Sleep Disturbance in Caregivers of Children With Respiratory and Atopic Disease

Sleep quality and daytime sleepiness amongst family caregivers of children with Spinal Muscular Atrophy

BACKGROUND

While there are limited studies focusing on sleep quality of family caregivers of children with Spinal Muscular Atrophy (SMA), there are no studies on daytime sleepiness in SMA.

AIMS

This study aimed a) to compare the sleep quality and daytime sleepiness between caregivers of children with SMA and those of healthy peers and b) to investigate the sleep quality and daytime sleepiness of family caregivers of children with different types of SMA.

METHODS AND PROCEDURES

This study included 30 family caregivers of children with SMA (SMA Type 1:12, SMA Type 2:10, and SMA Type 3:8) and 31 family caregivers of healthy peers. Sleep quality and daytime sleepiness of family caregivers were evaluated using the Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (EPS), consecutively.

OUTCOMES AND RESULTS

Demographic characteristics of children with SMA and healthy peers were similar (p > 0.05). The mean ages of family caregivers of children with SMA and healthy peers were 36.07 ± 5.84 and 35.26 ± 5.02 years, respectively (p = 0.6). The PSQI scores of family caregivers of children with SMA (7.50 ± 3.90 points) were lower than those of healthy peers (4.09 ± 1.97 points) (p < 0.001). There was no difference in PSQI scores between SMA types (p = 0.8). Also, no difference was found between SMA types and between SMA and healthy peers in terms of EPS (p > 0.05).

CONCLUSIONS AND IMPLICATIONS

Family caregivers of children with SMA had poor sleep quality but similar daytime sleepiness compared with those of healthy peers. Among SMA types, family caregivers had similar sleep quality and daytime sleepiness. It was demonstrated that the sleep quality of family caregivers should be taken into consideration in the disease management of SMA.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study

Introduction

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation.

Materials and methods

Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses.

Results

Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents.

Conclusion

Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Infantile atopic dermatitis - increasing severity predicts negative impacts on maternal and infant sleep: a mixed methods study

BACKGROUND

While the impacts of atopic dermatitis (AD) on maternal and child sleep outcomes have been previously explored, less is known about the associations between infantile AD and sleep quality and quantity.

OBJECTIVE

To describe the perceived causes of AD-associated maternal sleep disturbances and the association between AD severity and infant sleep outcomes.

METHODS

Mothers with infants aged < 19 months old with a diagnosis of AD were recruited from social media and medical clinics in Winnipeg, Canada between October 2021 and May 2022. Infant AD severity was classified using maternal-reported data on the Patient-Oriented Scoring Atopic Dermatitis tool (PO-SCORAD). Quantitative data were collected via a series of questionnaires with a subset of mothers subsequently completing semi-structured interviews. Quantitative and qualitative data were integrated in the discussion.

RESULTS

Mothers of infants with moderate/severe AD (6/12) were more likely to report their infant suffering from a higher degree of sleeplessness (i.e., ≥ 5 on a scale of 0-10) over the past 48 h compared to mothers of infants with mild AD (0/18). This was supported by qualitative findings where mothers described how their infant's sleep quality and quantity worsened with AD severity. Additionally, 7/32 mothers reported that their child's AD, regardless of severity, disturbed their sleep. Maternal sleep loss was most commonly attributed to infant itching (6/7), followed by worry (4/7).

CONCLUSION

Infantile AD severity was associated with worse sleep outcomes for both mothers and infants. We propose that maternal and infantile sleep quality and quantity can be improved by reducing AD severity through adherence to topical treatments.

Atopic dermatitis, cognitive function and psychiatric comorbidities across early childhood and adolescence in a population-based UK birth cohort

BACKGROUND

Atopic dermatitis (AD) may affect cognitive function, but studies are limited and inconsistent. The effect of AD severity on cognition remains underexplored and few previous studies have examined clinically validated or repeated measures of cognition throughout childhood.

OBJECTIVES

To evaluate the relationship of AD activity and severity with validated measures of general cognition in a longitudinal birth cohort.

METHODS

We conducted cross-sectional analyses using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK cohort of 14 975 individuals followed prospectively since their birth in 1991-92. AD was assessed 11 times between the age of 6 and 166 months. Mothers were asked if their child had an 'itchy, dry skin rash in the joints and creases', and AD status was time-updated accordingly as 'never', 'maybe', 'inactive', 'active/mild' or 'active/moderate-severe'. General cognition [i.e. intelligence quotient (IQ)] was measured at 18, 49, 103 and 186 months of age using the Griffiths Mental Development Scales (GMDS), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC) and Wechsler Abbreviated Scale of Intelligence (WASI), respectively. Multivariable linear regression was used to compare IQ with respect to nearest time-updated AD status. Secondary analyses were stratified by the presence or absence of psychiatric or learning disorders. An exploratory longitudinal analysis of IQ across all four outcome assessments was conducted using generalized estimating equations.

RESULTS

No significant associations between AD status and full-scale IQ scores on the GMDS, WPPSI, WISC and WASI were observed after adjustment for sociodemographic factors, atopic comorbidities and sleep characteristics. However, at 8 years of age, WISC Performance IQ was slightly, although statistically significantly, lower among children with active/moderate-severe AD [β coefficient -2.16, 95% confidence interval (CI) -4.12 to -0.19] and Verbal IQ was slightly, but statistically significantly, higher among those with inactive AD (β coefficient 1.31, 95% CI 0.28-2.34) compared with those without AD. Analyses stratified by psychiatric or learning disorders, and exploratory longitudinal analyses of cognition revealed similar findings.

CONCLUSIONS

We did not find any clinically meaningful associations between AD activity and severity and general cognitive function during early childhood and adolescence. Future studies should incorporate objective measures of AD severity and investigate outcomes beyond IQ.

Effects of comorbid asthma and eczema on child and family quality of life

Paediatric chronic health conditions are associated with poorer psychological wellbeing and quality of life for children and families. This study investigated differences in child and parent/family quality of life between families of children with asthma only, eczema only, or both asthma and eczema, and tested predictors of child and parent/family quality of life. A convenience sample of 106 families completed parent-report measures of child and parent/family quality of life, child emotional and behavioural difficulties, parent adjustment and parenting practices. Between-groups ANOVAs indicated no differences for child quality of life, whereas parent/family quality of life was worse for those with eczema only compared to asthma only. Multiple linear regression revealed that child emotional difficulties predicted worse child quality of life, whereas worse parent adjustment, child emotional difficulties and eczema only (compared to both asthma and eczema) predicted worse parent quality of life. Results suggest that families of children with eczema may be at particular risk for impaired parent/family quality of life. Interventions that take a family-centred approach to improving child and parent adjustment should be investigated as an adjunct to medical treatment to reduce the impact of chronic health conditions on quality of life for children and families.

The Sleep Patterns of Children and Adolescents with Chronic Conditions and Their Families: An Integrative Literature Review

Sleep is of vital necessity for health, and it has a restorative and protective function for children and adolescents with chronic conditions and their families. The purpose of this study was to identify the scientific production on sleep patterns in children and adolescents with chronic conditions and their families. This integrative review was conducted between March and June 2022 using the databases of MEDLINE, Web of Science, CINAHL and PsycINFO. The articles included were original papers published between January 2007 and mid-2022. Excluded were review studies that did not evaluate sleep and whose participants did not have chronic conditions or were not children, adolescents and/or their families. The searches returned 814 abstracts. After exclusions, 47 studies were selected to be read in full; of these, 29 were selected and were grouped empirically into four categories: major alterations in the sleep patterns of children and adolescents with chronic conditions; the relationship between sleep disorders and symptoms in children and adolescents with chronic conditions; the impaired sleep patterns of families of children and adolescents with chronic conditions; and sleep alterations and their relationship with other problems in families of children and adolescents with chronic conditions. All studies showed sleep pattern impairment in children and adolescents with chronic conditions as well as their families.

Atopic Dermatitis: Disease Background and Risk Factors

Multiple risk factors have been associated with the development of atopic dermatitis (AD). Recent advances in understanding the role of genetics in this disease have been made, with discovery of the filaggrin (FLG) gene as the most notable so far. In addition to FLG gene mutations as a risk factor for AD, a positive family history of atopic or allergic disease in either parent has been shown to confer a greater risk of developing AD. Atopic dermatitis usually presents early in life and is thought to represent the initial step in the "atopic march," which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis, and/or rhinoconjunctivitis, food allergies, and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD), and autistic spectrum disorder (ASD). Patients with AD have also been found to have worse sleep quality overall compared to patients without AD. In this chapter, we will discuss the risk factors associated with development of atopic dermatitis as well as the most commonly reported comorbidities in patients with this disease.

The experiences of mothers of children with food allergy: A qualitative study

BACKGROUND

Food allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model.

METHODS

This study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist.

FINDINGS

Three themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme.

DISCUSSION

It has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health.

APPLICATION TO PRACTICE

The findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.

Sleep Quality of Family Caregivers of Children With Tracheostomies or Home Ventilators: A Scoping Review

Family caregivers of children with tracheostomies or home ventilators are more likely to experience poor sleep quality when undertaking the full responsibility of caring for fragile children. This scoping review aimed to identify the sleep quality, related factors, and their impact on the health of family caregivers of children with tracheostomies or home ventilators. The included studies (N = 16) were retrieved through PubMed, CINAHL, Cochrane Library, Embase, PsycINFO, and Web of Science. Family caregivers' sleep were low in quality, frequently disturbed, and insufficient. Their sleep quality was related to fatigue, anxiety, depression, family functioning, and health-related quality of life. The sleep disturbing factors were classified as child, caregiver, or environment-related, which were mutually interrelated. This review emphasizes the need to develop nursing interventions to both improve the sleep quality of family caregivers and the health of children with tracheostomies or home ventilators based on an in-depth understanding of the family's context.

Assessment of Anxiety, Depression, and Sleep Quality in Mothers of Children with Atopic Dermatitis: A Qualitative Questionnaire Study

Purpose

To compare the anxiety, depression and sleep quality of mothers of healthy control children and mothers of children with atopic dermatitis (AD) of varying severity, both before and after treatment.

Methods

A total of 120 parent-child dyads participated in the study. These dyads were divided into four subgroups of 30 patients each: mild AD, moderate AD, severe AD, and control groups. The children's symptoms, their mothers' psychological status, and their mothers' sleep quality were evaluated using the Scoring of Atopic Dermatitis (SCORAD), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI), respectively, before and after a one-month comprehensive treatment.

Results

SCORAD, representing differences in severity of children's AD, decreased significantly after one month's treatment (p < 0.001). Anxiety in mothers significantly decreased in all AD severity groups after treatment (p < 0.05). However, for depression, only the mothers in the mild and moderate AD groups showed a decrease after treatment (p < 0.05). The PSQI total score also decreased in the mild AD group after treatment (p < 0.05).

Conclusion

The most severe effect was seen in the psychology and sleep quality of mothers of children with severe AD. After one month of treatment, the psychological health and sleep quality of the mothers in the mild AD group significantly improved, while those of mothers in the moderate and severe AD groups showed partial improvement.

Parental sleep when their child is sick: A phased principle-based concept analysis

Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.

Up all night? Sleep disruption in parents of young children newly diagnosed with type 1 diabetes

BACKGROUND

Despite the known challenges of parental adjustment to new-onset type 1 diabetes (T1D) in young children, little is known about parental sleep soon after diagnosis.

METHODS

Parents (n = 157) of young children (4.5 ± 1.6 years) with new-onset T1D (29 ± 15 days) self-reported their sleep (Pittsburgh Sleep Quality Index, PSQI) at the baseline of a behavioral randomized control trial. We examined sleep patterns and relations with continuous glucose monitor (CGM) use.

RESULTS

Over two-thirds (68.8%) reported poor sleep quality (PSQI > 5, M = 8.3 ± 4.1). The mean reported sleep duration was 5.9 ± 1.4 h/night. PSQI scores did not significantly differ by CGM use.

CONCLUSIONS

Sleep disruption is a pervasive self-reported problem among parents of young children emerging early after the T1D diagnosis. Healthcare providers should discuss parental sleep as part of diabetes care soon after diagnosis. Further interventions targeting parental sleep may be of benefit.

Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study)

BACKGROUND

Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting.

METHODS

This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings.

DISCUSSION

This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption.

TRIAL REGISTRATION

clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.

Parents' self-reported experiences and information needs related to acute pediatric asthma exacerbations: A mixed studies systematic review

Objective

To systematically review the scientific literature examining parents' experiences and information needs for the management of their child's asthma exacerbations.

Methods

We searched five databases for quantitative and qualitative studies in Canada and the United States from 2002 onwards. A convergent integrated approach and the Mixed Method Appraisal Tool were used to analyze and appraise the evidence, respectively.

Results

We included 84 studies (27 quantitative, 54 qualitative, 3 mixed methods). Some parents lacked confidence in recognizing or managing exacerbations. A few parents were uncertain when and where to seek medical help. The main barrier to accessing care was cost. Impacts on parents included poor sleep, distress, and lifestyle disruptions. Parents felt they lacked information and wanted education on treatments and how to recognize and manage exacerbations via education sessions, written materials, community outreach and online resources.

Conclusion

Improved education for parents may help reduce parents' stress, asthma-related morbidities for children and use of urgent health services.

Innovation

The development of tailored interventions and knowledge translation strategies with input from target audiences (e.g. parents, health care providers) is necessary to meet their information needs and support adherence to clinical recommendations.

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84 studies reviewed and analyzed using the convergent integrated approach

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Parents lacked confidence in recognizing, treating or seeking care for exacerbations

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Cost was a barrier to care; parents affected by psychosocial impacts

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Parent's desired education on treatments and how to recognize and manage exacerbations

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Interventions and knowledge translation strategies must be developed with parents

The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder

PURPOSE

The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality.

DESIGN AND METHODS

We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated.

RESULTS

A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%.

CONCLUSIONS

Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study

STUDY OBJECTIVES

The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range.

METHODS

Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline.

RESULTS

Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001).

CONCLUSIONS

SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.

Psychometric properties of the Insomnia Severity Index in a sample of family dementia caregivers

STUDY OBJECTIVES

Family caregivers of people with dementia frequently report sleep problems that are linked to depressive and anxious symptoms. However, data are needed regarding the psychometric properties of specific measures of sleep problems in caregiving populations. The aim of this study is to analyse the psychometric properties of the Insomnia Severity Index (ISI; Morin, 1993) in a Spanish dementia caregiver sample.

METHODS

271 participants took part in face-to face interviews where, along with sociodemographic variables, caregivers' sleep problems, depressive and anxious symptoms were measured. The psychometric properties of the ISI were analysed through Confirmatory Factor Analysis (CFA) and analysis of the internal consistency and convergent and criterion validity.

RESULTS

The Spanish version of the Insomnia Severity Index showed adequate indices of internal consistency (Cronbach's alpha = 0.78) in our sample of family caregivers of people with dementia. A one-factor structure provided a better fit to the data than two- and three-factor structures. The ISI was significantly associated with lower sleep quality, less average sleep time per day and lower self-perception of vitality, as well as with higher depressive and anxious symptoms. Differences in ISI scores were found between people with and without depressive and anxious symptoms. Statistically significant gender-based differences in sleep problems were also found, with female caregivers showing higher sleep problems.

CONCLUSIONS

The ISI is a reliable and valid instrument to assess the subjective severity of sleep problems in the family dementia caregiver population and may be a useful instrument in intervention and research settings. Additional evidence was also provided of the importance of considering sleep problems in the studied population.

Insights From Caregivers on the Impact of Pediatric Atopic Dermatitis on Families: "I'm Tired, Overwhelmed, and Feel Like I'm Failing as a Mother"

BACKGROUND

The impact of pediatric atopic dermatitis (AD) on families is largely hidden from view, and AD is commonly misunderstood as a minor skin condition. Few studies have examined the full burden of AD from the family perspective.

OBJECTIVE

The aim of the study was to assess the burden of AD on children and families using a caregiver-centered survey.

METHODS

A 72-item anonymous online survey was posted on social media sites targeted to or composed of parents of children with AD. It explored the following 9 domains of impact: sleep, social isolation, time requirements, life decisions, family relationship dynamics, energy/fatigue, mental health impacts, and unmet treatment needs. Atopic dermatitis severity was reported by respondents using the Patient-Oriented Eczema Measure. Statistical analyses were conducted using R 3.6.0.

RESULTS

Two hundred thirty-five individuals completed the survey during the 1-month period that it was promoted via social media. Caregivers reported frequent sleep disturbance, exhaustion, worry, and social isolation related to their child's AD.

CONCLUSIONS

Results highlight the need for psychosocial support and respite care for caregivers of children with AD.

Children with home mechanical ventilation-Parents' health-related quality of life, family functioning and sleep

AIM

Children requiring home mechanical ventilation (HMV) have grown in number and complexity. Parents of children with HMV are often responsible for the advanced homecare. This study explored the health-related quality of life (HRQoL), family functioning and sleep in parents of children with HMV. A secondary aim was to explore the impact on HRQoL, family functioning and sleep of selected potential determinants.

METHODS

Questionnaires were completed by 45 mothers and 40 fathers, to 55 children receiving HMV. Parents were identified via respiratory clinics in the Swedish national quality register for oxygen and home respiratory treatment and invited to participate between December 2016 and December 2018.

RESULTS

There were no differences between mothers and fathers overall HRQoL or family functioning reports, although differences within the physical (P < .043) and cognitive (P < .009) functioning dimensions were found. One of four parents reported moderate or severe insomnia. The variability in HRQoL and family functioning was predicted by HMV mode and sleep quality to an extent of 45% and 21%, respectively.

CONCLUSION

Sleep quality and the child's HMV mode predicted parental HRQoL and family functioning. The results underscore the importance of evaluating parents' sleep and of being aware that invasive ventilation influences parental HRQoL and family functioning.

Allergic diseases do not impair the cognitive development of children but do damage the mental health of their caregivers

This study aimed to investigate whether children with atopic diseases exhibited different neurodevelopment function from healthy controls and whether their caregivers had differential parental stress. In total, we recruited 109 patients with atopic diseases (mean age 6.8 years, 54.1% male) and 82 healthy children (mean age 6.3 years, 54.9% male). Based on the children’s age, they underwent developmental, cognitive evaluations and attention deficit/hyperactivity disorder (ADHD) symptoms. The parenting stress of children’s caregivers was evaluated using the Chinese Health Questionnaire (CHQ-12) and Family APGAR. Of the children with atopic diseases, 87.2%, 74.3%, 29.4%, and 8.3% of them had allergic rhinitis, asthma, atopic dermatitis, and urticaria, respectively. None of these conditions were associated with children’s cognitive profiles or ADHD symptoms. However, the caregivers of patients who had asthma suffered from higher CHQ-12 scores than those of patients without asthma. Furthermore, the number of atopic diseases had a dose–response effect on caregivers’ CHQ-12 scores. In conclusion, allergic diseases did not impair the cognitive development of children. However, caregivers of patients with asthma or multiple atopic diseases may suffer a greater mental health burden with regard to caring for their children. Such caregivers may require support to effectively fulfill their parenting roles.

Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review

INTRODUCTION

Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma.

METHOD

An integrative review was conducted to review and appraise 80 studies.

RESULTS

Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology.

DISCUSSION

As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.

Actor and partner effects of parenting stress and co-parenting on marital conflict among parents of children with atopic dermatitis

Background

It is important for healthcare providers to pay attention to parents’ rearing style and children’s physical symptoms to promote a healthy quality of life among children with atopic dermatitis. We aimed to identify effects of parenting stress and co-parenting on marital conflict among parents of children with atopic dermatitis.

Methods

Participants were 161 fathers and 161 mothers raising seven-year-old children treated for atopic dermatitis. To confirm the effects of parenting stress and co-parenting on marital conflict, the “actor-partner interdependence mediation model” was used. To verify goodness-of-fit, maximum likelihood method was used, and a confirmatory factor analysis was conducted to confirm the validity of latent variables for model analysis.

Results

Fathers’ parenting stress had actor (β = −.46, p < .001) and partner (β = −.22, p < .001) effects on co-parenting, and mothers’ parenting stress had actor (β = −.20, p < .001) and partner (β = −.36, p < .001) effects on co-parenting. Fathers’ parenting stress only had an actor effect on marital conflict (β = .32, p < .001). Father’s co-parenting had actor (β = −.29, p < .001) and partner (β = −.22, p < .001) effects on marital conflict, and mothers’ co-parenting had actor (β = −.39, p < .001) and partner (β = −.19, p < .001) effects on marital conflict. There were significant differences between the two groups concerning three path coefficients: fathers’ parenting stress affected fathers’ marital conflict, fathers’ co-parenting affected fathers’ marital conflict, and mothers’ co-parenting affected fathers’ marital conflict.

Conclusions

It is vital for healthcare providers to seek ways to reduce the marital conflicts of parents of children with atopic dermatitis, including further examination of the role of co-parenting, to address children’s physical symptoms and promote their health. Our findings inform management and intervention programs for the families of children with atopic dermatitis.

Sleep disturbances and affecting factors in young children with food allergy and their mothers

OBJECTIVE

To examine sleep patterns and sleep disturbance of children with food allergy (FA) and their mothers.

METHODS

The food allergy group included 71 children with mean age, 2.97±1.52 years, and 58 control children were recruited the study. Mothers of children completed the Childhood Sleep Habits Questionnaire (CSHQ) and The Pittsburgh Sleep Quality Index (PSQI) in order to evaluate sleep disturbance in both children and themselves. Depressive symptomatology of mothers of children with or without food allergy was assessed with Beck-Depression Inventory II (BDI-II).

RESULTS

The mean total scores of CSHQ was 49.33±7.93 (range=31-68) in the FA and 42.39±6.43 (range=30-62) in controls. The total CSHQ scores were significantly higher in children with FA than in controls (p=0.002). The total PSQI score was significantly higher in mothers of children with FA than in mothers of children without FA (7.09±3.11 vs 5.15±2.59, p<0.001) indicating that the mothers of children with FA had worse sleep quality. The mothers of children with FA had more depressive symptoms than mothers of children without FA. The mean total scores of BDI-II were 10.10±6.95 in mothers of children with FA and 7.78±6.64 in mothers of children without FA (p=0.005).

CONCLUSION

The presence of a food allergy in a child may be associated with a deterioration in sleep quality in children and mothers as well as increased depressive symptoms in mothers.

Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis

Importance

The well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking.

Objectives

To compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances.

Design, Setting, and Participants

In the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years.

Main Outcomes and Measures

Time-varying binary measures of maternal sleep duration (<6 vs ≥6 hours per night), difficulty falling asleep, early morning awakening, subjectively insufficient sleep, and daytime exhaustion.

Results

The study followed up 13 988 mother-child pairs from birth for a median duration of 11 (interquartile range, 7-11) years. Among the cohort, 11 585 of 13 972 mothers (82.9%) were aged 21 to 34 years and 12 001 of 12 324 (97.4%) were of white race/ethnicity; 7220 of 13 978 children (51.7%) were male. Sleep duration (adjusted odds ratio [AOR], 1.09; 95% CI, 0.90-1.32) and early morning awakenings (AOR, 1.16; 95% CI, 0.93-1.46) were similar between mothers of children with and without AD. In contrast, mothers of children with AD were more likely to report difficulty falling asleep (AOR, 1.36; 95% CI, 1.01-1.83), subjectively insufficient sleep (AOR, 1.43; 95% CI, 1.24-1.66), and daytime exhaustion (AOR, 1.41; 95% CI, 1.12-1.78) independent of the child's comorbid asthma and/or allergic rhinitis. For all measures, worse child AD severity was associated with worse maternal sleep outcomes. The magnitude and significance of the associations were largely unchanged after adjustment for child sleep disturbances.

Conclusions and Relevance

Mothers of children with AD reported difficulty falling asleep, subjectively insufficient sleep, and daytime exhaustion throughout the first 11 years of childhood. However, child sleep disturbances did not fully explain maternal sleep disturbances, and future research should investigate other mechanisms. In caring for children with AD, clinicians should consider maternal sleep disturbances and caregiver fatigue.

Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.

"To Cope with Everyday Life, I Need to Sleep" - A Phenomenographic Study Exploring Sleep Loss in Parents of Children with Atopic Dermatitis

PURPOSE

The whole family is affected when a child has atopic dermatitis (AD), and parents experience sleep disruption related to the child's condition leading to physical and mental exhaustion, mood swings, loss of concentration and lower job performance. This study aimed to explore and describe perceptions of sleep in parents of children <2 years old with AD, consequences of parental sleep loss, and what strategies the parents used to manage sleep loss and to improve sleep.

DESIGN AND METHODS

This qualitative interview study had an inductive and descriptive design. Twelve parents (eleven mothers and one father) participated in the study. Data analysis was performed using a phenomenographic approach.

RESULTS

Three categories of description were found: Acceptance and normalization of parental sleep loss; Changed routines and behavior to compensate for sleep loss; and Support is needed to gain sleep and manage daily life.

CONCLUSIONS

Sleep loss due to the child's AD affected the parents' emotional state, mood, well-being, cognitive function, ability to concentrate and take initiative, and sensitivity to stress and sound negatively. The parents managed their sleep loss mainly by changing their behavior and creating new routines, by taking me-time and through support from partners.

PRACTICE IMPLICATIONS

Pediatric nurses should acknowledge sleep loss in parents of small children with AD in time to prevent negative consequences, which affect the well-being of the entire family. Advice on how to improve sleep should be given early to increase the parents' understanding, make them feel safer and strengthen them in their parenthood.

Parents of children referred to a sleep laboratory for disordered breathing reported anxiety, daytime sleepiness and poor sleep quality

AIM

We evaluated the impact that having a child with sleep-disordered breathing had on their parents, including their own sleep quality.

METHODS

Questionnaires were completed by 96 parents of 86 children referred for a sleep study or control of continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) at the sleep laboratory of the Necker Hospital, Paris, France, between October 2015 and January 2016. The questionnaires evaluated anxiety and depression, family functioning, the parents' quality of life, daytime sleepiness and sleep quality.

RESULTS

The children had a mean age of seven ±five years and most of the responses (79%) came from their mothers. These showed that 26% of parents showed moderate-to-severe anxiety, 8% moderate-to-severe depression, 6% complex family cohesion, 59% moderate-to-severe daytime sleepiness and 54% poor sleep quality. Anxiety was higher in mothers than in fathers (p < 0.001). The questionnaire scores did not differ according to the child's age, the results of the sleep studies or the CPAP or NIV treatment. The symptoms seem to be more commonly related to the child's underlying disease than their sleep-disordered breathing.

CONCLUSION

The parents of children referred to a sleep laboratory reported frequent anxiety, daytime sleepiness and poor sleep quality.

Atopic Dermatitis: Disease Background and Risk Factors

Multiple risk factors have been associated with the development of atopic dermatitis (AD). Recent advances in understanding the role of genetics in this disease have been made, with discovery of the filaggrin (FLG) gene as the most notable so far. In addition to FLG gene mutations as a risk factor for AD, a positive family history of atopic or allergic disease in either parent, has been shown to confer a greater risk of developing AD. Atopic dermatitis usually presents early in life and is thought to represent the initial-step in the "atopic march" which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis and/or rhinoconjunctivitis, food allergies and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD) and autistic spectrum disorder (ASD). Patients with AD, have also been found to have worse sleep quality overall compared to patients without AD. In this chapter, we will discuss the risk factors associated with development of atopic dermatitis as well as the most commonly reported comorbidities in patients with this disease.

Chronic parenting stress and mood reactivity: The role of sleep quality

Sleep is a basic biological process supporting emotion regulation. The emotion regulation function of sleep may be particularly important in the context of chronic stress. To better understand how chronic stress and sleep interact to predict mood, 66 parents of children with autism completed daily diaries assessing parenting stress, negative mood, and sleep quality for 6 consecutive days. Hierarchical linear modelling revealed that daily negative mood was predicted by between-person differences in parenting stress and between-person differences in sleep efficiency. Further, between-person differences in sleep efficiency and within-person differences in sleep satisfaction moderated the impact of stress on mood. These data suggest that sleep disturbances may exacerbate the association between stress and mood in the context of chronic parenting stress. Further, high parenting stress appears to heighten the impact of transient sleep disturbances on mood.

The influence of psychosocial stressors and socioeconomic status on sleep among caregivers of teenagers with asthma, the Puff City study

OBJECTIVE

Insufficient sleep is common among caregivers and is associated with worse health outcomes; however, the contributors to poor sleep among caregivers are unknown. We investigated the cross-sectional association between socioeconomic status (SES), psychosocial stressors, and sleep among caregivers.

METHODS

Caregivers (n=98) of teenagers with asthma self-reported sleep duration (hours), sleep quality (very good to very bad), education (<high school to college graduate), income ($15,000 to $50,000), and psychosocial stressors (stress, worry, social support, depressive symptoms, nightly awakenings due to caregiving). Logistic and linear regression models were performed to study the association of between SES, psychosocial stressors, and sleep, adjusting for possible confounders.

RESULTS

Caregivers on average were 45.5 years, female (89%), and African American (90%). Average sleep duration was 5.9 hours (standard deviation: 1.5), 72% reported short sleep (<7 hours), and 65% reported "fairly bad or very bad" sleep quality. After adjustment for covariates, caregivers with greater social support had a 44% (95% confidence interval: 0.32, 0.98) lower odds of short sleep duration and slept 20.0 minutes (3.09, 37) longer on average. Greater depressive symptoms were associated with a 26% (1.11, 1.44) higher odds of short sleep and sleeping on average 6.08 minutes (-8.67, -3.49) less at night. SES and other psychosocial stressors were not associated with sleep.

CONCLUSIONS

Caregivers had a high prevalence of short and poor quality sleep. Depressive symptoms were associated with shorter sleep, whereas social support was associated with longer sleep. Identifying factors that mitigate the effect of psychosocial stressors on sleep is warranted.

The relationship between child and caregiver sleep in acute lymphoblastic leukemia maintenance

PURPOSE

The purposes of this study are to describe sleep quality and sleep disturbance among caregivers of children in the maintenance phase of acute lymphoblastic leukemia (ALL) and to examine the relationship between sleep quality, child sleep disturbance, and caregiver guilt and worry.

METHODS

Caregivers of 68 children with ALL, ages 3 to 12 years old, completed measures of caregiver guilt and worry, caregiver sleep quality, and child's developmental history and sleep habits. Demographic and treatment correlates of poor caregiver sleep were examined, and caregiver guilt and worry was tested as a moderator between child and caregiver sleep.

RESULTS

More than half of caregivers (55.9%) reported clinically significant poor sleep and less than 40% were obtaining adequate sleep durations. Caregiver sleep was significantly related to child age at diagnosis, child sleep, and caregiver guilt and worry. Caregiver guilt and worry did not moderate the relationship between child sleep and caregiver sleep.

CONCLUSIONS

Poor sleep is common in caregivers of children with cancer. Further research on the timing of sleep interventions and the most effective intervention targets are needed to maximize caregiver functioning during a child's cancer treatment. Targeted interventions seeking to improve caregiver sleep should be directed towards caregivers of children diagnosed in early childhood, caregivers of children with poor sleep, and caregivers with high guilt and worry.

Sleep in young children with asthma and their parents

Sleep problems are common in healthy young children, as well as in older children and adolescents with asthma; yet little is known about the sleep patterns and sleep issues of young children with asthma. Further, when young children have sleep disruptions, parental sleep is also typically disrupted. The purpose of this study was to characterize sleep in young children (one to four years) with and without asthma and their parents. Parents of young children ( n = 364) from the general community completed measures of sleep patterns and sleep issues in their children and in themselves. Compared to children with well-controlled asthma or no asthma, children with poorly controlled asthma had poorer sleep patterns, more difficulty falling asleep, and more sleep disruptions (i.e. restless sleep, frequent apneas and gasping during sleep, and frequent sleep terrors). Parents of children with poorly controlled asthma indicated their own sleep was regularly disrupted, and they had frequent night awakenings due to attending to, and stress caused by, their child's health needs. Children with poorly controlled asthma and their parents demonstrated significant sleep issues. Clinical implications for working with young children with asthma and their parents are discussed.

Associations Among Behavioral Sleep Disturbance, Family Functioning, and Controller Medication Adherence in Children with Asthma

OBJECTIVE

This study examined the associations among child sleep disturbances, family functioning, and asthma controller medication adherence in school-age children with persistent asthma.

METHODS

Thirty-four children aged 6 to 11 years and a parent independently reported on asthma control and controller medication adherence. Parents also reported on family functioning (behavior control) and child sleep disturbances (bedtime resistance, daytime sleepiness). Hierarchical linear regression models tested sleep disturbance variables as predictors of family functioning and medication adherence. A mediation model tested behavior control as a mediator between sleep disturbance and medication adherence.

RESULTS

Seventy-nine percent of the children had well-controlled asthma. Despite a mean of 9.48 hours of child sleep per night, 73% of the children had clinically significant disturbed sleep. Controlling for child age, bedtime resistance accounted for 32% of the variance in family behavior control (F(1,31) = 14.75, p < .01). Behavior control also significantly mediated the relationship between total sleep disturbance and medication adherence, with a standardized indirect effect of β = -.17 (95% confidence interval [CI], -.47 to -.03) for parent-reported adherence and β = -.12 (95% CI, -.36 to -.01) for child-reported adherence.

CONCLUSION

Child behavioral sleep disturbances significantly predicted family behavior control. Although child sleep disturbances did not significantly predict asthma controller medication adherence, there was a significant indirect effect of sleep disturbance on medication adherence through compromised family behavior control. Developmentally appropriate behavioral sleep interventions may improve family functioning and child asthma controller medication adherence. Family functioning may also be an entry point for intervention to improve medication adherence.

Psychiatry outpatient visits by atopic dermatitis patients varying in the complexity of their prescriptions: A nationwide cohort study conducted from 2005 to 2013

The uncomfortable symptoms of atopic dermatitis (AD) often trigger psychological stress.We investigated the association between AD severity and outpatient visits to psychiatrists using Korean National Health Insurance claims data from 2004 to 2013.This was a retrospective cohort analysis; we estimated hazard ratios (HRs).Of the 266,182 subjects, 18,290 (6.9%) had a history of visiting a psychiatrist, and 25,419 (9.5%) were diagnosed with AD. Compared with the subjects without AD, subjects with AD had a higher HR for visiting a psychiatrist (3.70, 95% confidence interval [CI]:48 3.43-3.98), and this significantly increased as the complexity of the AD medications increased. Subjects who received topical treatments plus a systematic steroid (HR: 4.88, 95% CI: 4.51-5.27) and those who received topical treatments plus a systematic steroid plus a systematic calcineurin inhibitor (HR: 9.56, 95% CI: 4.29-21.28) had higher HRs compared with those without AD.Severe AD patients exhibited greater psychological stress than those without AD or with mild AD symptoms. Moreover, medication diversity may represent an efficient and low-cost method by which to identify a vulnerable population.

Sleep Problems as Consequence, Contributor, and Comorbidity: Introduction to the Special Issue on Sleep, Published in Coordination With Special Issues in Clinical Practice in Pediatric Psychology and Journal of Developmental and Behavioral Pediatrics

Despite long-standing public and scientific interest in the phenomenon of sleep, the current decade has shown tremendous growth in our understanding of the sleep of children who have medical or developmental conditions. To accommodate, promote, and guide that growth, Journal of Pediatric Psychology, Clinical Practice in Pediatric Psychology, and Journal of Developmental and Behavioral Pediatrics have published coordinated special issues, encompassing >30 relevant articles. This article introduces the special issue in Journal of Pediatric Psychology, highlighting papers that illustrate how sleep problems are not only commonly comorbid with childhood medical and developmental conditions; they are also likely caused by and contribute to these conditions. In doing so, these coordinated special issues guide clinical care and reveal opportunities for future research.