI: 10.1016/j.sleep.2019.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/07/2023]
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Schwerdtle B, Kübler A, Schlarb A. External Validity of the Multicomponent Group Treatment KiSS for School-Aged Children With Insomnia. Behav Sleep Med 2020; 18:147-162. [PMID: 30482055 DOI: 10.1080/15402002.2018.1546706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Insomnia is common in school-aged children and often associated with other mental disorders. Here, we investigated the effectiveness and acceptance of the KiSS program in an "all-comer" pediatric insomnia clinic. Participants/Methods: Forty-five families (children: 5-10 years, 57.8% female) were randomly assigned to the multicomponent six-session KiSS treatment (CBT-I, hypnotherapy, and imaginations) or a wait-list control group. A sleep diary was recorded before intervention or waiting time, immediately after, as well as 3, 6, and 12 months postintervention (primary outcome: sleep efficiency, SE; sleep-onset latency, SOL). Results: Sleep improved significantly after the KiSS intervention. Three to 12 months after the intervention, only 1.75% of treated children still met the diagnostic criteria for insomnia. SE improved to 96%, and both SOL (reduced to 23 min) and total sleep time were normalized. All improvements were stable for at least one year after the intervention. KiSS was well accepted (0% dropout during intervention) and well tolerated. Conclusions: Treatment with the multimodal sleep training KiSS leads to positive changes in the sleep of children with insomnia, including a subset of children that presented with comorbid mental disorders. With only three sessions for parents and three sessions for children, the treatment can be readily implemented as a stand-alone treatment or be combined with other interventions. Dismantling studies and studies with an active control group are ongoing.
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Affiliation(s)
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Slim M, Westmacott R, Toutounji S, Singh J, Narang I, Weiss S, Krishnan P, Grbac E, Surmava AM, Andres K, MacGregor D, deVeber G, Moharir M, Dlamini N. Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke. Eur J Paediatr Neurol 2020; 25:82-89. [PMID: 31787553 DOI: 10.1016/j.ejpn.2019.11.006] [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: 01/07/2019] [Revised: 06/04/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the prevalence of obstructive sleep apnea syndrome (OSAS) in children with arterial ischemic stroke (AIS) and to evaluate its association with neuropsychological outcomes. METHODS We conducted a cross-sectional study of sleep health and neuropsychological outcome in children with AIS. A consecutive cohort of children attending a stroke clinic were assessed using a standardized pediatric sleep questionnaire (PSQ) and standardized measures of pediatric stroke outcome and intellectual, executive and adaptive function. High risk for OSAS was defined as PSQ score ≥0.33. RESULTS Overall, 102 children were included (55% males, median age: 9 years [interquartile-range [IQR]: 6-14]). The prevalence of OSAS in children with AIS was significantly higher compared to published normative prevalence rate (25.5% vs 5%, p < 0.001). Children with OSAS were more likely to have infarcts affecting both the anterior and posterior circulation (37.5% vs 9.5%, p = 0.021). In addition, children with OSAS had significantly higher median Pediatric Stroke Outcome Measure (PSOM) scores (2 [IQR: 0-2] vs 1 [IQR: 1-3.5], p = 0.01) and were more likely to be prescribed concomitant medications affecting sleep architecture (50% vs 22.4%, p = 0.007). OSAS was associated with significantly lower scores on intellectual, memory, cognitive, behavioral, attention, executive and adaptive function scales. The association between PSQ and intellectual ability and working memory remained statistically significant upon controlling for potential confounding factors including stroke related characteristics (neurologic impairment and arterial territory). CONCLUSIONS The prevalence of OSAS in children with AIS compared to healthy controls is significantly elevated and is associated with poor neuropsychological outcomes. We highlight the importance of regular screening for OSAS - a modifiable risk factor - in children with AIS. The specific risk factors for OSAS and the potential benefits of therapeutic interventions in this patient population warrant further investigation.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Sandra Toutounji
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Jaspal Singh
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Pradeep Krishnan
- Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Elena Grbac
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ann-Marie Surmava
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Kathleen Andres
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Daune MacGregor
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Gabrielle deVeber
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
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Shah YD, Stringel V, Pavkovic I, Kothare SV. Doxepin in children and adolescents with symptoms of insomnia: a single-center experience. J Clin Sleep Med 2020; 16:743-747. [PMID: 32029069 DOI: 10.5664/jcsm.8338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Pediatric insomnia is a widespread problem and especially difficult to manage in children with neurodevelopmental disorders. There are currently no US Food and Drug Administration-approved medications to use once first-line therapy fails. The objective of this study was to evaluate the efficacy and tolerability of doxepin in pediatric patients. METHODS This is a retrospective single-center chart review of children and adolescents (2-17 years of age) whose sleep failed to improve with behavioral intervention and melatonin who were then trialed on doxepin. Treatment was initiated at a median starting dose of 2 mg and slowly escalated to a median maintenance dose of 10 mg. Improvement in sleep was recorded using a 4-point Likert scale reported by parents on follow-up visits. RESULTS A total of 29 patients were included in the analysis. Mean follow-up duration was 6.5 ± 3.5 months. Of 29 patients, 4 (13.8%) patients discontinued doxepin because of lack of efficacy or side effects. Eight (27.6%) patients showed significant improvement of their insomnia, 8 (27.6%) showed moderate improvement, 10 (34.5%) showed mild improvement, and 3 (10.3%) showed minimal to no improvement on treatment with doxepin (P < .05) Only 2 patients (6.9%) experienced adverse effects in the form of behavioral side effects (aggression) and enuresis. CONCLUSIONS Results of our studies suggest that low-dose doxepin is both effective and well tolerated in pediatric patients with insomnia.
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Affiliation(s)
- Yash D Shah
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Virginia Stringel
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Ivan Pavkovic
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Sanjeev V Kothare
- Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
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Williams CN, Hartman ME, McEvoy CT, Hall TA, Lim MM, Shea SA, Luther M, Guilliams KP, Guerriero RM, Bosworth CC, Piantino JA. Sleep-Wake Disturbances After Acquired Brain Injury in Children Surviving Critical Care. Pediatr Neurol 2020; 103:43-51. [PMID: 31735567 PMCID: PMC7042044 DOI: 10.1016/j.pediatrneurol.2019.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. METHODS We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes. RESULTS Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001). CONCLUSIONS Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
| | - Mary E Hartman
- Division of Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Cindy T McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Miranda M Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Department of Neurology, Oregon Health and Science University, Portland, Oregon; Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon; Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon
| | - Madison Luther
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon
| | - Kristin P Guilliams
- Division of Critical Care Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri; Division of Pediatric and Developmental Neurology, Department of Neurology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Rejean M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher C Bosworth
- Department of Psychology, St Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, Oregon; Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Wei Q, Lee JH, Park HJ. Novel design of smart sleep-lighting system for improving the sleep environment of children. Technol Health Care 2020; 27:3-13. [PMID: 31045522 PMCID: PMC6597977 DOI: 10.3233/thc-199002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children struggle to fall asleep by themselves because of their physiological characteristics. Therefore, research has been carried on various devices (such as a smartphone) to assist in improving the sleep quality of children. However, all such devices need to be controlled by parents and do not have functions for monitoring the sleep environment. OBJECTIVE In this paper, a smart sleep-lighting system that includes a sleep-lighting device and a smartphone dongle is developed to improve the sleep environment of children. METHODS The temperature, humidity, and luminance of the sleep environment are monitored and analyzed by the sleep-lighting device to control multi-color light and audio components. The colored light emitted by the multi-color light can be adjusted to improve the sleep atmosphere. Also, the audio component can play white noise to induce sleep. In addition, parents can use a smartphone dongle with a multi-channel wireless communication method to monitor and control one or more lighting devices in different locations in real time. RESULTS For environmental monitoring, average difference between proposed device and commercial sensor from chamber setting temperature 15∘C to 35∘C was 0.588∘C ± 0.10∘C, and average error value of the humidity measurement was 0.74% at 40% ∼ 60% RH. Also, the manufactured sleep-lighting device shows good performance in multi-color light emission, and playing of white noise. As result, the smartphone connected to the proposed smartphone dongle enables monitoring and control of the proposed lighting device in a wireless well. CONCLUSIONS The manufactured sleep-lighting device has a high-precision temperature and humidity sensor and a luminance sensor that can accurately monitor the sleeping environment. The lighting device can play white noise to induce sleep in children. Also, a multi-color LED light is operated via a smartphone application to improve the sleep atmosphere. The measured data will be sent to the lighting device and processed together with sleep environment data in order to improve the sleep quality. Additionally, the final system will be tested for real end-users with clinical experiments by sleep research center of a university hospital.
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Affiliation(s)
- Qun Wei
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Korea
| | - Jyung Hyun Lee
- Department of Biomedical Engineering, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Joon Park
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Korea
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Khalyfa A, Gozal D, Kheirandish-Gozal L. Plasma Extracellular Vesicles in Children with OSA Disrupt Blood-Brain Barrier Integrity and Endothelial Cell Wound Healing in Vitro. Int J Mol Sci 2019; 20:ijms20246233. [PMID: 31835632 PMCID: PMC6941040 DOI: 10.3390/ijms20246233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/08/2019] [Accepted: 12/08/2019] [Indexed: 12/19/2022] Open
Abstract
Pediatric obstructive sleep apnea (P-OSA) is associated with neurocognitive deficits and endothelial dysfunction, suggesting the possibility that disruption of the blood-brain barrier (BBB) may underlie these morbidities. Extracellular vesicles (EVs), which include exosomes, are small particles involved in cell-cell communications via different mechanisms and could play a role in OSA-associated end-organ injury. To examine the roles of EVs in BBB dysfunction, we recruited three groups of children: (a) absence of OSA or cognitive deficits (CL, n = 6), (b) OSA but no evidence of cognitive deficits (OSA-NC(-), n = 12), and (c) OSA with evidence of neurocognitive deficits (OSA-NC(+), n = 12). All children were age-, gender-, ethnicity-, and BMI-z-score-matched, and those with OSA were also apnea-hypopnea index (AHI)-matched. Plasma EVs were characterized, quantified, and applied on multiple endothelial cell types (HCAEC, HIAEC, human HMVEC-D, HMVEC-C, HMVEC-L, and hCMEC/D3) while measuring monolayer barrier integrity and wound-healing responses. EVs from OSA children induced significant declines in hCMEC/D3 transendothelial impedance compared to CL (p < 0.001), and such changes were greater in NC(+) compared to NC(-) (p < 0.01). The effects of EVs from each group on wound healing for HCAEC, HIAEC, HMVED-d, and hCMEC/D3 cells were similar, but exhibited significant differences across the three groups, with evidence of disrupted wound healing in P-OSA. However, wound healing in HMVEC-C was only affected by NC(+) (p < 0.01 vs. NC(-) or controls (CO). Furthermore, no significant differences emerged in HMVEC-L cell wound healing across all three groups. We conclude that circulating plasma EVs in P-OSA disrupt the integrity of the BBB and exert adverse effects on endothelial wound healing, particularly among OSA-NC(+) children, while also exhibiting endothelial cell type selectivity. Thus, circulating EVs cargo may play important roles in the emergence of end-organ morbidity in pediatric OSA.
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Coto J, Garcia A, Hart KC, Graziano PA. Associations Between Disruptive Behavior Problems, Parenting Factors, and Sleep Problems Among Young Children. J Dev Behav Pediatr 2019; 39:610-620. [PMID: 29923894 PMCID: PMC6826338 DOI: 10.1097/dbp.0000000000000595] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine within an at-risk/clinical sample of preschool-aged children with externalizing problems: (1) which disruptive behavior and attention disorder symptoms (i.e., inattention, hyperactivity/impulsivity, and oppositionality/aggression) and (2) what aspects of parenting (e.g., discipline practices or stress) are related to children's sleep problems (e.g., sleep habit and night waking problems). METHOD The sample consisted of 148 children (meanage = 5.06 years, 82% male) with at-risk/clinically elevated levels of externalizing behavior problems and their primary caregiver. As part of a larger study, parents reported on their stress and parenting practices and their children's behavioral and sleep functioning. Positive and negative parenting behaviors ("do" and "don't" skills, respectively) were also observed during a 15-minute parent-child interaction during play. RESULTS Oppositionality/aggression was the only disruptive behavior and attention disorder symptom associated with more sleep habit problems. Higher levels of inconsistent discipline and "don't" skills were also associated with more sleep habit problems. Within a combined model, an interaction emerged such that the association between "don't" skills and elevated sleep habit problems was only evident at low levels of inconsistent discipline. In terms of night waking problems, there was only an association with parenting stress, whereas the other parenting factors and disruptive behavior and attention disorder symptoms were unrelated. CONCLUSION Although the directionality of our associations cannot be ascertained because of the cross-sectional nature of our study, these findings, nevertheless, highlight the importance of parenting factors (e.g., inconsistent discipline and parenting stress) when considering sleep difficulties in young children with disruptive behavior and attention disorders.
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Affiliation(s)
- Jennifer Coto
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
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Peng X, Yuan G, Ma N. Cosleeping and sleep problems in children: a systematic review and meta-analysis. Sleep Biol Rhythms 2019; 17:367-378. [DOI: 10.1007/s41105-019-00226-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/10/2019] [Indexed: 01/10/2023]
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Fernandez-Mendoza J, Li Y, Fang J, Calhoun SL, Vgontzas AN, Liao D, Bixler EO. Childhood high-frequency EEG activity during sleep is associated with incident insomnia symptoms in adolescence. J Child Psychol Psychiatry 2019; 60:742-751. [PMID: 29989664 PMCID: PMC6328336 DOI: 10.1111/jcpp.12945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Insomnia has been associated in cross-sectional studies with increased beta (15-35 Hz) electroencephalogram (EEG) power during nonrapid eye movement (NREM) sleep, an index of cortical hyperarousal. However, it is unknown whether this cortical hyperarousal is present before individuals with insomnia develop the disorder. To fill this gap, we examined the association of childhood sleep high-frequency EEG activity with incident insomnia symptoms (i.e., absence of insomnia symptoms in childhood but presence in adolescence). METHODS We studied a case-control subsample of 45 children (6-11 years) from the Penn State Child Cohort, a population-based random sample of 421 children, who were followed up after 8 years as adolescents (13-20 years). We examined low-beta (15-25 Hz) and high-beta (25-35 Hz) relative power at central EEG derivations during NREM sleep and, in secondary analyses, during sleep onset latency, sleep onset, and REM sleep. Incident insomnia symptoms were defined as the absence of parent-reported difficulty falling and/or staying asleep during childhood and a self-report of these insomnia symptoms during adolescence. RESULTS Childhood high-beta power during NREM sleep was significantly increased in children who developed insomnia symptoms in adolescence (n = 25) as compared to normal sleeping controls (n = 20; p = .03). Multivariable-adjusted logistic regression models showed that increased childhood high-beta EEG power during NREM sleep was associated with a threefold increased odds (95% CI = 1.12-7.98) of incident insomnia symptoms in adolescence. No other significant relationships were observed for other sleep/wake states or EEG frequency bands. CONCLUSIONS Increased childhood high-frequency EEG power during NREM sleep is associated with incident insomnia symptoms in adolescence. This study indicates that cortical hyperarousal during sleep may be a premorbid neurophysiological sign of insomnia, which may mediate the increased risk of psychiatric disorders associated with insomnia.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yun Li
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
- Mental Health Center, Shantou University Medical College, Shantou, China
| | - Jidong Fang
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Susan L. Calhoun
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexandros N. Vgontzas
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Edward O. Bixler
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Clinical presentation, diagnosis and polysomnographic findings in children with migraine referred to sleep clinics. Sleep Med 2019; 63:57-63. [PMID: 31606650 DOI: 10.1016/j.sleep.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE An association between migraine and sleep disturbances in children was reported, yet limited clinical data exist. The current study addresses the clinical presentation, polysomnographic (PSG) characteristics, and comorbid sleep diagnoses of children with migraine referred to the sleep clinic. PATIENTS A retrospective review was performed of headache center patients evaluated by the sleep center between 2007 and 2017. Children ≤18 years old, diagnosed with migraine headache, and who had PSG within one year of evaluation in the headache clinic, were included. PSG findings, as well as demographics, were compared to a group of controls aged 5-14 years-old. RESULTS In sum, 185 children with a diagnosis of migraine were included: 39% males, 75% Caucasian, mean age 13.5 ± 3.4, and 57% obese. Additionally, 180 children were included in the control group. The common presenting sleep symptoms were snoring (66%), sleep onset and sleep maintenance problems (25%), and excessive daytime sleepiness (20%). For the sleep diagnosis, 40% had obstructive sleep apnea (OSA), 27% had insomnia, 15% had periodic limb movement disorder (PLMD), and 6% had a central disorder of hypersomnolence. In terms of sleep architecture, children with migraine had significantly higher NREM 2 (p < 0.001) and a lower percentage of NREM3 (p < 0.001) compared to controls after adjustment for demographics and the presence of sleep-disordered breathing. CONCLUSIONS Children referred to the sleep clinic who also had migraine, experience various types of sleep complaints. OSA, insomnia, and PLMD were relatively common in this population. Changes in sleep architecture, specifically increased NREM2 and decreased slow wave sleep compared to the control group, were also observed.
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Bose S, Ross KR, Rosa MJ, Chiu YHM, Just A, Kloog I, Wilson A, Thompson J, Svensson K, Rojo MMT, Schnaas L, Osorio-Valencia E, Oken E, Wright RO, Wright RJ. Prenatal particulate air pollution exposure and sleep disruption in preschoolers: Windows of susceptibility. ENVIRONMENT INTERNATIONAL 2019; 124:329-335. [PMID: 30660846 PMCID: PMC6615028 DOI: 10.1016/j.envint.2019.01.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND The programming of sleep architecture begins in pregnancy and depends upon optimal in utero formation and maturation of the neural connectivity of the brain. Particulate air pollution exposure can disrupt fetal brain development but associations between fine particulate matter (PM2.5) exposure during pregnancy and child sleep outcomes have not been previously explored. METHODS Analyses included 397 mother-child pairs enrolled in a pregnancy cohort in Mexico City. Daily ambient prenatal PM2.5 exposure was estimated using a validated satellite-based spatio-temporally resolved prediction model. Child sleep periods were estimated objectively using wrist-worn, continuous actigraphy over a 1-week period at age 4-5 years. Data-driven advanced statistical methods (distributed lag models (DLMs)) were employed to identify sensitive windows whereby PM2.5 exposure during gestation was significantly associated with changes in sleep duration or efficiency. Models were adjusted for maternal education, season, child's age, sex, and BMI z-score. RESULTS Mother's average age was 27.7 years, with 59% having at least a high school education. Children slept an average of 7.7 h at night, with mean 80.1% efficiency. The adjusted DLM identified windows of PM2.5 exposure between 31 and 35 weeks gestation that were significantly associated with decreased sleep duration in children. In addition, increased PM2.5 during weeks 1-8 was associated with decreased sleep efficiency. In other exposure windows (weeks 39-40), PM2.5 was associated with increased sleep duration. CONCLUSION Prenatal PM2.5 exposure is associated with altered sleep in preschool-aged children in Mexico City. Pollutant exposure during sensitive windows of pregnancy may have critical influence upon sleep programming.
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Affiliation(s)
- Sonali Bose
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, United States of America; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Kristie R Ross
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States of America
| | - Maria J Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Yueh-Hsiu Mathilda Chiu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, BeerSheba, Israel
| | - Ander Wilson
- Department of Statistics, Colorado State University, United States of America
| | - Jennifer Thompson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Katherine Svensson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | | | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Erika Osorio-Valencia
- Department of Developmental Neurobiology, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Robert O Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America; Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Rosalind J Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America; Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, United States of America.
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Tsukada E, Kitamura S, Enomoto M, Moriwaki A, Kamio Y, Asada T, Arai T, Mishima K. Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness. PLoS One 2018; 13:e0204409. [PMID: 30281638 PMCID: PMC6169921 DOI: 10.1371/journal.pone.0204409] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 09/09/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives To investigate childhood obstructive sleep apnea syndrome (OSAS) and its role in daytime sleepiness among school-age children. Methods A questionnaire survey was conducted with 25,211 children aged 6–15 (mean, 10.39) years attending 148 elementary and 71 middle schools in 10 prefectures across Japan and their parents. Questions concerned 4 sleep habit items (bedtime, sleep onset latency, wake time after sleep onset, wake-up time) and 4 sleep disorder items (loud snoring, snorts/gasps, breathing pauses, seems very sleepy in the daytime). Total sleep time (TST) was calculated with sleep habits. Severe possible OSAS (p-OSAS) was defined as having loud snoring, snorts and gasps, or breathing pauses “frequently” (≥ 5 times per week), and mild p-OSAS was rated as having any of these “sometimes” (2–4 times per week). Severe daytime sleepiness was defined as seeming very sleepy “frequently” and mild daytime sleepiness as seeming very sleepy “sometimes”. Results Mean prevalence of mild to severe p-OSAS and severe p-OSAS in children across all grade levels was 9.5% and 1.6%, respectively. p-OSAS was particularly prevalent in children at lower elementary levels, decreasing with advancing grade levels. Prevalence of mild and severe daytime sleepiness was 6.1% and 0.9%, respectively, among all children (7.0%). Prevalence of daytime sleepiness increased with advancing grade levels, particularly in middle-school level. Average TST was 8.4 ± 2.2 h in both elementary and middle-school levels, and decreased as grades advanced, particularly in middle-school levels. Multivariate logistic regression analysis showed that middle-school level, TST < 8 h, and p-OSAS were independent factors for daytime sleepiness. Strong correlations were found between severe daytime sleepiness and severe p-OSAS or TST < 6 h, and between daytime sleepiness and loud snoring or breathing pauses. Conclusion p-OSAS may be an independent factor influencing daytime sleepiness in school-age children. Loud snoring and breathing pauses could be clinical markers for children with severe daytime sleepiness.
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Affiliation(s)
- Eriko Tsukada
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan
- Department of Psychiatry, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba-city, Ibaraki, Japan
- Department of Psychiatry, University of Tsukuba Hospital, Tsukuba-city, Ibaraki, Japan
| | - Shingo Kitamura
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan
| | - Minori Enomoto
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan
| | - Aiko Moriwaki
- Support Room for Students with Disabilities, Tokyo Gakugei University, Koganei-city, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan
| | - Takashi Asada
- Department of Neuropsychiatry, University of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba-city, Ibaraki, Japan
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan
| | - Kazuo Mishima
- Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita-city, Akita, Japan
- * E-mail:
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40
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Normative values for sleep parameters in pre-schoolers using actigraphy. Clin Neurophysiol 2018; 129:1964-1970. [DOI: 10.1016/j.clinph.2018.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/18/2018] [Accepted: 06/20/2018] [Indexed: 11/19/2022]
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41
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Schlarb AA, Bihlmaier I, Velten-Schurian K, Poets CF, Hautzinger M. Short- and Long-Term Effects of CBT-I in Groups for School-Age Children Suffering From Chronic Insomnia: The KiSS-Program. Behav Sleep Med 2018; 16:380-397. [PMID: 27645834 DOI: 10.1080/15402002.2016.1228642] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND This intervention study evaluates the short- and long-term effects of cognitive behavior therapy for insomnia (CBT-I) in groups for school-age children and their parents, named the KiSS-program. CBT-I was implemented in three sessions for children and three sessions for parents. PARTICIPANTS AND METHODS All in all, 112 children with chronic childhood insomnia were randomly assigned to a wait-list (WL) control or treatment condition. RESULTS According to subjective measures as well as objective wrist actigraphy, children in the CBT-I condition reported greater improvements in sleep behavior immediately after the treatment compared to the WL group. Improvements in sleep behavior after CBT-I persisted over the 3-, 6-, and 12-month follow-up assessments. CONCLUSIONS The present study is the first randomized controlled trial that provides evidence for the long-term effectiveness of CBT-I in treating school-age children with chronic insomnia.
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Affiliation(s)
- Angelika A Schlarb
- a Department of Psychology and Sports , Bielefeld University , Bielefeld , Germany.,b Department of Psychology , University of Tuebingen , Tuebingen , Germany
| | - Isabel Bihlmaier
- b Department of Psychology , University of Tuebingen , Tuebingen , Germany
| | - Kerstin Velten-Schurian
- b Department of Psychology , University of Tuebingen , Tuebingen , Germany.,c Department of Psychiatry , University of Tuebingen , Tuebingen , Germany
| | - Christian F Poets
- d Childrens Clinic, Department for Neonatology , University of Tuebingen , Tuebingen , Germany
| | - Martin Hautzinger
- b Department of Psychology , University of Tuebingen , Tuebingen , Germany
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Domany KA, Hantragool S, Smith DF, Xu Y, Hossain M, Simakajornboon N. Sleep Disorders and Their Management in Children With Ehlers-Danlos Syndrome Referred to Sleep Clinics. J Clin Sleep Med 2018; 14:623-629. [PMID: 29609717 DOI: 10.5664/jcsm.7058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES The nature of sleep disorders in children with Ehlers-Danlos syndrome (EDS) is unknown. We aimed to describe the type, the management, and the short-term outcome of sleep disorders in children with EDS referred to sleep clinics. METHODS This is a retrospective review of medical records and polysomnography tests of children with EDS younger than 18 years who were referred to the sleep clinic. Demographic information and medical history were collected, and polysomnography tests were reviewed. Questionnaires completed during previous clinic visits, including the Pediatrics Sleep Questionnaire (PSQ), Epworth Sleepiness Scale (ESS), and Pediatric Quality of Life Inventory (PedsQL), were also evaluated. RESULTS Sixty-five patients with EDS-hypermobility type were included. The mean age was 13.15 ± 3.9 years. There were 68% of patients who were female, and 91% of patients were Caucasian. The mean follow-up period was 1.14 ± 1.55 years. Common sleep diagnoses included insomnia (n = 14, 22%), obstructive sleep apnea (OSA) (n = 17, 26%), periodic limb movement disorder (PLMD) (n = 11, 17%), and hypersomnia (n = 10, 15%). In addition, 65% required pharmacologic treatment and 29% were referred to behavioral sleep medicine. For OSA, two patients required continuous positive airway pressure. A significant improvement was observed in the PSQ, ESS, and PedsQL scores during follow-up visits after treatment (n = 34; P = .0004, 0.03, and 0.01, respectively). CONCLUSIONS There is a high prevalence of sleep disorders, including OSA, insomnia, PLMD, and hypersomnia in children with EDS referred to sleep clinics. Specific management can improve quality of life and questionnaire scores of this patient population. Our study emphasizes the importance of screening for sleep disorders in children with EDS.
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Affiliation(s)
- Keren Armoni Domany
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sumalee Hantragool
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio.,Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - David F Smith
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio.,Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Yuanfang Xu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
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Wamser-Nanney R, Chesher RE. Trauma characteristics and sleep impairment among trauma-exposed children. CHILD ABUSE & NEGLECT 2018; 76:469-479. [PMID: 29268207 DOI: 10.1016/j.chiabu.2017.11.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
Trauma-related sleep difficulties are quite common and their functional and clinical importance are increasingly recognized. High rates of sleep problems have been documented among trauma-exposed adults, particularly those diagnosed with posttraumatic stress disorder (PTSD); however, research with trauma-exposed children is relatively limited. Research specifically with child samples is critical due to the numerous developmental and functional implications that may result from sleep impairment. Characteristics of the traumatic event may play a key role in understanding sleep difficulties, yet, these associations are not well understood among trauma-exposed children. The current study therefore investigated whether aspects of the traumatic event (i.e., type, nature, chronicity, age of onset, removal from home, and complex trauma) were related to higher levels of sleep disturbances among 276 treatment-seeking children ages 6-18 years (M = 10.88, SD = 3.39; 63.4% female; 62.7% Black). Sleep problems were common in this sample. Domestic and community violence exposure were associated with higher levels of select sleep difficulties, as were interpersonal trauma, chronic trauma, a trauma that began early in life, and complex trauma. Nonetheless, type of trauma and characteristics of the traumatic event were largely unrelated to sleep problems on either caregiver's or children's reports. Removal from the home was not linked with sleep impairment. Although findings signify the relevance of sleep disturbances among trauma-exposed children, trauma characteristics may have limited influence on sleep problems.
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Affiliation(s)
- Rachel Wamser-Nanney
- Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121, United States.
| | - Rebecca E Chesher
- Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121, United States
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Pierce JS, Aroian K, Caldwell C, Ross JL, Lee JM, Schifano E, Novotny R, Tamayo A, Wysocki T. The Ups and Downs of Parenting Young Children With Type 1 Diabetes: A Crowdsourcing Study. J Pediatr Psychol 2017; 42:846-860. [PMID: 28369409 DOI: 10.1093/jpepsy/jsx056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Parenting young children with type 1 diabetes (YC-T1D) entails pervasive challenges; parental coping may influence child and parent outcomes. This study used a qualitative descriptive design to describe these challenges comprehensively to inform the user-centered design of an Internet coping resource for parents. Methods A "Parent Crowd" of 153 parents of children with T1D onset at ≤ 5 years old submitted textual responses online to open-ended questions about parenting YC-T1D. Systematic coding organized responses into domains, themes, and examples. A supplemental focus group of racial/ethnic minority parents enhanced the sample's diversity and validated findings from the Parent Crowd. Results Similar domains and themes emerged from responses of crowdsourcing and focus group participants. In each domain, parenting YC-T1D was challenging, but there was also substantial evidence of positive coping strategies and adaptability. Conclusions The study yielded rich data to inform user-centered design of an Internet resource for parents of YC-T1D.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, FL
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45
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Trosman I, Trosman SJ. Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children. Med Sci (Basel) 2017; 5:E30. [PMID: 29194375 PMCID: PMC5753659 DOI: 10.3390/medsci5040030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/14/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022] Open
Abstract
There is now a plethora of evidence that children with sleep disordered breathing (SDB) show deficits in neurocognitive performance, behavioral impairments, and school performance. The following review will focus on the neurobehavioral impacts of SDB, pediatric sleep investigation challenges, potential mechanisms of behavioral and cognitive deficits in children with SDB, and the impact of SDB treatment.
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Affiliation(s)
- Irina Trosman
- Sleep Medicine Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Samuel J Trosman
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Sun B, Cloonan YK, Collett BR, Speltz ML. Sleep Outcomes in Children With Single-Suture Craniosynostosis Compared With Unaffected Controls. Cleft Palate Craniofac J 2017; 54:734-738. [PMID: 27518405 PMCID: PMC7039619 DOI: 10.1597/16-090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare risk for sleep-disordered breathing between children with and without single-suture craniosynostosis. PARTICIPANTS A total of 184 children with single-suture craniosynostosis and 184 controls. MAIN OUTCOME MEASURES Parent reported sleep-disordered breathing-related symptoms. RESULTS Current sleep problems were reported in 19% of patients with single-suture craniosynostosis and 14% of controls (adjusted odds ratio = 1.6; 95% CI, 0.9 to 2.8). Ever having sleep problems was reported in 25% and 23% of cases and controls, respectively (adjusted odds ratio = 1.2; 95% CI, 0.7 to 1.9). Overall, snoring was statistically associated with single-suture craniosynostosis (P = .01) and was more often reported as 2+ nights per week (versus never) in patients with single-suture craniosynostosis (13%) than in controls (4%) (adjusted odds ratio = 3.5; 95% CI, 1.5 to 8.2). CONCLUSIONS Though preliminary, increased presence of snoring during sleep in children with single-suture craniosynostosis compared with controls suggests that children with isolated single-suture craniosynostosis may be at increased risk for sleep-disordered breathing. Further study using standardized assessments of sleep-disordered breathing is needed.
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Knupp KG, Scarbro S, Wilkening G, Juarez-Colunga E, Kempe A, Dempsey A. Parental Perception of Comorbidities in Children With Dravet Syndrome. Pediatr Neurol 2017; 76:60-65. [PMID: 28982531 DOI: 10.1016/j.pediatrneurol.2017.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/08/2017] [Accepted: 06/17/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND We hypothesized that children with Dravet syndrome may have additional common features beyond seizures and cognitive impairment. To address this gap in knowledge, we conducted a survey of caregivers of children with Dravet syndrome to identify and quantify their perception of associated symptoms in this population. METHODS An electronic survey was developed in REDcap (Research Electronic Data Capture) and sent via e-mail to the participants on the Dravet Syndrome Foundation e-mail list. Questions focused on eating, sleep, behavior, and other symptoms that might be related to Dravet syndrome. The questions were assessed using a four-point Likert scale (e.g., strongly agree to strongly disagree). Results were later dichotomized for analysis. Logistic regression was used to calculate odds ratios of various demographic factors potentially associated with symptoms. Multivariable models were constructed using backward elimination to assess the relationship among a variety of symptoms. RESULTS There were 202 respondents, 96% were parents of a child with Dravet syndrome (the remainder were grandparents or guardians); 90.5% were female. The median age of the affected child was eight years (interquartile range five to 14), 50% were male, and 90.5% were reported to have a known SCN1A mutation. At least one symptom associated with appetite was reported in 99% of respondents, 82% reported a disturbance of sleep, one third reported autonomic symptoms, and 75% reported problems with gait. Inattention and perseveration were reported more commonly than other behavioral disturbances. SIGNIFICANCE Caregivers have the perception of many symptoms in children with Dravet syndrome in addition to those that have been previously reported, including appetite, sleep, gait, and behavior. Many of these can significantly affect quality of life for both the child and the caregiver.
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Affiliation(s)
- Kelly G Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado.
| | - Sharon Scarbro
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Greta Wilkening
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Elizabeth Juarez-Colunga
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Kempe
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amanda Dempsey
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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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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Camoin A, Tardieu C, Blanchet I, Orthlieb JD. [Sleep bruxism in children]. Arch Pediatr 2017; 24:659-666. [PMID: 28587727 DOI: 10.1016/j.arcped.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/13/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study investigated sleep bruxism. The etiology is multifactorial: mainly central (neuropathic disorder, anxiety) but also genetic and local (posture, mouth breathing). The diagnosis is based primarily on the anamnesis and examination of dental wear and progression over time (photos and dental castings). A diagnostic guide is proposed in this article. Frequently found in children, bruxism is not always considered pathological. The severity criteria relate intensity (number of dental attrition facets) as well as the context found in children: anxiety, ventilation disorders, and fragile dental structures. Management is multidisciplinary and depends on the etiologic diagnosis.
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Affiliation(s)
- A Camoin
- Service d'odontologie, hôpital Timone, Aix-Marseille université, AP-HM, 27, boulevard Jean-Moulin, 13385 Marseille, France.
| | - C Tardieu
- Service d'odontologie, hôpital Timone, Aix-Marseille université, AP-HM, 27, boulevard Jean-Moulin, 13385 Marseille, France; Aix-Marseille université, 13385 Marseille, France; ADES UMR 7268, service d'odontologie, hôpital Timone, AP-HM, 13385 Marseille, France
| | - I Blanchet
- Service d'odontologie, hôpital Timone, Aix-Marseille université, AP-HM, 27, boulevard Jean-Moulin, 13385 Marseille, France
| | - J-D Orthlieb
- Service d'odontologie, hôpital Timone, Aix-Marseille université, AP-HM, 27, boulevard Jean-Moulin, 13385 Marseille, France
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Kim DS, Lee CL, Ahn YM. Sleep problems in children and adolescents at pediatric clinics. KOREAN JOURNAL OF PEDIATRICS 2017; 60:158-165. [PMID: 28592979 PMCID: PMC5461280 DOI: 10.3345/kjp.2017.60.5.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. METHODS Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. RESULTS Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0-18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2-5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys. CONCLUSION Sleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health.
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Affiliation(s)
- Dong Soon Kim
- Department of Medicine, Graduate School, Eulji University, Daejeon, Korea
| | - Cho Long Lee
- Department of Medicine, Graduate School, Eulji University, Daejeon, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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