Learning, attention/hyperactivity, and conduct problems as sequelae of excessive daytime sleepiness in a general population study of young children

The effects of sleep deprivation and text messaging on pedestrian safety in university students

STUDY OBJECTIVES

This study assesses the impact of sleep deprivation and text messaging on pedestrian injury risk.

METHODS

A total of 36 university students engaged in a virtual reality pedestrian environment in two conditions: sleep deprived (no sleep previous night) and normal sleep (normal sleep routine). Sleep was assessed using actigraphy and pedestrian behavior via four outcomes: time to initiate crossing, time before contact with oncoming vehicle, hits/close calls, and looks left/right. During each condition, participants made half the crossings while text messaging. Participants also completed the Useful Field of View test, the Psychomotor Vigilance Test, and Conners' Continuous Performance Test in both conditions.

RESULTS

While sleep deprived, students crossed significantly closer to oncoming vehicles compared with after normal sleep. While text messaging, crossed closer to vehicles and took longer to initiate crossings. Safety risks were amplified through combined sleep deprivation plus text messaging, leading to more virtual hits and close calls and shorter time before vehicle contact while crossing. Sleep-deprived students demonstrated impairments in functioning on cognitive tests.

CONCLUSIONS

University students' pedestrian behavior was generally riskier, and their cognitive functioning was impaired, when sleep deprived compared with after normal sleep. This effect was exacerbated when distracted by text messaging.

Perinatal antecedents of sleep disturbances in schoolchildren

STUDY OBJECTIVES

Prematurity has been associated with an increased risk for sleep apnea. However, sleep disturbances in children born preterm have not been extensively investigated. Considering that determinants of sleep may originate early in life, the potential impact of prematurity on sleep disturbances later in life could be important. To establish the role of prematurity on sleep disturbances in a cohort of schoolchildren that were born preterm and compare them with healthy controls.

METHODS

A cohort of 147 schoolchildren, 45 born at term (≥37 weeks) and 102 very preterm (<32 weeks), was recruited and evaluated at school age (5-9 years). The Pediatric Sleep Questionnaire (PSQ) and the Sleep Disturbance Scale for Children (SDSC) were used to assess sleep disturbances in different domains.

RESULTS

PSQ score was significantly higher in former preterm children (0.26 ± 0.18 vs. 0.18 ± 0.14 in controls; p = 0.004), and SDSC total score was also significantly different among groups (21.7 ± 11.6 vs. 14.1 ± 12.6; p < 0.001). Regression models showed significant mean differences in PSQ score, total SDSC score, and two SDSC subscale scores (i.e. sleep-wake transition disorders, sleep-breathing disorders, and sleep hyperhidrosis) even after adjustment for confounders. Maternal age and type of delivery were not significantly associated with total PSQ scores.

CONCLUSIONS

Sleep disturbances may originate early in life since children born preterm exhibit an increased risk for developing long-term sleep problems. These findings may have important implications for management of preterm children and for implementation of early interventions focused on optimizing sleep habits.

Sleep characteristics and problems of 2-year-olds with Williams syndrome: relations with language and behavior

Background

Sleep problems have been shown to have a negative impact on language development and behavior for both typically developing children and children with a range of neurodevelopmental disorders. The relation of sleep characteristics and problems to language and behavior for children with Williams syndrome (WS) is unclear. The goal of this study was to address these relations for 2-year-olds with WS. Associations of nonverbal reasoning ability, nighttime sleep duration, and excessive daytime sleepiness with language ability and behavior problems were considered.

Method

Ninety-six 2-year-olds with genetically confirmed classic-length WS deletions participated. Parents completed the Pediatric Sleep Questionnaire, which includes a Sleep-Related Breathing Disorder (SRBD) scale with a subscale measuring excessive daytime sleepiness, to assess sleep characteristics and problems. Parents also completed the Child Behavior Checklist (CBCL) and the MacArthur-Bates Communicative Development Inventory: Words and Sentences to assess behavior problems and expressive vocabulary, respectively. Children completed the Mullen Scales of Early Learning to measure nonverbal reasoning and language abilities.

Results

Parents indicated that children slept an average of 10.36 h per night (SD = 1.09, range 7.3–13.3), not differing significantly from the mean reported by Bell and Zimmerman (2010) for typically developing toddlers (p = .787). Sixteen percent of participants screened positive for SRBD and 30% for excessive daytime sleepiness. Children who screened positive for SRBD had significantly more behavior problems on all CBCL scales than children who screened negative. Children with excessive daytime sleepiness had significantly more attention/hyperactivity, stress, and externalizing problems than those who did not have daytime sleepiness. Individual differences in parent-reported nighttime sleep duration and directly measured nonverbal reasoning abilities accounted for unique variance in expressive language, receptive language, and internalizing problems. Individual differences in parent-reported daytime sleepiness accounted for unique variance in externalizing problems.

Conclusions

The relations of nighttime sleep duration, positive screens for SRBD, and excessive daytime sleepiness to language and behavior in toddlers with WS parallel prior findings for typically developing toddlers. These results highlight the importance of screening young children with WS for sleep problems. Studies investigating the efficacy of behavioral strategies for improving sleep in children with WS are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11689-020-09336-z.

Sleepiness, Neuropsychological Skills, and Scholastic Learning in Children

Excessive daytime sleepiness is a frequent condition among children and adolescents that may lead to several and significant daytime consequences, including impaired neurocognitive skills and scholastic performance. Here, we evaluated in one hundred and ninety-one unselected primary school children, the relationship between sleepiness and a wide range of cognitive and academic skills through a standardized neuropsychological test battery. In order to assess the statistical relationship, we performed a partial least squares path modelling, a non-parametrical approach which combined a model of paths between latent variables and the coefficients between indicators and dimensions. Results were validated through the bootstrap approach and suggest that sleepiness is not associated with all cognitive and scholastic abilities, but only with those relying on verbal abilities and complex cognitive functions (i.e., reading comprehension, oral/syntactic comprehension, spelling, and mathematic skills). Our data suggest the idea that sleepiness in children is associated mostly with “higher” (mainly verbal) cognitive function(s), while the visuospatial domain was not affected.

A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability

General cognitive ability, often referred to as ‘general intelligence’, comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother’s ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child’s total environment and early cognitive development.

Using Parental Report to Identify Children at Risk for Poor Sleep and Daytime Problems

OBJECTIVE

To examine objective sleep patterns and the daytime behavioral, emotional and academic functioning of school-age children above and below the clinical cutoff score for the Child Sleep Habits Questionnaire (CSHQ), which is a parental-report-based measure of sleep disturbances.

PARTICIPANTS

48 boys and 74 girls aged 7-11 years.

METHODS

Participants' sleep was assessed in their home environment using a miniature actigraph (AW-64 series; Mini-Mitter, Sunriver, OR, USA) for five consecutive weeknights. The parents provided their child's report card and completed a battery of questionnaires that included the CSHQ, the Child Behavior Checklist, a demographic questionnaire and a health questionnaire.

RESULTS

Children that were above the cutoff score of the CSHQ had later objectively measured sleep schedule, were less likely to obtain the recommended amount of sleep for their age, had higher levels of internalizing and externalizing symptoms and a higher prevalence of clinical levels of externalizing and internalizing problems, had lower grades in English and French as a Second Language, and were more likely to fail these subjects. Discriminant analysis revealed that information from the objective sleep and emotional/behavioral and academic measures could significantly discriminate between those with or without parent-reported sleep disturbance.

CONCLUSION

Parental reports of sleep disturbances can be used to identify children at increased risk for sleep, emotional, behavioral and academic problems. Such questionnaires should be incorporated into clinical practice and school-based evaluations with the goal of identifying undiagnosed children who might be at risk for poor adjustment related to night- and daytime difficulties.

External Validity of the Multicomponent Group Treatment KiSS for School-Aged Children With Insomnia

Background: Insomnia is common in school-aged children and often associated with other mental disorders. Here, we investigated the effectiveness and acceptance of the KiSS program in an "all-comer" pediatric insomnia clinic. Participants/Methods: Forty-five families (children: 5-10 years, 57.8% female) were randomly assigned to the multicomponent six-session KiSS treatment (CBT-I, hypnotherapy, and imaginations) or a wait-list control group. A sleep diary was recorded before intervention or waiting time, immediately after, as well as 3, 6, and 12 months postintervention (primary outcome: sleep efficiency, SE; sleep-onset latency, SOL). Results: Sleep improved significantly after the KiSS intervention. Three to 12 months after the intervention, only 1.75% of treated children still met the diagnostic criteria for insomnia. SE improved to 96%, and both SOL (reduced to 23 min) and total sleep time were normalized. All improvements were stable for at least one year after the intervention. KiSS was well accepted (0% dropout during intervention) and well tolerated. Conclusions: Treatment with the multimodal sleep training KiSS leads to positive changes in the sleep of children with insomnia, including a subset of children that presented with comorbid mental disorders. With only three sessions for parents and three sessions for children, the treatment can be readily implemented as a stand-alone treatment or be combined with other interventions. Dismantling studies and studies with an active control group are ongoing.

Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.

Sleep quality and its effect on event related potential P300 in adolescents with and without sleep disturbances

OBJECTIVES

The present study aimed: (i) to investigate the sleep quality and cortical arousal (ERP P300) in adolescents with and without sleep disturbances, and (ii) to examine whether P300 vary as a function of quality of the previous night's sleep in sleep disturbed adolescents and to compare the findings with healthy controls.

METHODS

Fifteen sleep disturbed adolescents and 15 age-matched controls were recruited. Participants filled 10 days of sleep logs to identify their good (GN) and bad nights (BN). GN and BN were scored as a measure of sleep efficiency (SE), with nights having greater SE defined as GN and nights with lower SE scores labelled as BN. Afterwards, subjects were summoned to the lab for recording ERP P300 once after a night of good sleep (GN) and once after a night of bad sleep (BN).

RESULTS

The findings demonstrate that sleep disturbed adolescents exhibited poorer quality of sleep than controls. The ERP P300 also revealed significant difference in participants with and without sleep disturbance. Moreover, the P300 amplitude was higher and the latency was shorter after a GN in sleep disturbed as well as in controls, however, the values were better for adolescents without disturbed sleep. Similarly, amplitude and latency of P300 was lower and longer, respectively, after a BN in both the groups, however, participants with sleep disturbance demonstrated very penurious scores for amplitude and latency than the controls.

CONCLUSION

Adolescents with sleep disturbance have poorer sleep quality and ERP characteristics than their healthy counterparts. Moreover, the quality of the previous night sleep determines cortical arousal in both sleep disturbed and healthy controls.

The safety and tolerability profile of bilastine for chronic urticaria in children

Background

Urticaria is a condition defined by the development of wheals, angioedema or both. It is classified based on its duration as acute (≤ 6 weeks) or chronic (> 6 weeks). Chronic urticaria is less frequent than acute one in children, but it represents a debilitating condition, always needing treatment. Symptoms affect child's daily activities and disturb sleeping patterns, causing emotional distress and negatively influencing learning and cognition. Therefore, the management of chronic urticaria must point to a complete control of symptoms, taking into account tolerability and the patient quality of life.

Review of literature

The recently revised version of EAACI/GA²LEN/EDF/WAO guideline on the management of urticaria, in addition to recommending the use of second-generation H₁ antihistamines as the treatment of choice, gives particular attention to their use in the paediatric population. Bilastine has been studied in children; at the dose of 10 mg/once daily, it is licenced for the symptomatic relief of urticaria in children ≥ 6 to 11 years, in the European Union, in appropriate formulation, as oral solution or orodispersible tablet.

Conclusions

In line with the recent guideline recommendation for the use of second generation H₁ antihistamines in children we have reviewed the safety and tolerability profile of bilastine in children with chronic urticaria.

Midday napping in children: associations between nap frequency and duration across cognitive, positive psychological well-being, behavioral, and metabolic health outcomes

STUDY OBJECTIVES

Poor sleep and daytime sleepiness in children and adolescents have short- and long-term consequences on various aspects of health. Midday napping may be a useful strategy to reduce such negative impacts. The effect of habitual napping on a wide spectrum of cognitive, behavioral, psychological, and metabolic outcomes has not been systematically investigated.

METHODS

This study characterized midday napping habits in 3819 elementary school children from the China Jintan Cohort Study. In 2011, weekly nap frequency and average duration were collected once from students at grades 4-6. Prior to their completion of elementary school at grade 6 (in 2011-2013 respective to each grade), the following outcomes were collected once: behavioral and academic achievement evaluated by teachers, and self-reported positive psychology measures including grit, self-control, and happiness. IQ tests were conducted on a subgroup. Metabolic indices, including body mass index and fasting glucose concentration, were measured through physical exams. For the whole sample, we assessed associations between napping and each outcome, adjusted for sex, grade, school location, parental education, and time in bed at night. We also conducted stratified analyses on grade 6 (cross-sectional), grade 4 (2-year gap), and grade 5 (1-year gap) data.

RESULTS

Overall, napping was significantly associated with higher happiness, grit, and self-control, reduced internalizing behavior problem, higher verbal IQs, and better academic achievement, although specific patterns varied across frequency and duration for different outcomes. More limited significant associations were found for decreased externalizing behavior problems, compared to non-nappers, while no significant associations were found for performance IQ and metabolic outcomes.

CONCLUSIONS

Results indicate benefits of regular napping across a wide range of adolescent outcomes, including better cognition, better psychological wellness, and reduced emotional/behavioral problems. The current study underscores the need for further large-scale intervention studies to establish causal effects.

The prevalence of neck-shoulder pain, back pain and psychological symptoms in association with daytime sleepiness - a prospective follow-up study of school children aged 10 to 15

Background and aims Chronic and recurrent pain is prevalent in adolescents and generally girls report more pain symptoms than boys. Also, pain symptoms and sleep problems often co-occur. Pain symptoms have negative effects on school achievement, emotional well-being, sleep, and overall health and well-being. For effective intervention and prevention there is a need for defining factors associated with pain symptoms and daytime sleepiness. The aim of this longitudinal study was to investigate the prevalence and association between neck-shoulder pain, back pain, psychological symptoms and daytime sleepiness in 10-, 12- and 15-year-old children. This study is the first that followed up the same cohort of children from the age of 10 to 15. Methods A cohort study design with three measurement points was used. Participants (n=568) were recruited from an elementary school cohort in a city of 1,75,000 inhabitants in South-Western Finland. Symptoms and daytime sleepiness were measured with self-administered questionnaires. Regression models were used to analyze the associations. Results Frequent neck-shoulder pain and back pain, and psychological symptoms, as well as daytime sleepiness, are already common at the age of 10 and increase strongly between the ages 12 and 15. Overall a greater proportion of girls suffered from pain symptoms and daytime sleepiness compared to boys. Daytime sleepiness in all ages associated positively with the frequency of neck-shoulder pain and back pain. The more that daytime sleepiness existed, the more neck-shoulder pain and back pain occurred. Daytime sleepiness at the age of 10 predicted neck-shoulder pain at the age of 15, and back pain at the age of 10 indicated that there would also be back pain at the age of 15. In addition, positive associations between psychological symptoms and neck-shoulder pain, as well as back pain, were observed. Subjects with psychological problems suffered neck-shoulder pain and back pain more frequently. Conclusions This study is the first study that has followed up the same cohort of children from the age of 10 to 15. The studied symptoms were all already frequent at the age of 10. An increase mostly happened between the ages of 12 and 15. Moreover, the self-reported daytime sleepiness at the age of 10 predicted neck-shoulder pain at the age of 15. More attention should be paid to the daytime sleepiness of children at an early stage as it has a predictive value for other symptoms later in life. Implications School nurses, teachers and parents are in a key position to prevent adolescents' sleep habits and healthy living habits. Furthermore, the finding that daytime sleepiness predicts neck-shoulder pain later in adolescence suggests that persistent sleep problems in childhood need early identification and treatment. Health care professionals also need take account of other risk factors, such as psychological symptoms and pain symptoms. The early identification and treatment of sleep problems in children might prevent the symptoms' development later in life. There is a need for an individuals' interventions to treat adolescents' sleep problems.

Clinical and polysomnographic characteristics of excessive daytime sleepiness in children

PURPOSE

This study aimed to delineate the clinical and polysomnography (PSG) characteristics of sleep disorders in children with excessive daytime sleepiness (EDS).

METHODS

Between February 2002 and June 2015, 622 pediatric patients with EDS were evaluated with overnight PSG and the Multiple Sleep Latency Test at the Samsung Medical Center. The medical records; questionnaire responses about depression, sleepiness, sleep habits; and sleep study data of 133 patients without obstructive sleep apnea (OSA) were reviewed retrospectively.

RESULTS

The patients (63 girls, 70 boys) slept for an average of 7 h 30 min and 8 h 44 min on weekdays and weekends, respectively. The mean Epworth Sleepiness Scale score was 11.01 ± 4.09 and did not differ significantly among sleep disorders. Among the 102 patients who completed the depression questionnaire, 53 showed depressive feelings, which were moderate or severe in 39, with no significant differences among specific sleep disorders. Thirty-four patients exhibited normal PSG results. Seventeen of them were concluded as not having any sleep disorders, and the others as having delayed sleep phase disorder (DSPD). Narcolepsy (n = 78) was the most common disorder, followed by DSPD (n = 17) and idiopathic hypersomnia (n = 12).

CONCLUSIONS

Pediatric patients with EDS had various sleep disorders and some did not have any sleep disorder despite EDS. More than half the patients with EDS showed depressive feelings affecting their daily lives. For pediatric patients with EDS, a systematic diagnostic approach including questionnaires for sleep habits and emotion and PSG is essential for accurate diagnosis and treatment.

Sleep disordered breathing symptoms and daytime sleepiness are associated with emotional problems and poor school performance in children

This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3979 children (10.99±0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB symptoms included 3 items: loud snoring, stopped breathing, and snorting/gasping during sleep. Teachers rated the children's school performance. The prevalence rates of parent- and self-reported SDB symptoms were 17.2% and 10.1% for "sometimes" and 8.9% and 5.6% for "usually". SDB symptoms, more prevalent in boys than in girls, increased the risks for depression, loneliness, and poor school performance. Daytime sleepiness mediated the relationship between SDB symptoms and depression, loneliness, and poor school performance. This study suggests the importance of early screening and intervention of SDB and daytime sleepiness in child behavioral and cognitive development.

Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review

The etiology of a child’s cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children’s cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003–2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child’s total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child’s ability to learn.

Early Blood Lead Levels and Sleep Disturbance in Preadolescence

STUDY OBJECTIVES

Little is known about the effect of lead exposure on children's sleep. This study examined the association between blood lead levels (BLL) and sleep problems in a longitudinal study of children.

SETTING

Four community-based elementary schools in Jintan City, China.

PARTICIPANTS

1,419 Chinese children.

MEASUREMENT AND RESULTS

BLL were measured when children were aged 3-5 y, and sleep was assessed at ages 9-13 y. Sleep was assessed by both parents' report, using the Children's Sleep Habits Questionnaire (CSHQ), and children's report, using an adolescent sleep questionnaire. A total of 665 children with complete data on BLL and sleep at both ages were included in the current study. Mean age of the sample at BLL assessment was 4.74 y (standard deviation [SD] = 0.89) and at sleep assessment was 11.05 y (SD = 0.88). Mean BLL was 6.26 μg/dL (SD = 2.54). There were significant positive correlations between BLL and 3 CSHQ subscales: Sleep onset delay (r = 0.113, P < 0.01), sleep duration (r = 0.139, P < 0.001), and night waking (r = 0.089, P < 0.05). Excessive daytime sleepiness (EDS) (26.1% versus 9.0%, P < 0.001) and use of sleeping pills (6.5% versus 1.8%, P = 0.03) were more prevalent in children BLL ≥ 10.0 μg/dL than in those children BLL < 10.0 μg/dL. After adjusting for demographics, BLL ≥ 10.0 μg/dL was significantly associated with increased risk for insomnia symptoms (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.03-3.95) and EDS (OR = 2.90, 95% CI = 1.27-6.61).

CONCLUSION

The findings indicate that elevated blood lead levels in early childhood are associated with increased risk for sleep problems and excessive daytime sleepiness in later childhood.

Effect of age and gender in the prevalence of excessive daytime sleepiness among a sample of the Saudi population

The aim of this study is to assess whether the effect of gender on the excessive daytime sleepiness (EDS) is influenced by two confounders (age and hours of sleep per night). A cross-sectional study was conducted at King Abdulaziz Medical City-Riyadh (KAMC-R). A total of 2095 respondents answered a questionnaire that included questions regarding gender, age, hours of sleep per night, and daytime sleepiness using the Epworth Sleepiness Scale (ESS). The prevalence of EDS was 20.5% (females 22.2%, males 19.5%, p-value = 0.136). The EDS did not differ between genders, age groups, or hours of sleep per night (<6 vs. ⩾6 h). However, stratified statistical analysis shows that the prevalence of EDS did differ according to gender (25.3% in females, 19.0% in males, p-value = 0.036) in respondents with shorter hours of sleep per night. EDS was strongly related to female gender and young age (ages ⩽ 29 years) in respondents with short hours of sleep. This study reveals that one out of five of the general Saudi population has EDS. The effect of gender on EDS appeared to be influenced by hours of sleep per night. High EDS strongly related to female gender with short hours of sleep.

Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: gender effects

OBJECTIVE

Our population-based study examined the prevalence of insomnia symptoms and its sociodemographic, subjective, and polysomnographic (PSG) sleep risk factors in young and preadolescent children.

METHODS

We performed a cross-sectional study of 700 children, ages 5-12 years who underwent a 9-h PSG and parent-completed sleep and development questionnaires (Penn State Child Cohort). Insomnia symptoms were defined as parent report of difficulty falling or staying asleep and sleep-disordered breathing (SDB) as an apnea hypopnea index of ≥1.

RESULTS

The prevalence of insomnia symptoms was 19.3% and did not significantly change (20.2%) when children with SDB were excluded. A significant interaction between gender and age revealed that the prevalence of insomnia symptoms was highest in girls ages 11 to 12 years (30.6%). This gender difference was not associated with significant differences between girls and boys ages 11-12 years in anxiety and depressive symptoms. In contrast girls ages 11-12 years with insomnia symptoms, but not boys of the same group, demonstrated clinically significant PSG sleep disturbances compared to those without insomnia symptoms.

CONCLUSIONS

These data suggest that one out of five young children and preadolescents of the general population have insomnia symptoms. Importantly, the prevalence of insomnia symptoms peaks in girls ages 11 to 12 years and is associated with objective sleep disturbances which may be related to hormonal changes associated with the onset of puberty rather than anxiety and depression.