1
|
Owens J, Barnett N, Lucchini M, Berger S. Melatonin use in infants and toddlers. Sleep Med 2024; 120:53-55. [PMID: 38878351 DOI: 10.1016/j.sleep.2024.06.008] [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: 02/28/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Abstract
Background Melatonin use in the pediatric population is on the rise in the United States, where it is available as an over-the-counter and online supplement. There are no data regarding the safety and efficacy of melatonin in children less than 2 years old. The aim of this study was to examine various aspects of melatonin use by caregivers of infants and toddlers in the US. Methods Caregiver users of the Nanit baby monitoring system with a child aged 0-36 months were invited to complete an online survey regarding melatonin use, sources of information/recommendations about melatonin, formulations used and reasons for administering melatonin to their child. Participants also completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Results A total of 3063 caregivers (1.93%) responded to the survey, of whom 1.7% had ever used melatonin for their child. About half of those caregivers had received a recommendation for melatonin from a source other than a healthcare professional. Caregiver perception of 'sleep as a problem' as assessed by the BISQ-R was not significantly different between those who had or had not used melatonin for their child, and reasons for use included non-supported indications such as sleeping later or promoting "more restful and better sleep". Conclusions The results of this study support mounting concerns regarding the widespread use of melatonin in the US pediatric population, especially given the lack of regulatory oversight and the documented inaccuracy of label claims versus actual melatonin content.
Collapse
Affiliation(s)
- Judith Owens
- Boston Children's Hospital, Harvard Medical School, 9 Hope Avenue, Waltham, MA, USA.
| | | | | | - Sarah Berger
- Department of Psychology, College of Staten Island and the Graduate Center of the City University New York, USA
| |
Collapse
|
2
|
Thomas DC, Somaiya T, Meira E Cruz M, Kodaganallur Pitchumani P, Ardeshna A, Ravi A, Prabhakar S. The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient. J Am Dent Assoc 2024:S0002-8177(24)00298-8. [PMID: 39007793 DOI: 10.1016/j.adaj.2024.05.007] [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: 12/30/2023] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine. RESULTS The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science. CONCLUSIONS AND PRACTICAL IMPLICATIONS The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.
Collapse
|
3
|
Cason-Wilkerson R, Sherrill A, Simon SL, Thompson DA, Kaar JL. Perceptions of sleep health among African American mothers regarding their preschool-aged children: A qualitative study to decrease sleep health disparities. Sleep Health 2024:S2352-7218(24)00063-9. [PMID: 38955582 DOI: 10.1016/j.sleh.2024.03.007] [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: 06/20/2023] [Revised: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES African American children are documented as having poor sleep health due to shorter sleep duration, sleep timing, and sleep behaviors compared to White peers, contributing to child health disparities. Identifying cultural-environmental, and societal factors impacting a child's sleep among African American families is essential for developing interventions for this population. This study evaluated holistically why African American children may have poorer sleep health by examining sleep duration, timing, and behaviors. This was assessed by examining sleep-related beliefs, barriers, and facilitators to sleep schedules and routines. We also explored parental ideas for a sleep intervention. METHODS African American mothers of preschool-aged children (2-5years) were recruited using local partnerships and social media. Individual semistructured interviews were conducted by phone. Interviews were transcribed, coded, and analyzed thematically using grounded-theory. RESULTS Eighteen African American mothers completed the study. Five themes related to sleep emerged: The importance of adequate nighttime sleep, the influence of family and friends on parental sleep practices, the relationship between environmental and home dynamics on child sleep duration, the impact of acute and chronic societal-level stressors on family sleep health, and considerations for culturally tailored interventions to improve child sleep health. CONCLUSIONS Good sleep health was important among African American mothers. Cultural-environmental and societal factors significantly impact children's sleep health. Clinicians and researchers should be aware of financial resources and home dynamics leading to challenges with adequate sleep health when developing or adapting sleep interventions. Identifying cultural-environmental, and societal factors must be considered for targeted efforts to improve sleep health in African American children.
Collapse
Affiliation(s)
- Rochelle Cason-Wilkerson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Ashley Sherrill
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Darcy A Thompson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill L Kaar
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
van der Linden M, Veldhoen ES, Arasteh E, Long X, Alderliesten T, de Goederen R, Dudink J. Noncontact respiration monitoring techniques in young children: A scoping review. Pediatr Pulmonol 2024; 59:1871-1884. [PMID: 38661255 DOI: 10.1002/ppul.27028] [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: 10/13/2023] [Revised: 03/22/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Pediatric sleep-related breathing disorders, or sleep-disordered breathing (SDB), cover a range of conditions, including obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation disorders, and sleep-related hypoxemia disorder. Pediatric SDB is often underdiagnosed, potentially due to difficulties associated with performing the gold standard polysomnography in children. This scoping review aims to: (1) provide an overview of the studies reporting on safe, noncontact monitoring of respiration in young children, (2) describe the accuracy of these techniques, and (3) highlight their respective advantages and limitations. PubMed and EMBASE were searched for studies researching techniques in children <12 years old. Both quantitative data and the quality of the studies were analyzed. The evaluation of study quality was conducted using the QUADAS-2 tool. A total of 19 studies were included. Techniques could be grouped into bed-based methods, microwave radar, video, infrared (IR) cameras, and garment-embedded sensors. Most studies either measured respiratory rate (RR) or detected apneas; n = 2 aimed to do both. At present, bed-based approaches are at the forefront of research in noncontact RR monitoring in children, boasting the most sophisticated algorithms in this field. Yet, despite extensive studies, there remains no consensus on a definitive method that outperforms the rest. The accuracies reported by these studies tend to cluster within a similar range, indicating that no single technique has emerged as markedly superior. Notably, all identified methods demonstrate capability in detecting body movements and RR, with reported safety for use in children across the board. Further research into contactless alternatives should focus on cost-effectiveness, ease-of-use, and widespread availability.
Collapse
Affiliation(s)
- Marjolein van der Linden
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center of Home Mechanical Ventilation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emad Arasteh
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Thomas Alderliesten
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robbin de Goederen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
DeBoer EM, Smith BM, Williamson AA, Tapia IE, Gaffin JM, Hamlington KL, Zeeman JM, McLaughlin J, Hatch J, Davis SD, Flower KB, Tschudy MM. Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference. Pediatr Pulmonol 2024. [PMID: 38869166 DOI: 10.1002/ppul.27129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND OBJECTIVES The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. STUDY DESIGN A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. RESULTS Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. CONCLUSIONS To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.
Collapse
Affiliation(s)
- Emily M DeBoer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brandon M Smith
- Division of General Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Ballmer Institute, University of Oregon, Portland, Oregon, USA
| | - Ignacio E Tapia
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pediatric Pulmonology, University of Miami, Miami, Florida, USA
| | - Katharine L Hamlington
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jacqueline M Zeeman
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Jacqueline McLaughlin
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Joseph Hatch
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kori B Flower
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Megan M Tschudy
- Division of General Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med 2024; 20:595-601. [PMID: 38217477 PMCID: PMC10985290 DOI: 10.5664/jcsm.10936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
STUDY OBJECTIVES To examine the risk of increased health care utilization (HU) linked to individual sleep disorders in children with chronic medical conditions. METHODS Medicaid claims data from a cohort of 16,325 children enrolled in the Coordinated Healthcare for Complex Kids (CHECK) project were used. Sleep disorders and chronic medical conditions were identified using International Classification of Diseases, Ninth, and 10th Revision, codes. Three HU groups were identified based on participants' prior hospitalizations and emergency department (ED) visits in the 12 months prior to enrollment: low (no hospitalization or ED visit), medium (1-2 hospitalizations or 1-3 ED visits), and high (≥ 3 hospitalizations or ≥ 4 ED visits). The odds of being in an increased HU group associated with specific sleep disorders after controlling for confounding factors were examined. RESULTS Children with chronic medical conditions and any sleep disorder had nearly twice the odds (odds ratio = 1.83; 95% confidence interval: 1.67-2.01) of being in an increased HU group compared with those without a sleep disorder. The odds of being in the increased HU group varied among sleep disorders. Only sleep-disordered breathing (odds ratio = 1.51; 95% confidence interval : 1.17-1.95), insomnia (odds ratio = 1.46; 95% confidence interval : 1.06-2.02), and circadian rhythm sleep disorder (odds ratio = 2.45; 95% confidence interval : 1.07-5.64) increased those odds. Younger age and being White were also linked to increased HU. CONCLUSIONS Sleep disorders are associated with increased risk of heightened HU (ED visits and/or hospitalizations) in children with chronic medical conditions. This risk varies by specific sleep disorders. These findings indicate the need for careful evaluation and management of sleep disorders in this high-risk cohort. CITATION Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med. 2024;20(4):595-601.
Collapse
Affiliation(s)
| | - Lee Brooks
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | | | - Alan Schwartz
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Kenneth Rasinski
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Molly A. Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
8
|
Rischard ME, Buck TR, Pruiksma KE, Johns A, Cromer LD. Construction and Initial Examination of Inter-Rater Reliability of a Structured Clinical Interview for DSM-5-TR Sleep Disorders (SCISD) - Kid. Behav Sleep Med 2024:1-18. [PMID: 38457486 DOI: 10.1080/15402002.2024.2324035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
STUDY OBJECTIVES To construct and evaluate the inter-rater reliability of the Structured Clinical Interview for DSM-5-TR Sleep Disorders - Kid (SCISD-Kid). METHOD The SCISD-Kid was modeled on the adult SCISD-R and accounted for pediatric developmental and sociocultural factors. Fifty sleep-disturbed children (Mage = 11.9, SD = 2.9) and 50 caregivers responded to the final SCISD-Kid. Video recordings were double-scored to evaluate inter-rater reliability. RESULTS The final SCISD-Kid contained approximately 90 questions. Eight of the nine covered disorders had prevalence rates sufficient for analyses for both samples (i.e., k > 2). Inter-rater reliability was examined using Cohen kappa coefficients (κ); reliability estimates ranged from excellent to good. For youth, restless legs syndrome yielded the lowest reliability (.48), while nightmare disorder, narcolepsy, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00). Across caregivers, NREM sleep arousal disorder - sleep terror type (.49) and hypersomnolence (.54) had the lowest reliability. In contrast, circadian rhythm - delayed sleep phase type, nightmare disorder, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00). CONCLUSIONS The SCISD-Kid is a promising tool for screening sleep disorders. It showed good to excellent reliability across both samples. Next steps for validation will be discussed.
Collapse
Affiliation(s)
| | - Tara R Buck
- Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Kristi E Pruiksma
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Aviva Johns
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Lisa D Cromer
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| |
Collapse
|
9
|
Yu MWL, Au CT, Yuen HM, Chan NY, Chan JW, Wing YK, Li AM, Chan KCC. Effects of childhood obstructive sleep apnea with and without daytime sleepiness on behaviors and emotions. Sleep Med 2024; 115:93-99. [PMID: 38350308 DOI: 10.1016/j.sleep.2024.01.025] [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: 09/22/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the relationship between obstructive sleep apnea (OSA) with and without excessive daytime sleepiness (EDS) and behavioral and emotional outcomes in non-obese prepubertal children. METHODS This was a retrospective analysis of children aged 5-11 years who presented to our unit for assessment of their sleep-related complaints. All children underwent polysomnography (PSG). They also completed the Pediatric Daytime Sleepiness Scale (PDSS) and a sleep diary. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was ≥1 event/hour. EDS was defined as PDSS >15. Behavioral and emotional outcomes were assessed using the Child Behavioral Checklist (CBCL). RESULTS Data from 391 children (mean age of 8.6 ± 1.7 years; 67 % male) were analyzed. Seventy children did not have OSA or EDS, 137 had OSA, 50 had reported having EDS but without OSA, and 134 children had both OSA and EDS. There were significantly higher CBCL total problems score in the combined group (61 ± 9) compared to the non-OSA/EDS group (54 ± 10), and the OSA-only group (54 ± 10) (p < 0.001). The presence of EDS was significantly associated with higher CBCL T score and higher odds for clinically significant behavioral problems (T score ≥65) after adjusting for age, sex, BMI z-score and average sleep duration (p < 0.001). CONCLUSION Excessive daytime sleepiness is an important contributory factor associated with suboptimal behavioral and emotional outcomes in children with OSA.
Collapse
Affiliation(s)
- Michelle Wai-Ling Yu
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ting Au
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hoi-Man Yuen
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan-Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching-Ching Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
10
|
Baddam SKR, Canapari CA, Van de Grift J, McGirr C, Nasser AY, Crowley MJ. Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:65-86. [PMID: 38302214 DOI: 10.1016/j.psc.2023.06.005] [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
Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.
Collapse
Affiliation(s)
- Suman K R Baddam
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA.
| | - Craig A Canapari
- Pediatric Pulmonology, Allergy, Immunology & Sleep Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA
| | - Jenna Van de Grift
- Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Christopher McGirr
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | | | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| |
Collapse
|
11
|
Himelfarb M, Shatkin JP. Pediatric Insomnia. Psychiatr Clin North Am 2024; 47:121-134. [PMID: 38302201 DOI: 10.1016/j.psc.2023.06.008] [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
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
Collapse
Affiliation(s)
- Madeline Himelfarb
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Jess P Shatkin
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA.
| |
Collapse
|
12
|
Donbaloğlu Z, Barsal Çetiner E, İnan Yüksel A, Singin B, Aydın Behram B, Bedel A, Parlak M, Tuhan H. Sleep disturbances in children and adolescents with type 1 diabetes mellitus: Prevalence, and relationship with diabetes management. Sleep Med 2024; 115:55-60. [PMID: 38330696 DOI: 10.1016/j.sleep.2024.01.031] [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] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE A decline in sleep quality and regularity has been reported in patients with type 1 diabetes mellitus (T1D) in many studies. However, research on medical-based sleep disorders in patients with T1D is limited. Diagnosing sleep disorders is crucial, as it negatively impacts academic performance, cardiovascular health, and cognitive functions among children as well as essential skills for effective diabetes management. Our objective was to assess sleep disturbances in patients diagnosed with T1D and explore whether these patients experience significantly more sleep disturbances compared to their healthy peers. METHODS This study, designed as a cross-sectional case-control investigation, involved a cohort of 250 participants (144 T1D, 106 control cases) aged 6-15 years. The Sleep Disturbance Scale for Children (SDCS) scores of the T1D group were compared with those of the control group. Furthermore, the study explored the correlation between clinical/biochemical parameters and SDCS scores within the T1D group. RESULTS The mean age of individuals in the T1D group was 10.27 ± 3.25 years, while the control group had a comparable mean age of 10.48 ± 3.5 years (P = 0.303). Within the T1D group, the median duration of diabetes was 5 (1-15) years, and the median glycosylated hemoglobin A1c (HbA1c) level for the past one year was 8.4 %. Although there was no significant difference in total SDSC scores between the T1D and control groups, both groups exhibited average scores that remained close to the threshold indicative of sleep disturbances (>39). Notably, individuals with total SDSC scores surpassing 39 were identified at rates of 48.6 % in the T1D group and 47.6 % in the control group, respectively. Furthermore, disorders of arousal nightmares (DA) were more prevalent in T1D patients compared to their healthy peers (P = 0.049). Additionally, HbA1c showed a positive correlation with scores for disorders of excessive somnolence (DOES) and total scores (P < 0.001, R = 0.368; P = 0.003, R = 0.243). CONCLUSION Our study found that the prevalence of sleep disturbances among children and adolescents with T1D was not significantly higher than that observed in their healthy peers. Nevertheless, it is crucial to note that a notable portion, 48.6 % of T1D cases and 47.6 % of healthy cases, displayed sleep disturbances based on SDSC scores. To optimize diabetes management and proactively address potential challenges, incorporating routine screening for sleep disturbances in the monitoring of T1D patients can yield valuable benefits.
Collapse
Affiliation(s)
- Zeynep Donbaloğlu
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Ebru Barsal Çetiner
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Aynur İnan Yüksel
- Department of Pediatrics, Akdeniz University Hospital, Antalya, Turkey
| | - Berna Singin
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Bilge Aydın Behram
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Aynur Bedel
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Hale Tuhan
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey.
| |
Collapse
|
13
|
Davenport MA, Sirrianni JW, Chisolm DJ. Machine learning data sources in pediatric sleep research: assessing racial/ethnic differences in electronic health record-based clinical notes prior to model training. FRONTIERS IN SLEEP 2024; 3:1271167. [PMID: 38817450 PMCID: PMC11138315 DOI: 10.3389/frsle.2024.1271167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Introduction Pediatric sleep problems can be detected across racial/ethnic subpopulations in primary care settings. However, the electronic health record (EHR) data documentation that describes patients' sleep problems may be inherently biased due to both historical biases and informed presence. This study assessed racial/ethnic differences in natural language processing (NLP) training data (e.g., pediatric sleep-related keywords in primary care clinical notes) prior to model training. Methods We used a predefined keyword features set containing 178 Peds B-SATED keywords. We then queried all the clinical notes from patients seen in pediatric primary care between the ages of 5 and 18 from January 2018 to December 2021. A least absolute shrinkage and selection operator (LASSO) regression model was used to investigate whether there were racial/ethnic differences in the documentation of Peds B-SATED keywords. Then, mixed-effects logistic regression was used to determine whether the odds of the presence of global Peds B-SATED dimensions also differed across racial/ethnic subpopulations. Results Using both LASSO and multilevel modeling approaches, the current study found that there were racial/ethnic differences in providers' documentation of Peds B-SATED keywords and global dimensions. In addition, the most frequently documented Peds B-SATED keyword rankings qualitatively differed across racial/ethnic subpopulations. Conclusion This study revealed providers' differential patterns of documenting Peds B-SATED keywords and global dimensions that may account for the under-detection of pediatric sleep problems among racial/ethnic subpopulations. In research, these findings have important implications for the equitable clinical documentation of sleep problems in pediatric primary care settings and extend prior retrospective work in pediatric sleep specialty settings.
Collapse
Affiliation(s)
- Mattina A. Davenport
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Joseph W. Sirrianni
- Abigail Wexner Research Institute, IT Research and Innovation, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Deena J. Chisolm
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
14
|
Liu J, Ji X, Rovit E, Pitt S, Lipman T. Childhood sleep: assessments, risk factors, and potential mechanisms. World J Pediatr 2024; 20:105-121. [PMID: 36441394 PMCID: PMC9702880 DOI: 10.1007/s12519-022-00628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed. DATA SOURCES A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included. RESULTS This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children. CONCLUSIONS Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.
Collapse
Affiliation(s)
- Jianghong Liu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA, 19104, USA.
| | - Xiaopeng Ji
- School of Nursing, College of Health Sciences, University of Delaware, Newark, DE, 19716, USA
| | - Elizabeth Rovit
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA, 19104, USA
| | - Susannah Pitt
- Geisinger Commonwealth School of Medicine, Scranton, PA, 18510, USA
| | - Terri Lipman
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA, 19104, USA
| |
Collapse
|
15
|
Leung TNH, Wong KL, Chan AKC, Li AM. Common Childhood Sleep Problems and Disorders. Curr Pediatr Rev 2024; 20:27-42. [PMID: 36043722 DOI: 10.2174/1573396318666220827102018] [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: 02/20/2022] [Revised: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. OBJECTIVE To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. METHODS A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. RESULTS Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. CONCLUSION Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.
Collapse
Affiliation(s)
- Theresa Ngan Ho Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kin Lok Wong
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony Kam Chuen Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
16
|
Dye TJ. Diagnosis and Treatment of Disorders of Sleep in Children: Current Concepts. Semin Pediatr Neurol 2023; 48:101102. [PMID: 38065638 DOI: 10.1016/j.spen.2023.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| |
Collapse
|
17
|
Gorovoy SB, Tubbs AS, Grandner MA. Sleep disorders symptoms in children, adolescents, and emerging adults: Reducing mortality and population health burden through improved identification, referral, and treatment. Sleep Health 2023; 9:991-992. [PMID: 37648647 PMCID: PMC11041109 DOI: 10.1016/j.sleh.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Suzanne B Gorovoy
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA.
| | - Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| |
Collapse
|
18
|
Paulsrud C, Thorsen SU, Helms P, Weis MSF, Karacan MN, Lydolph SR, Ranjan AG, Leonthin H, Jennum PJ, Svensson J, Mol Debes N. Validation of the newly developed Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) with objective sleep measures. Sleep Med 2023; 112:359-367. [PMID: 37979560 DOI: 10.1016/j.sleep.2023.10.010] [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: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Objectively validated pediatric sleep questionnaires covering a broader age range and different sleep disturbances are lacking, therefore we developed the Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) and compared it with objective sleep parameters. METHODS This child-reported questionnaire was developed by a multidisciplinary panel and face validated. In a cross-sectional prospective design, participants aged 6-17, answered the questionnaire twice with 21-28 days in between, wore actigraphy (AG) and kept a sleep diary for seven nights and home-polysomnography (PSG) for one of these nights. Exploratory factor analyses (EFA), reliability and validity assessments were performed. RESULTS Of the 139 participants, 128 (F:47.7%, AG: n = 128, PSG: n = 59), were included in the analyses. Mean age: 11.3 years (SD: 2.9). EFA revealed 11 factors and 40 items loading above r = 0.4. Subscale internal consistency: 0.54-0.92. Subscale test-retest reliability: r = 0.71-0.87. Total sleep time (TST) from SSQ-CA on weekdays correlated with PSG (r = 0.48, p = 0.001) and with AG (r = 0.75, p < 0.001). The subscale total score for "Sleep duration and latency" correlated with TST from AG (r = -0.19, p = 0.03) and sleep latency (r = 0.31, p < 0.001), but not for PSG variables. The subscale "Awakenings" showed no correlation with objective measures whereas "Circadian rhythm" correlated to AG-derived mid-sleep time (r = 0.34, p < 0.001). CONCLUSIONS The SSQ-CA shows adequate reliability for the 6-17-year-olds and acceptable criterion validity for two subscales. It appears to be a useful tool for screening for sleep disturbances in combination with objective tools as the subjective and objective parameters seem to uncover different aspects of sleep.
Collapse
Affiliation(s)
- Cecilie Paulsrud
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark.
| | | | - Pernille Helms
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Mia Sofie F Weis
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Munise N Karacan
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Siff R Lydolph
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | | | | | | | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Oh A, Koehler A, Yonker M, Troester M. Sleep Disorders and Chronic Pain Syndromes in the Pediatric Population. Semin Pediatr Neurol 2023; 48:101085. [PMID: 38065632 DOI: 10.1016/j.spen.2023.101085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023]
Abstract
Sleep problems are widespread in children and adolescents suffering from chronic pain disorders. Sleep loss intensifies the experience of pain and is detrimental to the budding self-efficacy of a young individual with limitless horizons. Addressing sleep disorders may prevent the chronification of pain and prevent adverse health outcomes, such as functional impairment, psychiatric comorbidities and overall poor quality of life. This review will explore the cyclical nature between sleep, pain and mood, as well as the functional impact of this relationship on children and adolescents. There will be a discussion about sleep assessment and diagnostic testing, followed by a description of sleep disturbances found in specific pain conditions, ranging from headache, musculoskeletal/abdominal pain, to rheumatologic disorders. Finally, there will be a brief review of pharmacologic and behavioral interventions designed to improve sleep quality, and when possible, to alleviate pain.
Collapse
Affiliation(s)
- Ann Oh
- Division of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall, 550 16th Street, 5th Floor, San Francisco, CA 94158, USA.
| | - Angelina Koehler
- Division of Neurology, Pediatric Headache Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Marcy Yonker
- Division of Neurology, Pediatric Headache Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | |
Collapse
|
20
|
Zeghari R, Gindt M, Guivarch J, Auby P, Robert P, Rolling J, Schröder C, Valo P, Askenazy F, Fernandez A. July 14th 2016 Nice Terrorist Attack Court Trial: A Protocol on Sleep Quality and Somatic Symptoms as Markers of Risk for Traumatic Reactivation in Adolescents Exposed to This Attack. Healthcare (Basel) 2023; 11:2953. [PMID: 37998445 PMCID: PMC10671086 DOI: 10.3390/healthcare11222953] [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: 09/17/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The court trial of the 14th of July 2016 terrorist attack in Nice (France) opened in September 2022 and ended in December 2022. Engaging in court proceedings, whether as a victim or a witness, can lead to a significant risk of traumatic reactivation (i.e., the re-emergence of post-traumatic stress symptoms). The present protocol aimed to improve knowledge of the pathophysiology of traumatic reactivation due to the media coverage of the trial by assessing sleep disturbances and somatic symptoms that could reappear if there is a traumatic reactivation. Method and Analysis: This is a monocentric longitudinal study, with recruitment solely planned at the Nice Pediatric Psychotrauma Center (NPPC). We intended to include 100 adolescents aged 12 to 17 years who were directly or indirectly exposed to the attack and included in the "14-7" program). Assessments began one month before the trial, in August 2022, and were scheduled once a month until the end of the trial. A smartwatch recorded sleep activity. Somatic and PTSD symptoms and sleep were assessed through validated questionnaires. The main analyses comprised the variance and regression analyses of predictors of clinical evolution over time. Ethics and Dissemination: The National Ethics Committee "NORD OUEST III" approved the "14-7" program protocol (number 2017-A02212-51). The specific amendment for this research was approved in April 2022 by the same national ethical committee. Inclusions started in August 2022.
Collapse
Affiliation(s)
- Radia Zeghari
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Morgane Gindt
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Jokthan Guivarch
- Department of Child Psychiatry, APHM, 13009 Marseille, France;
- CANOP Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix Marseille University, 13005 Marseille, France
- Faculty of Medicine, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Auby
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Philippe Robert
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Julie Rolling
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, 67000 Strasbourg, France
| | - Petri Valo
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Florence Askenazy
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Arnaud Fernandez
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| |
Collapse
|
21
|
Gissandaner TD, Stearns MA, Sarver DE, Walker B, Ford H. Understanding the Impact of Insufficient Sleep in Children with Behavior Problems on Caregiver Stress: Results from a U.S. National Study. Clin Child Psychol Psychiatry 2023; 28:1550-1564. [PMID: 36781225 PMCID: PMC10423297 DOI: 10.1177/13591045231156342] [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] [Indexed: 02/15/2023]
Abstract
Research indicates strong connections between child ADHD, child ODD/CD, and sleep. Children experiencing these concerns also have caregivers who report feeling more stress. However, no studies have examined how child ADHD and ODD/CD interact together and with insufficient sleep to potentially exacerbate caregiver stress. Data were acquired from the 2018/2019 National Survey of Children's Health, a nationally representative survey of parents or caregivers conducted across the United States (U.S.). The current study used data for children 6-17 years old with a final analytic sample size of 41,541, representing a total of 47,357,862 U.S. youth. Overall child ADHD and ODD/CD were each uniquely associated with increased caregiver stress, while adequate child sleep duration was related to decreased caregiver stress. However, these findings were qualified by a significant two-way interaction that revealed that caregiver stress among children with comorbid ADHD and ODD/CD was not significantly greater than that of children with ODD/CD alone. Significant interactions between sleep and ODD/CD on caregiver stress were generally not observed, except potentially in females with ADHD. Our findings underscore the importance of considering strategies to reduce both youth symptoms and caregiver stress simultaneously. Additionally, ensuring adequate sleep for all children is recommended.
Collapse
Affiliation(s)
- Tre D Gissandaner
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Hannah Ford
- University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
22
|
Carson M, Cicalese O, Bhandari E, Stefanovski D, Fiks AG, Mindell JA, Williamson AA. Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral. Acad Pediatr 2023; 23:1234-1241. [PMID: 36764578 PMCID: PMC10409870 DOI: 10.1016/j.acap.2023.02.001] [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: 10/06/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (ie, habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent. METHODS The sample included 170 caregiver-child dyads (child Mage = 3.3 years, range = 2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record. RESULTS About 92.3% of children had at least 1 caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine). CONCLUSIONS There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.
Collapse
Affiliation(s)
- Mikayla Carson
- Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa
| | - Olivia Cicalese
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa
| | - Esha Bhandari
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa
| | - Darko Stefanovski
- Veterinary School of Medicine (D Stefanovski), University of Pennsylvania, Philadelphia, Pa
| | - Alexander G Fiks
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa
| | - Jodi A Mindell
- Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa; Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa
| | - Ariel A Williamson
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa.
| |
Collapse
|
23
|
Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
Collapse
|
24
|
Lupini F, Williamson AA. Health Disparities in Pediatric Sleep. Sleep Med Clin 2023; 18:225-234. [PMID: 37120165 PMCID: PMC10210975 DOI: 10.1016/j.jsmc.2023.01.005] [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: 02/27/2023]
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.
Collapse
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.
| |
Collapse
|
25
|
Ghermezian A, Nami M, Shalbaf R, Khosrowabadi R, Nasehi M, Kamali AM. Sleep Micro-Macro-structures in Psychophysiological Insomnia. PSG Study. SLEEP AND VIGILANCE 2023; 7:1-9. [PMID: 37361911 PMCID: PMC10106013 DOI: 10.1007/s41782-023-00228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/24/2023] [Accepted: 04/03/2023] [Indexed: 06/28/2023]
Abstract
Study Objectives To address sleep micro-macro-structures in psychophysiological insomnia (PPI) as denoted by cyclic alternating pattern (CAP), Sleep spindles, and hyperarousal as microstructures and sleep characteristics such as sleep stages' variables, and heart rate as macrostructures. Methods Two statistical populations, with 20 participants in each, are addressed: good sleepers (GS) and patients with psychophysiological insomnia (PPI). The sleep polysomnography (PSG) for one night was performed and sleep macro-micro-structures extraction was implemented for each participant. Cyclic alternating patterns were scored manually and other structures were monitored by the original PSG's device software. Analytical methods are used to dissect the results. Result The findings imply: (a) psychophysiological insomnia is characterized by CAP differences from good sleepers which are associated with hyperarousal; (b) Regarding microstructure, more microarousals in sleep stages caused more number of wake index. (c) The ratio of sleep stages, sleep latency and heart rate as sleep macrostructure are significantly changed. (d) There is no significant difference between PPI and GS groups on spindles length in our research. Conclusion Regarding all sleep disorders and especially PPI, CAP variables, EEG arousals, and sleep spindles as microstructures and Total Sleep Time, Sleep Latency, number of waking, REM duration, and Heart Rate as macrostructures were found to be critical for the diagnosis of psychophysiological insomnia The analysis contributes to understanding better approaches in the quantitative specification of psychophysiological insomnia compare to good sleepers.
Collapse
Affiliation(s)
- Ali Ghermezian
- Shahid Beheshti University, Shahid Shahriari Square, Evin, Tehran, Iran
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies, Tehran, Iran
- Dana Brain Health Institute, Shiraz, Iran
| | - Mohammad Nami
- Brain, Cognition, and Behavior Unit at Dana Brain Health Institute, Shiraz, Iran
- Harvard Alumni for Mental Health dataset, Middle-East Ambassador, Dubai, UAE
- Iranian Academy of Neuroscience, Fars Chapter, Shiraz, Iran
- Society for Brain Mapping and Therapeutics, Brain Mapping Foundation, Los Angeles, CA USA
| | - Reza Shalbaf
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies, Tehran, Iran
| | - Reza Khosrowabadi
- Shahid Beheshti University, Shahid Shahriari Square, Evin, Tehran, Iran
| | - Mohammad Nasehi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies, Tehran, Iran
- Cognitive and Neuroscience research center(cnrc), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Dana Brain Health Institute, Shiraz, Iran
| |
Collapse
|
26
|
AlEidan A, Al-Shamrani M, AlGhofaily M, AlDraiweesh N, AlGhamdi B, AlHabshan H, Kobeisy S, Alharbi S, Al-Shamrani A. Prevalence of sleep problems and habits among children in Saudi Arabia: A cross-sectional study. Saudi Med J 2023; 44:289-295. [PMID: 36940968 PMCID: PMC10043900 DOI: 10.15537/smj.2023.44.3.20220894] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVES To investigate children's sleep problems, habits, and lifestyle changes. METHODS A cross-sectional study was carried out in Riyadh, Saudi Arabia, over a period of 2 months, from August through September 2022, with parents of children aged 2-14 years after reviewing the literature and formulating a validated Google questionnaire containing 30 questions related to sleep habits, problems, and disorders. RESULTS In total, 585 questionnaires were included in the analysis. The sample comprised 345 (59%) males and 240 (41%) females. The mean age of patients was 7 (range: 2-14) years. Bed-time resistance was the most prevalent sleep problem (70.3%), followed by sleep-onset delay (58.1%), difficulty waking up in the morning on weekdays (41.3%), weekends (38%), and interrupted sleep (31%). An alarmingly high prevalence of hyperactivity (41.8%) and aggressive behaviour (42.2%) was noted. Co-sleeping with parents was reported in 41% of children. Night terror was reported in 20.6% and 26.5% in nightmares. Statistically significant associations were noted between screen time, snoring, and witnessed apnoea with sleep problems. CONCLUSION Sleep problems are common among children in Saudi Arabia. The study sheds some light on sleep habits and practices in this age group in Saudi Arabia, such as the high prevalence of bed-time resistance and sleep-onset delay, hyperactivity, and sleep-affecting culprits such as screen time, snoring, and witnessed apnoea.
Collapse
Affiliation(s)
- Ahmed AlEidan
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mohammad Al-Shamrani
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mazen AlGhofaily
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Najlaa AlDraiweesh
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Basem AlGhamdi
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Hattan AlHabshan
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Summayah Kobeisy
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Saleh Alharbi
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Abdullah Al-Shamrani
- From the Department of Pediatrics (AlEidan, AlGhofaily), King Fahad Medical City, from the Department of Pediatrics (M. Al-Shamrani, AlDraiweesh, AlGhamdi, AlHabshan), Sulaiman AlHabib Medical Center, from the Department of Pediatrics (A. Al-Shamrani), Prince Sultan Military Medical City, from the Department of Pediatrics (A. Al-Shamrani), Al Faisal University, Riyadh, from the Department of Pediatrics (Kobeisy, Alharbi), Fakeeh Hospital, Jeddah, and from the Department of Pediatrics (Alharbi), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| |
Collapse
|
27
|
Papadopoulos D, Sosso FAE. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med 2023; 19:605-620. [PMID: 36239056 PMCID: PMC9978435 DOI: 10.5664/jcsm.10336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship. METHODS Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions. RESULTS Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship. CONCLUSIONS Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes. CITATION Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.
Collapse
|
28
|
Fang Y, van Grieken A, Windhorst DA, Fierloos IN, Jonkman H, Hosman CMH, Wang L, Crone MR, Jansen W, Raat H. Longitudinal associations between parent, child, family factors and dyssomnias in children from birth to 8 years: The CIKEO study. J Affect Disord 2023; 323:496-505. [PMID: 36513160 DOI: 10.1016/j.jad.2022.12.012] [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: 12/01/2021] [Revised: 11/23/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dyssomnias, are the most common parent-reported sleep complaints in young children. The present study investigated the prevalence, one-year development (incidence and persistence) of dyssomnia in early childhood, and the parent, child, and family factors associated with dyssomnia. METHODS Longitudinal data of 700 children aged 0-8, gathered in the CIKEO cohort study in the Netherlands were analyzed. Dyssomnias were defined as the presence of night awakenings ≥3 times per night or sleep-onset latency of >30 min. Least absolute shrinkage and selection operator (LASSO) was used to identify the parental, child, and family factors associated with the incidence and persistence of dyssomnias in children. RESULTS The mean age of the children (47 % girls) was 3.2 ± 1.9 years at baseline and 4.4 ± 1.8 years at follow-up. The prevalence of dyssomnias was 13.3 % and 15.4 % at baseline and follow-up, respectively. The incidence and persistence rates of dyssomnias at follow-up were 12.0 % and 37.6 %, respectively. New incidence of insomnia was associated with being a girl, having medical conditions, experiencing stressful life events, and lower parenting self-efficacy at baseline (P < 0.05). Higher levels of parental psychological distress were associated with the persistence of dyssomnias in children (P < 0.05). CONCLUSIONS Dyssomnias are common with a moderate persistent rate in young children. Several parental, child, and family factors in relation to the incidence and persistence of dyssomnias were identified. Preventive programs and interventions targeting modifiable factors, particularly parental psychological distress, parenting self-efficacy, and resilience to stressful life events, might benefit child sleep.
Collapse
Affiliation(s)
- Yuan Fang
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Dafna A Windhorst
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; TNO Child Health, Leiden, the Netherlands
| | - Irene N Fierloos
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Clemens M H Hosman
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands; Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands; Hosman Prevention and Innovation Consultancy, Berg en Dal, the Netherlands
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Matty R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands; Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| |
Collapse
|
29
|
Insomnia in Infancy, Childhood, and Adolescence. Sleep Med Clin 2023; 18:135-145. [PMID: 37120157 DOI: 10.1016/j.jsmc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, cause, and treatment of pediatric insomnia, highlighting areas that warrant further research and addressing the unique characteristics of this disorder in infants, children, and adolescents.
Collapse
|
30
|
Nuo M, Fang H, Wang T, Liang J, He Y, Han H, Lei J. Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews. Digit Health 2023; 9:20552076231165967. [PMID: 37051563 PMCID: PMC10084565 DOI: 10.1177/20552076231165967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Objectives In solving the global challenge of sleep disorders, Mobile Health app is one of the important means to monitor, diagnose, and intervene in sleep disorders. This study aims to (1) summarize the status and trends of research in this field; (2) assess the production and usage of sleep mHealth apps; (3) calculate the conversion rate of grants that the proportion of newly developed apps from being funded and developed to published on application stores. Methods Using bibliometric and content analysis methods, based on "Research Paper-Product Output-Product Application" chain and considering the "Research Grants" of articles, we conducted a systematic review of eight databases, to identify relevant studies over the last decade. Results Over the past decade, 1399 authors published 313 papers in 182 journals and conferences. The number of publications increased with an average annual growth of 41.6%. The current focus area is research using cognitive behavioral therapy to intervene in sleep. Sleep-staging tracking is a shortcoming of this field. A total 368 sleep mHealth apps (233 newly developed and 135 existing) were examined in 313 papers; 323 grants supported 178 articles (56.9%). Only 12 of the newly developed apps are used in the real world, resulting in a 9% grant conversion rate. Conclusions In the last decade, the field of tracking, diagnosing, and intervening in sleep disorders using mHealth apps has shown a trend of rapid development. However, the conversion rate of products from being funded and developed for use by end-users is low.
Collapse
Affiliation(s)
- Mingfu Nuo
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
| | - Hongjuan Fang
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunfan He
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Hongbin Han
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Department of Radiology, Peking University Third Hospital, Health Science Center, Peking University, Beijing, China
| | - Jianbo Lei
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Center for Medical Informatics, Health Science Center, Peking University, Beijing, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
- Jianbo Lei, Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China.
| |
Collapse
|
31
|
Hosokawa R, Tomozawa R, Fujimoto M, Anzai S, Sato M, Tazoe H, Katsura T. Association between sleep habits and behavioral problems in early adolescence: a descriptive study. BMC Psychol 2022; 10:254. [PMID: 36335370 PMCID: PMC9636702 DOI: 10.1186/s40359-022-00958-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sleep habits are related to children's behavior, emotions, and cognitive functioning. A strong relationship exists between sleep habits and behavioral problems. However, precisely which sleep habits are associated with behavioral problems remains unclear. Therefore, the purpose of this study is to clarify the relationship between sleep habits and behavioral problems in early adolescence. Methods This study used data from a larger longitudinal research, specifically, data from the year 2021. First-year junior high school students (12–14 years) in Japan were surveyed; their parents (N = 1288) completed a parent-report questionnaire. The main survey items were subject attributes, the Pittsburgh Sleep Quality Index (PSQI), and the Strength and Difficulties Questionnaire (SDQ). Results Of the 652 valid responses received, 604 individuals who met the eligibility criteria (no developmental disability in the child and completion of all survey items) were included in the analysis. To examine the relationship between sleep habits and behavioral problems, logistic regression analysis using the inverse weighted method with propensity score was conducted with sleep habits (sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep difficulty, use of sleeping pills, difficulty waking during the day, and sleep disturbances) as explanatory variables and behavioral problems (overall difficulty in SDQ) as objective variables. The propensity score was calculated by employing the logistic regression using the inverse weighted method based on propensity scores. Propensity scores were calculated based on gender, family structure, household income, and parental educational background. The results showed that behavioral problems tended to be significantly higher in the group at risk for sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances than in the group with no risk. Conclusion The results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.
Collapse
Affiliation(s)
- Rikuya Hosokawa
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Riho Tomozawa
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Megumi Fujimoto
- grid.444356.40000 0004 0616 2895Osaka Seikei University, Osaka, 533-0007 Japan
| | - Sumire Anzai
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Mai Sato
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Haruko Tazoe
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Toshiki Katsura
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan ,grid.410780.a0000 0004 0642 4306Faculty of Nursing, Meiji University of Integrative Medicine, Kyoto, 629-0392 Japan
| |
Collapse
|
32
|
Lee JW, Hwang J, Hyun MK. Prevalence and Treatment Patterns of Sleep Disorders in the Under 20 Population: analysis using a national health insurance claims database. J Pharmacopuncture 2022; 25:276-289. [PMID: 36186096 PMCID: PMC9510137 DOI: 10.3831/kpi.2022.25.3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Child and adolescent sleep is an important factor for brain and physical development. Therefore, it is necessary to investigate the prevalence of sleep disorders and nonorganic sleep disorders in children and adolescents and determine the type of utilization of medical institutions. This study analyzed the prevalence and type of medical institutions in Korean children and adolescents with sleep disorders and nonorganic sleep disorders. Methods This study used data recorded in the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database from 2010 to 2017. Details of medical institution type and patient’s sex, age, and treatment type were extracted for patients younger than 20 years with sleep disorders and nonorganic sleep disorders. Results Among 2,536,478 patients under age 20, we identified 3,772 patients with sleep disorders or nonorganic sleep disorders. From 2010 to 2017, the prevalence of sleep disorders in children and adolescents was 0.07% to 0.09%. The utilization rate of Korean medical institutions was 30.47%. The prevalence of nonorganic sleep disorders and the utilization rate of Korean medical institutions were 0.06% to 0.08% and 45.99%, respectively. Conclusion The prevalence of sleep disorders and nonorganic sleep disorders in the under-20 population was 0.14% to 0.16%. More than 70% of patients with nonorganic sleep disorder who were younger than 9 years used Korean medical institutions.
Collapse
Affiliation(s)
- Jang Won Lee
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics, Daegu University, Gyeongsan, Republic of Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| |
Collapse
|
33
|
Corrêa CDC, Maximino LP, Abramides DVM, Weber SAT. Oral language skills in Brazilian children with obstructive sleep apnea. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104300. [PMID: 35810542 DOI: 10.1016/j.ridd.2022.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/22/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a negative impact on neurocognitive development in children. Receptive/expressive oral language is a complex process, with limited investigations on the repercussion of OSA. This study aimed to analyze receptive and expressive oral language skills in children with obstructive sleep apnea (OSA). METHODOLOGY This study included 52 children (27 females, 51.92 %) with a mean age of 7 ± 2 years (age range of 4-11 years), which underwent type 3 polysomnography (PSG). The participants were divided into N-OSA (n = 16) and OSA (n = 36) groups based on the apnea-hypopnea index. The speech-language therapist evaluated hearing and oral language for phonology, expressive semantics, syntax, receptive semantics (Peabody Image Vocabulary Test), pragmatics, and understanding of verbal instructions (Token Test). RESULTS Oral language assessments showed a difference in the pragmatics subsystem (p = 0.047), with positive correlation between OSA severity and oral language functions such as pragmatics and syntax (desaturation index, p = 0.045). CONCLUSION Obstructive sleep apnea (OSA) had a negative impact on oral language skills, including the syntax and pragmatics subsystems.
Collapse
Affiliation(s)
| | - Luciana Paula Maximino
- Department of Speech-Language Pathology at Dentistry School of Bauru (FOB-USP), Bauru, SP, Brazil.
| | | | - Silke Anna Theresa Weber
- Department of Ophthalmology and Otorhinolaryngology, Botucatu Medical School, UNESP, Botucatu, SP, Brazil.
| |
Collapse
|
34
|
Cooper JN, Koppera S, Bliss AJ, Lind MN. Characteristics associated with caregiver willingness to consider tonsillectomy for a child's obstructive sleep disordered breathing: Findings from a survey of families in an urban primary care network. Int J Pediatr Otorhinolaryngol 2022; 158:111143. [PMID: 35552164 DOI: 10.1016/j.ijporl.2022.111143] [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: 09/28/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Tonsillectomy use is lower among Black children than White children in the U.S. despite their higher prevalence of obstructive sleep disordered breathing (oSDB). We aimed to identify factors associated with parents' willingness to consider tonsillectomy for their child's oSDB and to identify whether parents of Black children are less willing than parents of non-Black children to be willing to consider the procedure. STUDY DESIGN Prospective cohort study. SETTING Primary care network of a tertiary children's hospital. METHODS We surveyed parents/guardians of children aged 2-10 years with oSDB, to assess their knowledge about oSDB and tonsillectomy, perceived severity of their child's oSDB, perceived level of their child's sleep disturbance, perceived risks and benefits of tonsillectomy, stress, trust in their child's primary care physician and physicians in general, and health literacy. We also assessed child clinical and sociodemographic characteristics. Associations between these characteristics and parent/guardian willingness to consider tonsillectomy for their child's oSDB were assessed. RESULTS Of the 59 parents/guardians included, 90% were mothers and 71% were Black. Only 58% of caregivers of Black children but 85% of caregivers of non-Black children were willing to consider tonsillectomy (p = 0.04). Caregivers with another child who had undergone tonsillectomy and caregivers who perceived their child's sleep to be more disturbed were more often willing to consider tonsillectomy (both p = 0.02). CONCLUSIONS Parents of Black children are less willing to consider tonsillectomy for their child's oSDB, but this was not explained by any factors assessed in this study. Future studies should evaluate additional factors that may explain this difference and that might be targeted to ensure appropriate and equitable access to tonsillectomy among children with oSDB.
Collapse
Affiliation(s)
- Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra J Bliss
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Wang LB, Gong YC, Fang QL, Cui XX, Dharmage SC, Jalaludin B, Knibbs LD, Bloom MS, Guo Y, Lin LZ, Zeng XW, Yang BY, Chen G, Liu RQ, Yu Y, Hu LW, Dong GH. Association Between Exposure to Outdoor Artificial Light at Night and Sleep Disorders Among Children in China. JAMA Netw Open 2022; 5:e2213247. [PMID: 35594042 PMCID: PMC9123501 DOI: 10.1001/jamanetworkopen.2022.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Healthy sleep has an important role in the physical and mental health of children. However, few studies have investigated the association between outdoor artificial light at night (ALAN) and sleep disorders in children. OBJECTIVE To explore the associations between outdoor ALAN exposure and sleep disorders in children. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study, part of the National Chinese Children Health Study, was conducted from April 1, 2012, to June 30, 2013, in the first stage and from May 1, 2016, to May 31, 2018, in the second stage in 55 districts of 14 cities in China. This analysis included 201 994 children and adolescents aged 2 to 18 years. Data were analyzed from February 20 to March 21, 2022. EXPOSURES Outdoor ALAN exposure (in nanowatts per centimeters squared per steradian) within 500 m of each participant's residential address obtained from the satellite imagery data, with a resolution of approximately 500 m. MAIN OUTCOMES AND MEASURES Sleep disorders were measured by the Chinese version of the Sleep Disturbance Scale for Children. Generalized linear mixed models were used to estimate the associations of outdoor ALAN with sleep scores and sleep disorders. RESULTS The study included 201 994 children and adolescents (mean [SD] age, 11.3 [3.2] years; 106 378 boys [52.7%]), 7166 (3.5%) of whom had sleep disorder symptoms. Outdoor ALAN exposure of study participants ranged from 0.02 to 113.48 nW/cm2/sr. Compared with the lowest quintile (Q1) of outdoor ALAN exposure, higher quintiles of exposure (Q2-Q5) were associated with an increase in total sleep scores of 0.81 (95% CI, 0.66-0.96) in Q2, 0.83 (95% CI, 0.68-0.97) in Q3, 0.62 (95% CI, 0.46-0.77) in Q4, and 0.53 (95% CI, 0.36-0.70) in Q5. Higher quintiles of exposure were also associated with odds ratios for sleep disorder of 1.34 (95% CI, 1.23-1.45) in Q2, 1.43 (95% CI, 1.32-1.55) in Q3, 1.31 (95% CI, 1.21-1.43) in Q4, and 1.25 (95% CI, 1.14-1.38) in Q5. Similar associations were observed for sleep disorder subtypes. In addition, greater effect estimates were found among children younger than 12 years. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that sleep disorders are more prevalent among children residing in areas with high levels of outdoor ALAN and the associations are generally stronger in children younger than 12 years. These findings further suggest that effective control of outdoor ALAN may be an important measure for improving the quality of children's sleep.
Collapse
Affiliation(s)
- Le-Bing Wang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yan-Chen Gong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Qiu-Ling Fang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xin-Xin Cui
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Public Health and Community Medicine Sydney, University of New South Wales, Sydney, Australia
| | - Luke D Knibbs
- School of Public Health, University of Sydney, Sydney, Australia
| | - Michael S Bloom
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
37
|
Simon SL, Kaar JL, Talker I, Reich J. Evidence-Based Behavioral Strategies in Smartphone Apps for Children's Sleep: Content Analysis. JMIR Pediatr Parent 2022; 5:e32129. [PMID: 35238787 PMCID: PMC8931643 DOI: 10.2196/32129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empirically supported treatments for pediatric sleep problems exist, but many families turn to other sources for help with their children's sleep, such as smartphone apps. Sleep apps are easy for families to access, but little evidence exists regarding the validity of the services and information provided in the developer descriptions of the apps. OBJECTIVE The goal of this study was to examine the features and claims of developer descriptions of sleep apps for children. METHODS A search of the Apple iTunes store and Google Play was conducted using the terms "kids sleep," "child sleep," and "baby sleep." Data on the type of app, price, user rating, and number of users were collected. Apps were analyzed in comparison with evidence-based behavioral strategies and were thematically coded on the basis of claims provided in developer descriptions. RESULTS A total of 83 app descriptions were examined, of which only 2 (2.4%) offered sleep improvement strategies. The majority were sound and light apps (78%) and 19% were bedtime games or stories. Only 18 of 83 (21.6%) apps were identified as containing empirically supported behavioral sleep strategies. Despite this, many apps asserted claims that they will help children "fall asleep instantly," "cry less and sleep better," or improve child development. CONCLUSIONS A large variety of sleep apps exist for use among children, but few include evidence-based behavioral strategies according to the developer descriptions of the apps. Addressing sleep difficulties in children is important to promote physical, cognitive, and emotional development. Collaboration between sleep researchers and technology developers may be beneficial for creating evidence-supported apps to help with children's sleep in the future.
Collapse
Affiliation(s)
- Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jill L Kaar
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ishaah Talker
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Reich
- Department of Sociology, University of Colorado Denver, Denver, CO, United States
| |
Collapse
|
38
|
Measuring Sleep Health Disparities with Polysomnography: A Systematic Review of Preliminary Findings. Clocks Sleep 2022; 4:80-87. [PMID: 35225955 PMCID: PMC8883971 DOI: 10.3390/clockssleep4010009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/17/2022] Open
Abstract
Socioeconomic status (SES) has an unrecognized influence on behavioral risk factors as well as public health strategies related to sleep health disparities. In addition to that, objectively measuring SES’ influence on sleep health is challenging. A systematic review of polysomnography (PSG) studies investigating the relation between SES and sleep health disparities is worthy of interest and holds potential for future studies and recommendations. A literature search in databases was conducted following Prisma guidelines. Search strategy identified seven studies fitting within the inclusion criteria. They were all cross-sectional studies with only adults. Except for one study conducted in India, all of these studies took place in western countries. Overall emerging trends are: (1) low SES with its indicators (income, education, occupation and employment) are negatively associated with PSG parameters and (2) environmental factors (outside noise, room temperature and health worries); sex/gender and BMI were the main moderators of the relation between socioeconomic indicators and the variation of sleep recording with PSG. Socioeconomic inequalities in sleep health can be measured objectively. It will be worthy to examine the SES of participants and patients before they undergo PSG investigation. PSG studies should always collect socioeconomic data to discover important connections between SES and PSG. It will be interesting to compare PSG data of people from different SES in longitudinal studies and analyze the intensity of variations through time.
Collapse
|
39
|
Peersmann SHM, Grootenhuis MA, van Straten A, Kerkhof GA, Tissing WJE, Abbink F, de Vries ACH, Loonen J, Kremer LCM, Kaspers GJL, van Litsenburg RRL. Prevalence of Sleep Disorders, Risk Factors and Sleep Treatment Needs of Adolescents and Young Adult Childhood Cancer Patients in Follow-Up after Treatment. Cancers (Basel) 2022; 14:926. [PMID: 35205674 PMCID: PMC8870170 DOI: 10.3390/cancers14040926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sleep disorders negatively impact adolescent and young adult childhood cancer patients' physical and psychosocial health. Early recognition improves timely treatment. We therefore studied the prevalence of subjective sleep disorders, risk factors and sleep treatment needs after completion of childhood cancer treatment. METHODS Childhood cancer patients (12-26 years old), ≥6 months after treatment, were invited to fill out the Holland Sleep Disorders Questionnaire, which distinguishes six sleep disorders in substantial agreement with the International Classification of Sleep Disorders, second edition (ICSD-2). They additionally indicated sleep treatment needs. Prevalence rates and needs were displayed in percentages. Logistic regression models were used for risk factors. RESULTS 576 patients participated (response rate 55.8%)-49.5% females, mean age 17.0 years, 44.4% hemato-oncology, 31.9% solid tumors, 23.6% neuro-oncology. Prevalence rates were: insomnia (9.6%), circadian rhythm sleep disorder (CRSD; 8.1%), restless legs syndrome (7.6%), parasomnia (3.5%), hypersomnia (3.5%) and sleep-related breathing disorders (1.8%). Female sex, comorbid health conditions and young adulthood seem to be risk factors for sleep disorders, but cancer-related factors were not. Differing per sleep disorder, 42-72% wanted help, but only 0-5.6% received sleep treatment. CONCLUSIONS Insomnia and CRSD were most prevalent. An unmet need for sleep treatment was reported by childhood cancer patients during follow-up. Screening for sleep disorders after cancer might improve access to treatment and patient wellbeing.
Collapse
Affiliation(s)
- Shosha H. M. Peersmann
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Oncology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands;
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Science & Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 BT Amsterdam, The Netherlands;
| | - Gerard A. Kerkhof
- Department of Psychology, University of Amsterdam, P.O. Box 94208, 1090 GE Amsterdam, The Netherlands;
- Department Sleep Disorders Center, Haaglanden Medisch Centrum (HMC), 2512 VA The Hague, The Netherlands
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9713 GZ Groningen, The Netherlands
| | - Floor Abbink
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Oncology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands;
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Department of Pediatric Hemato-Oncology, Erasmus MC–Sophia Children’s Hospital, P.O. Box 2060, 3015 GD Rotterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands;
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Oncology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands;
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Oncology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands;
| | - Raphaële R. L. van Litsenburg
- Princess Máxima Center for Pediatric Oncology, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (L.C.M.K.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Oncology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands;
| |
Collapse
|
40
|
Clarke A, Fiorvanti C. Meeting families where they sleep: a collaborative approach to improving sleep health for urban children. J Clin Sleep Med 2022; 18:971-972. [PMID: 35356861 PMCID: PMC8974387 DOI: 10.5664/jcsm.9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Allison Clarke
- Pritzker Department Psychiatry and Behavioral Health, Department of Sleep Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Christina Fiorvanti
- Pediatric Behavioral Health Integration Program, HealthySteps Program, Department of Pediatrics, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
41
|
Lupini F, Leichman ES, Gould RA, Walters RM, Mindell JA, Williamson AA. Correlates of a caregiver-reported child sleep problem and variation by community disadvantage. Sleep Med 2022; 90:83-90. [PMID: 35123150 PMCID: PMC9206234 DOI: 10.1016/j.sleep.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies of sleep patterns and perceived problems in early childhood indicate variation by family socioeconomic status. The purpose of this study was to examine variation in correlates of a caregiver-perceived child sleep problem across and within levels of community disadvantage in a large US sample. METHODS Caregivers of 14,980 young children (ages 0-35.9 months) in the US completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) on the freely and publicly available Johnson's® Bedtime® Baby Sleep App. Zip code was used to identify a Distressed Communities Index (DCI) score, which represents community disadvantage based on neighborhood indicators. RESULTS Across all levels of community disadvantage, caregivers who reported greater impact of child sleep on their own sleep, bedtime difficulty, more frequent and longer night wakings, and increased total nighttime sleep were more likely to endorse a child sleep problem. These associations varied by level of community disadvantage. For caregivers living in more disadvantaged communities, impact of child sleep on their own sleep and night wakings were the strongest correlates of endorsing a child sleep problem, whereas for those in more advantaged communities the impact of child sleep on their own sleep and night wakings as well as additional aspects of sleep health, such as short sleep duration, were associated with endorsement of a child sleep problem. CONCLUSIONS Findings suggest that families living in more distressed communities are most likely to identify the impact of child sleep on their own sleep and night wakings in reporting a child sleep problem, whereas those from more prosperous communities consider these factors as well as other sleep parameters, including sleep duration. Clinicians should consider expanding screening questions for child sleep problems to include the perceived impact on caregiver sleep.
Collapse
Affiliation(s)
| | | | | | | | - Jodi A. Mindell
- Saint Joseph’s University, USA,Children’s Hospital of Philadelphia, USA,University of Pennsylvania, Perelman School of Medicine, USA,Corresponding author. Department of Psychology, Saint Joseph’s University, Philadelphia, PA 19131, USA. (J.A. Mindell)
| | - Ariel A. Williamson
- Children’s Hospital of Philadelphia, USA,University of Pennsylvania, Perelman School of Medicine, USA
| |
Collapse
|
42
|
Damian A, Gozal D. Pediatric Obstructive Sleep Apnea: What’s in a Name? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:63-78. [PMID: 36217079 DOI: 10.1007/978-3-031-06413-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.
Collapse
Affiliation(s)
- Allan Damian
- Departments of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
| |
Collapse
|
43
|
Jin M, Kato M, Itakura S. Development of a classifier to screen for severe sleep disorders in children. Front Pediatr 2022; 10:902012. [PMID: 35935356 PMCID: PMC9354400 DOI: 10.3389/fped.2022.902012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to develop an automatic classifier for the identification of severe sleep disorders that require immediate intervention in children. Our study assessed 7,008 children (age: 0-83 months) in Japan, whose parents and nursery teachers recorded their 14-day sleep patterns. Sleep quality was assessed by pediatricians and scored as 1 (no severe sleep disorder) or 0 (severe sleep disorder). Discriminant analysis was performed for each age group using sleep quality (0 or 1) as the dependent variable and variables in the 14-day sleep log as independent variables. A stepwise method was used to select the independent variables to build the best model. The accuracy of the discriminant analysis for the age groups ranged from 71.3 to 97.3%. In summary, we developed an automatic classifier with sufficient application value to screen for severe sleep disorders in children. In the future, this classifier can be used to rapidly determine the presence or absence of severe sleep disorders in children based on their 14-day sleep logs, thus allowing immediate intervention.
Collapse
Affiliation(s)
- Mingwen Jin
- Center for Baby Science, Doshisha University, Kyoto, Japan
| | - Masaharu Kato
- Center for Baby Science, Doshisha University, Kyoto, Japan
| | - Shoji Itakura
- Center for Baby Science, Doshisha University, Kyoto, Japan
| |
Collapse
|
44
|
Mehrdad M, Azarian M, Sharafkhaneh A, Alavi A, Zare R, Hassanzadeh Rad A, Dalili S. Association Between Poor Sleep Quality and Glycemic Control in Adult Patients with Diabetes Referred to Endocrinology Clinic of Guilan: A Cross-sectional Study. Int J Endocrinol Metab 2022; 20:e118077. [PMID: 35432555 PMCID: PMC8994826 DOI: 10.5812/ijem.118077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/28/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetes is a prevalent chronic medical comorbid condition worldwide. Diabetes mellitus is associated with various sleep disorders. OBJECTIVES We aimed to determine the prevalence of poor sleep and the main factors of sleep interruptions in patients with diabetes mellitus. We further evaluated the association of sleep interruptions with glycemic control in this cohort. METHODS We conducted a cross-sectional study on 266 patients with type 1 and type 2 diabetes recruited from a university outpatient endocrinology clinic. Patients completed a checklist including demographic and disease-related characteristics in addition to the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Using the PSQI cutoff score of 5, we created two subgroups of good sleepers (GS) and poor sleepers (PS). RESULTS Our results showed that good sleeper and poor sleeper patients with diabetes were significantly different regarding sex, employment status, BMI, presence of diabetes-related complications, HbA1c, and 2-hour postprandial blood sugar (2HPPBS) (all significant at P < 0.05). The most prevalent factors of sleep interruptions were "waking up to use a bathroom", "feeling hot", "pain", "having coughs or snores", and "bad dreams". Among the subjective factors of sleep interruption, problems with sleep initiation, maintenance, or early morning awakenings in addition to having pain or respiratory problems such as coughing or snoring had the most significant associations with HbA1c. CONCLUSIONS Our study showed significant subjective sleep disturbances (both quality and quantity) in patients with diabetes mellitus (both type I and II) and its association with diabetes control. We further identified the main factors that led to sleep interruptions in this cohort.
Collapse
Affiliation(s)
- Mojtaba Mehrdad
- Department of Endocrinology, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Azarian
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Sharafkhaneh
- Telehealth Cardio-Pulmonary Rehabilitation Program, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Ali Alavi
- Department of Internal Medicine, Inflammatory Lung Diseases Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Roghayeh Zare
- Neuroscience Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Afagh Hassanzadeh Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Setila Dalili
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| |
Collapse
|
45
|
Knaus ME, Koppera S, Lind MN, Cooper JN. Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy. Otolaryngol Head Neck Surg 2021; 166:1106-1117. [PMID: 34905437 DOI: 10.1177/01945998211064233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess sociodemographic differences in care plans and time to evaluation or treatment after otolaryngologic consultation among children with obstructive sleep-disordered breathing (oSDB). STUDY DESIGN Retrospective cohort study. SETTING Single tertiary children's hospital. METHODS We included children aged 2 to 9 years with oSDB seen from June to December 2018 as new otolaryngology clinic patients. Logistic regression was used to examine whether sociodemographic factors were associated with having adenotonsillectomy or polysomnography planned at the end of the visit. Kaplan-Meier analyses and Cox proportional hazards models were used to compare times to these events. RESULTS An overall 1020 children were included, of whom 65% were White and 18% were Black. Approximately 77% were metropolitan residents, 52% were publicly insured, and 88% of caregivers spoke primarily English. Treatment plans included adenotonsillectomy for 62% of patients, polysomnography for 15%, and new medication therapy for 13%. In multivariable analyses, there were no significant differences by child race/ethnicity, metropolitan/nonmetropolitan residence, type of health insurance, or caregiver primary language in the likelihood of having adenotonsillectomy or polysomnography planned. Among children for whom adenotonsillectomy was planned, children from metropolitan areas had greater times to surgery than children from nonmetropolitan areas (hazard ratio, 0.81 [95% CI, 0.66-0.99]; P = .04). This was explained by a difference between Black children from metropolitan areas and White children from nonmetropolitan areas (hazard ratio, 0.65 [95% CI, 0.49-0.86]; P = .003); there were no racial/ethnic differences in time to surgery among metropolitan-residing children (P = .09). CONCLUSIONS After initial otolaryngology consultation, children with oSDB from metropolitan areas have longer times to adenotonsillectomy than those from nonmetropolitan areas.
Collapse
Affiliation(s)
- Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Otolaryngology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
46
|
Ackley E, Clementi MA, Yonker ME. Headache and Sleep Disturbances in the Pediatric Population. Semin Pediatr Neurol 2021; 40:100924. [PMID: 34749912 DOI: 10.1016/j.spen.2021.100924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022]
Abstract
The relationship between sleep disturbances and headaches in the pediatric population is bidirectional. Common underlying molecular mechanisms of sleep and headaches have been speculated to explain the clinical connection. We will summarize various sleep disturbances and their known relationships to headache, focusing on the pediatric population. Careful recognition and assessment of sleep disturbances in patients with headache is critical and may help guide treatment. First line therapies for sleep disturbances consist of behavioral approaches, though surgical and pharmacologic strategies are utilized in particular circumstances.
Collapse
Affiliation(s)
- Elizabeth Ackley
- University of Colorado School of Medicine, Aurora CO; Children's Hospital of Colorado, Department of Child Neurology, Aurora CO.
| | - Michelle A Clementi
- University of Colorado School of Medicine, Aurora CO; Children's Hospital of Colorado, Department of Psychiatry and Pediatrics, Aurora CO
| | - Marcy E Yonker
- University of Colorado School of Medicine, Aurora CO; Children's Hospital of Colorado, Department of Child Neurology, Aurora CO
| |
Collapse
|
47
|
Knobbe K, Partha M, Seckeler MD, Klewer S, Hsu CH, Edgin J, Morgan WJ, Provencio-Dean N, Lopez S, Parthasarathy S, Combs D. Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. J Am Heart Assoc 2021; 10:e021749. [PMID: 34668394 PMCID: PMC8751823 DOI: 10.1161/jaha.121.021749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (P<0.001 for all). Similarly, parent-reported disturbance was associated with decreased HRQOL on both parent and child-reported HRQOL (P<0.001 for most domains). Child-reported sleep disturbances were associated with increased odds of anxiety, depression, and attention problems as well as worse HRQOL. These associations were present even after adjustment for cardiac, demographic, and socioeconomic factors that may affect HRQOL and neurodevelopmental status. Conclusions Sleep disturbances in children with Fontan circulation are associated with an increased risk of neurodevelopmental problems as well as reduced HRQOL compared with those without sleep disturbance. Better understanding of sleep disturbances is needed in children with Fontan circulation, as sleep disturbances may represent a reversible cause of neurodevelopmental problems and decreased HRQOL in this population.
Collapse
Affiliation(s)
- Kirstin Knobbe
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | - Meghana Partha
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | | | - Scott Klewer
- Department of Pediatrics University of Arizona Tucson AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health University of Arizona Tucson AZ
| | - Jamie Edgin
- Department of Psychology University of Arizona Tucson AZ.,Sonoran University Center for Excellence in Developmental DisabilitiesUniversity of Arizona Tucson AZ
| | - Wayne J Morgan
- Department of Pediatrics University of Arizona Tucson AZ
| | | | - Silvia Lopez
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ
| | | | - Daniel Combs
- UAHS Center for Sleep & Circadian Sciences University of Arizona Tucson AZ.,Department of Pediatrics University of Arizona Tucson AZ
| |
Collapse
|
48
|
Banaschewski T, Bruni O, Fuentes J, Hill CM, Hvolby A, Posserud MB, Schroder C. Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3758-3768. [PMID: 34463899 PMCID: PMC9296438 DOI: 10.1007/s10803-021-05236-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/24/2022]
Abstract
Between 50-80% of children with autism spectrum disorder (ASD) have insomnia, which adversely affects their mental and physical health. However, there is no consensus to-date on suitable tools for insomnia screening and monitoring in daily clinical practice. An expert panel of child neuropsychiatry and sleep specialists, with expertise in children with neurodevelopmental disabilities, recommends: (1) performing insomnia screening of all children with ASD; (2) considering discussion or referral to a sleep specialist when comorbid sleep disorders are suspected. The panel further developed structured, brief screening and monitoring tools to facilitate insomnia screening and management in daily practice, monitor treatment effectiveness and standardize and compare outcomes across clinical settings to improve care and well-being of children with ASD and their families.
Collapse
Affiliation(s)
- Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
| | - Joaquin Fuentes
- Service of Child and Adolescent Psychiatry, Policlínica Gipuzkoa and GAUTENA Autism Society, San Sebastián, Spain
| | - Catherine Mary Hill
- School of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Sleep Medicine, Southampton Children's Hospital, Southampton, UK
| | - Allan Hvolby
- Department of Child and Adolescent Psychiatry, Psychiatry in Region of South Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maj-Britt Posserud
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Carmen Schroder
- Department of Child and Adolescent Psychiatry & Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000, Strasbourg, France.
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France.
- Sleep Disorders Center& International Research Center for ChronoSomnology, Strasbourg, France.
| |
Collapse
|
49
|
Honaker SM, McQuillan ME, Mindell JA, Downs SM, Slaven JE, Schwichtenberg AJ. Screening for Problematic Sleep in a Diverse Sample of Infants. J Pediatr Psychol 2021; 46:824-834. [PMID: 34283243 PMCID: PMC8357224 DOI: 10.1093/jpepsy/jsab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine screening strategies for identifying problematic sleep in a diverse sample of infants. METHODS Parents of infants (5-19 months; N = 3,271) presenting for a primary care visit responded to five screening items and the Infant Sleep Questionnaire (ISQ), a validated measure of problematic infant sleep. If parents responded affirmatively to any screening item, primary care providers received a prompt to evaluate. For each of the screening questions, we examined differences in item endorsement and criterion related validity with the ISQ. Using conceptual composites of night waking and sleep difficulty, prevalence, criterion-related validity, and concurrent demographic correlates were analyzed. RESULTS Infants were primarily of Black race (50.1%) or Hispanic ethnicity (31.7%), with the majority (63.3%) living in economically distressed communities. Rates of problematic sleep ranged from 7.4%, for a single item assessing parental perception of an infant having a sleep problem, to 74.0%, for a single item assessing night wakings requiring adult intervention. Items assessing sleep difficulty had high (95.0-97.8%) agreement with the ISQ in identifying infants without problematic sleep, but low agreement (24.9-34.0%) in identifying those with problematic sleep. The opposite was true for items assessing night waking, which identified 91.0-94.6% of those with sleep problems but only 31.8-46.9% of those without. CONCLUSIONS Screening strategies for identifying problematic infant sleep yielded highly variable prevalence rates and associated factors, depending on whether the strategy emphasized parent-perceived sleep difficulty or night wakings. The strategy that is most appropriate will depend on the system's goals.
Collapse
Affiliation(s)
- Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine
| | | | - Jodi A Mindell
- Department of Psychology, Saint Joseph’s University
- Children’s Hospital of Philadelphia
| | | | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine
| | | |
Collapse
|
50
|
Kline CE, Hillman CH, Bloodgood Sheppard B, Tennant B, Conroy DE, Macko RF, Marquez DX, Petruzzello SJ, Powell KE, Erickson KI. Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report. Sleep Med Rev 2021; 58:101489. [PMID: 33934046 PMCID: PMC8338757 DOI: 10.1016/j.smrv.2021.101489] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/21/2022]
Abstract
Physical activity (PA) is widely considered to improve sleep, but a comprehensive review of the research on this topic has not been performed. In this umbrella review, conducted initially for the 2018 Physical Activity Guidelines for Americans Advisory Committee and updated to reflect more recent research, we examined whether PA enhances sleep outcomes across the lifespan as well as among individuals with sleep disorders. Systematic reviews and meta-analyses were utilized to assess the evidence. We also examined dose-response considerations and whether the association between PA and sleep was moderated by various factors (e.g., timing, sociodemographic characteristics). We found strong evidence that both acute bouts of PA and regular PA improved sleep outcomes. Moderate evidence indicated that longer bouts of PA (both acute and regular) improved sleep, and that the effects of PA on sleep outcomes were generally preserved across adult age groups and sex. Finally, moderate evidence demonstrated that PA improved sleep in adults with insomnia symptoms or obstructive sleep apnea. Several important areas in need of future research were also identified. Overall, the review supported the claim that PA improves sleep, but highlighted gaps that need to be addressed to facilitate more widespread utilization of PA for improving sleep.
Collapse
Affiliation(s)
- Christopher E Kline
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Charles H Hillman
- Department of Psychology, Northeastern University, Boston, MA, USA; Department of Physical Therapy, Movement, & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | | | | | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Richard F Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven J Petruzzello
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kenneth E Powell
- Centers for Disease Control and Prevention (Retired), Atlanta, GA, USA
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|