9. Common causes of sleep disruption and daytime sleepiness: childhood sleep disorders II

Characteristic Sleep Patterns and Associated Obesity in Adolescents

Poor sleep adversely affects health and may cause obesity. Poor sleep includes short sleep duration, low quality of sleep, and sleep discrepancy. Although most studies have focused on the association between sleep duration and obesity, poor sleep is a significant risk factor for obesity. Adolescents have characteristic sleep patterns which correspond to poor sleep. Adolescents sleep late due to various biological and psychosocial factors; also, they wake up early to be on time for school. This causes them to sleep less. To make up for this sleep debt, adolescents sleep more on non-school days, which causes sleep discrepancies. Therefore, since adolescents have characteristic sleep patterns, an in-depth investigation is needed to identify whether poor sleep is a risk for obesity. This article presents an overview of the characteristic sleep patterns of adolescents, and reviews studies on the association of each sleep pattern with obesity.

Prevalence of Sleep Disorders Among Children 4 - 6 Years Old in Tehran Province, Iran

BACKGROUND

Sleep patterns may change over a person's lifetime; however, the quantity and quality of sleep always depend on individual factors such as age, sex, and psychological and environmental factors. In children, sleep is as important as development. Quantitative sleep problems related to sleep onset and qualitative sleep disorders such as frequent awakenings may lead to insufficient sleep.

OBJECTIVES

This study aimed to assess the prevalence of sleep disorders among children 4 - 6 years old attending the health centers of Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2013.

PATIENTS AND METHODS

This was a cross-sectional study on 400 children selected using a multistage sampling method. Data were collected by interviews. The questionnaire included two sections: a demographic section with questions about the demographic characteristics of the children and parents and a children's sleep habit questionnaire (CSHQ). Data were analyzed by SPSS 16 and different statistical tests were used (P < 0.05).

RESULTS

The mean age of the children was 64.27 ± 9.3 months. The prevalence of sleep disorders was 36.25%. Sleep disorders were significantly associated with age, height, body mass index, residence of children, father's occupation, mother's diseases, father's drug abuse, and parents' marital status (P < 0.05).

CONCLUSIONS

Sleep disorders in children threaten growth and development, and are dangerous for their health. Sleep disorders should be considered in the differential diagnosis of children's learning and behavioral problems.

Sleep Promotion Program for Improving Sleep Behaviors in Adolescents: A Randomized Controlled Pilot Study

Aims. The purpose of this pilot trial was to determine the efficacy of sleep promotion program to adapt it for the use of adolescents studying in various schools of Mangalore, India, and evaluate the feasibility issues before conducting a randomized controlled trial in a larger sample of adolescents. Methods. A randomized controlled trial design with stratified random sampling method was used. Fifty-eight adolescents were selected (mean age: 14.02 ± 2.15 years; intervention group, n = 34; control group, n = 24). Self-report questionnaires, including sociodemographic questionnaire with some additional questions on sleep and activities, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, The Cleveland Adolescent Sleepiness Questionnaire, and PedsQL™ Present Functioning Visual Analogue Scale, were used. Results. Insufficient weekday-weekend sleep duration with increasing age of adolescents was observed. The program revealed a significant effect in the experimental group over the control group in overall sleep quality, sleep onset latency, sleep duration, daytime sleepiness, and emotional and overall distress. No significant effect was observed in sleep hygiene and other sleep parameters. All target variables showed significant correlations with each other. Conclusion. The intervention holds a promise for improving the sleep behaviors in healthy adolescents. However, the effect of the sleep promotion program treatment has yet to be proven through a future research. This trial is registered with ISRCTN13083118.

Exposure to visible mould or dampness at home and sleep problems in children: Results from the LISAplus study

BACKGROUND

Exposure to mould or dampness at home has been associated with adverse respiratory effects in all age groups. This exposure has also been related to insomnia in adults. We aimed to investigate the association between exposure to visible mould or dampness at home and sleep problems in children.

METHODS

The study population consisted of 1719 10-year-old children from the German population-based birth cohort LISAplus with available data on current mould or dampness at home and sleep problems. The presence of visible mould or dampness at home was assessed by questionnaire. Parent-reported sleep problems of their child were analysed by four binary variables: presence of any sleep problems, problems to fall asleep, problems sleeping through the night and a 24h sleep time of less than 9h. Logistic regression models adjusted for study centre, sex, age and level of parental education were applied to examine the association between visible mould or dampness at home and sleep problems. Sensitivity analyses included a further adjustment for bedroom sharing and subgroup analyses in children without current allergic diseases.

RESULTS

Thirteen percent of parents reported visible mould or dampness at home. We observed increased risks for all four sleep problem variables for children exposed to visible mould or dampness at home. Results were significant for any sleep problems (odds ratio (OR)=1.77 (95%-confidence interval (CI): 1.21-2.60), problems sleeping through the night (OR=2.52(1.27-5.00) and a short sleep time (OR=1.68(1.09-2.61)). While a further adjustment for bedroom sharing and the exclusion of children with asthma or eczema led to similar results, only the association with a short sleep time was still present in children without allergic rhinoconjunctivitis.

CONCLUSION

Our data suggests that visible mould or dampness at home might negatively influence sleep in children. The influence of allergic rhinoconjunctivitis on this association needs to be investigated in future studies.

Transitions in the Swedish school system and the impact on student's positive self-reported-health

Background

To explore three school based transitions and their impact on positive self- reported- health (SRH), pre-school to elementary school (6–10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study.

Methods

The study followed three cohorts through one school transition each.

A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007–2012 with school children age 6–16 years old.

Results

Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age.

Conclusion

The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1045) contains supplementary material, which is available to authorized users.

Sleep, school performance, and a school-based intervention among school-aged children: a sleep series study in China

BACKGROUND

Sufficient sleep during childhood is essential to ensure a transition into a healthy adulthood. However, chronic sleep loss continues to increase worldwide. In this context, it is imperative to make sleep a high-priority and take action to promote sleep health among children. The present series of studies aimed to shed light on sleep patterns, on the longitudinal association of sleep with school performance, and on practical intervention strategy for Chinese school-aged children.

METHODS AND FINDINGS

A serial sleep researches, including a national cross-sectional survey, a prospective cohort study, and a school-based sleep intervention, were conducted in China from November 2005 through December 2009. The national cross-sectional survey was conducted in 8 cities and a random sample of 20,778 children aged 9.0±1.61 years participated in the survey. The five-year prospective cohort study included 612 children aged 6.8±0.31 years. The comparative cross-sectional study (baseline: n = 525, aged 10.80±0.41; post-intervention follow-up: n = 553, aged 10.81±0.33) was undertaken in 6 primary schools in Shanghai. A battery of parent and teacher reported questionnaires were used to collect information on children's sleep behaviors, school performance, and sociodemographic characteristics. The mean sleep duration was 9.35±0.77 hours. The prevalence of daytime sleepiness was 64.4% (sometimes: 37.50%; frequently: 26.94%). Daytime sleepiness was significantly associated with impaired attention, learning motivation, and particularly, academic achievement. By contrast, short sleep duration only related to impaired academic achievement. After delaying school start time 30 minutes and 60 minutes, respectively, sleep duration correspondingly increased by 15.6 minutes and 22.8 minutes, respectively. Moreover, intervention significantly improved the sleep duration and daytime sleepiness.

CONCLUSIONS

Insufficient sleep and daytime sleepiness commonly existed and positively associated with the impairment of school performance, especially academic achievement, among Chinese school-aged children. The effectiveness of delaying school staring time emphasized the benefits of optimal school schedule regulation to children's sleep health.

Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

Short sleep duration is associated with teacher-reported inattention and cognitive problems in healthy school-aged children

PURPOSE

Pediatric, clinical, and research data suggest that insufficient sleep causes tiredness and daytime difficulties in terms of attention-focusing, learning, and impulse modulation in children with attention deficit hyperactivity disorder (ADHD) or in those with ADHD and primary sleep disorders. The aim of the present study was to examine whether sleep duration was associated with ADHD-like symptoms in healthy, well-developing school-aged children.

PATIENTS AND METHODS

Thirty-five healthy children (20 boys, 15 girls), aged 7-11 years participated in the present study. Each child wore an actigraphic device on their nondominant wrist for two nights prior to use of polysomnography to assess their typical sleep periods. On the third night, sleep was recorded via ambulatory assessment of sleep architecture in the child's natural sleep environment employing portable polysomnography equipment. Teachers were asked to report symptoms of inattention and hyperactivity/impulsivity on the revised Conners Teacher Rating Scale.

RESULTS

Shorter sleep duration was associated with higher levels of teacher-reported ADHD-like symptoms in the domains of cognitive problems and inattention. No significant association between sleep duration and hyperactivity symptoms was evident.

CONCLUSION

Short sleep duration was found to be related to teacher-derived reports of ADHD-like symptoms of inattention and cognitive functioning in healthy children.

Never enough sleep: a brief history of sleep recommendations for children

BACKGROUND AND OBJECTIVE

There is a common belief that children are not getting enough sleep and that children's total sleep time has been declining. Over the century, many authors have proposed sleep recommendations. The aim of this study was to describe historical trends in recommended and actual sleep durations for children and adolescents, and to explore the rationale of sleep recommendations.

METHODS

A systematic literature review was conducted to identify recommendations for children's sleep requirements and data reporting children's actual total sleep time. For each recommendation identified, children's actual sleep time was determined by identifying studies reporting the sleep duration of children of the same age, gender, and country in the same years. Historical trends in age-adjusted recommended sleep times and trends in children's actual sleep time were calculated. A thematic analysis was conducted to determine the rationale and evidence-base for recommendations.

RESULTS

Thirty-two sets of recommendations were located dating from 1897 to 2009. On average, age-specific recommended sleep decreased at the rate of -0.71 minute per year. This rate of decline was almost identical to the decline in the actual sleep duration of children (-0.73 minute per year). Recommended sleep was consistently ∼37 minutes greater than actual sleep, although both declined over time.

CONCLUSIONS

A lack of empirical evidence for sleep recommendations was universally acknowledged. Inadequate sleep was seen as a consequence of "modern life," associated with technologies of the time. No matter how much sleep children are getting, it has always been assumed that they need more.

Treatment options for parasomnias

Parasomnias are undesirable physical or experiential events that occur in and around sleep. Treatments include reassurance in some cases, various forms of cognitive-behavioral therapy (CBT), and pharmacologic agents. Cognitive restructuring, imagery rehearsal, relaxation, hypnosis, desensitization, and anticipatory awakenings are some of the common CBT and nonpharmacologic interventions. Medications that are used belong to a wide variety of pharmacologic classes, such as alpha-blockers (prazosin), tricyclic antidepressants (imipramine and clomipramine), selective serotonin reuptake inhibitors, benzodiazepines (diazepam and clonazepam), anticonvulsants (topiramate and gabapentin), desmopressin acetate, and anticholinergic agents (oxybutynin and tolterodine). Data on efficacy are only available from randomized trials on CBT and prazosin for nightmares and on pharmacologic and alarm therapy for enuresis. No large-scale randomized trials are available to assess the efficacy of the other treatments, and most data come from anecdotal case reports, case series, or small open-label trials.

Melatonin and sleep-related problems in children with intractable epilepsy

Children with epilepsy have high rates of sleep problems. Melatonin has been advocated in treatment of sleep disorders, and its beneficial effect has been confirmed in insomnia. The aim of this study was to assess melatonin levels in children with intractable epilepsy and its relation to pattern of sleep and characteristics of seizure disorder, as well as the effect of melatonin therapy on those parameters. The study was conducted on 23 children with intractable epilepsy and 14 children with controlled seizures. Patients were evaluated by psychometric sleep assessment and assay of diurnal and nocturnal melatonin levels. Children with intractable epilepsy received oral melatonin before bedtime. They were reassessed after 3 months. Children with intractable epilepsy had higher scores for each category of sleep walking, forcible teeth grinding, and sleep apnea. At the end of therapeutic trial, patients with intractable epilepsy exhibited significant improvement in bedtime resistance, sleep duration, sleep latency, frequent nocturnal arousals, sleep walking, excessive daytime sleepiness, nocturnal enuresis, forcible teeth grinding, sleep apnea, and Epworth sleepiness scores. There was also significant reduction in seizure severity. Thus, use of melatonin in patients with intractable seizures was associated with improvement of both many sleep-related phenomena and the severity of seizures.

Does assessing sleep inadequacy across its continuum inform associations with child and family health?

INTRODUCTION

The purpose of this study was to examine the prevalence and characteristics of children experiencing a continuum of inadequate sleep and its associations with child, family, and environmental variables.

METHOD

A secondary analysis of weighted responses of 68,418 parents or caregivers of children aged 6 to 17 years participating in the 2003 National Survey of Children's Health was conducted. Inadequate sleep was categorized as mild, moderate, or severe.

RESULTS

Approximately one third of parents reported their child's sleep inadequacy as mild (18.6%), moderate (6.8%), or severe (5.8%). Age (P < .001), fair/poor health status (P < .001), frequent depressive symptoms (P < .001), and high parental stress (P < .001) demonstrated a progressive relationship from adequate to severe inadequate sleep. Controlling for child, family, and environment variables, parents of children with inadequate sleep were more likely to report frequent child depressive symptoms, high parental stress, and violent family conflict style.

DISCUSSION

Sleep inadequacy affects 15 million American children, 6 million at a moderate or severe level. Identification of inadequate sleep should prompt further assessment of its associated factors-depressive symptoms, parental stress, and family conflict-for targeted clinical intervention.

Trends in medication prescribing for pediatric sleep difficulties in US outpatient settings

OBJECTIVES

This study examined trends in physician-prescribing of medications for children with sleep difficulties in outpatient settings in the US. Additionally, we explored the incidence of physician prescribing patterns of medications with high abuse potential for children with sleep difficulties.

METHODS

A cross-sectional study was conducted on patients aged < or =17 years with sleep difficulties from 1993-2004 using data from the National Ambulatory Medical Care Survey (NAMCS). Office visits were considered related to sleep difficulties if relevant ICD-9 codes were recorded and if sleep difficulties were reported as the reason for the visits. Medications were retrieved using the NAMCS drug codes, and all analyses were weighted to determine national estimates.

RESULTS

During 1993 to 2004, approximately 18.6 million visits occurred for sleep related difficulty in children. The highest percentage of visits were by school-aged children (6 to 12 years). Pediatricians saw 35% of patients, psychiatrists saw 24%, and general/family practice physicians saw 13% of the patients. Eighty-one percent of visits among children with sleep difficulties resulted in a prescription for a medication. Many of these medications prescribed lack FDA approved labeling to assure their effectiveness and safety in this population.

CONCLUSION

The findings of this study suggest that physicians frequently prescribed medications for sleep difficulties in children in US outpatient settings. Of particular concern is prescribing of many unapproved medications for this population.

The association between sleep and injury among school-aged children in rural China: a case-control study

OBJECTIVE

To explore the association between sleep and accidental injury among school-aged children in a rural area of China.

METHODS

Information was collected regarding parent-reported sleep patterns and problems of 182 children with a history of a medically attended injury in the previous 12 months and of 207 non-injured control children, and data were analyzed to compare differences between the two groups of children.

RESULTS

Global sleep disturbance (Children's Sleep Habits Questionnaire [CSHQ] total score) was significantly higher in the injured group (IG) than in the non-injured group (NIG), and a greater percentage of the IG scored above the clinical cut-off score on the CSHQ. Stepwise multivariate logistic regression analysis showed that the CSHQ parasomnias and daytime sleepiness subscale scores were significantly and positively related to injury. Sleep duration was also shorter in the IG, and this group had a greater percentage (23% vs 12%) of "short sleepers" (<9h). In addition, a greater percentage of "short sleepers" (91% vs 27%) had more than two injuries.

CONCLUSION

This study supports an association between injuries and sleep disturbances, including shorter sleep duration and daytime sleepiness, in Chinese children.

Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children

OBJECTIVE

Our goal was to identify characteristics associated with inadequate sleep for a national random sample of elementary school-aged children (6-11 years) and adolescents (12-17 years).

METHODS

Data from 68418 participants in the 2003 National Survey of Children's Health were analyzed by using weighted bivariate and multivariate regression models. The dependent variable was report of not getting enough sleep for a child of his or her age >or=1 night of the past week. Independent variables included demographic characteristics, child health, school and other activities, and family life.

RESULTS

Parents of elementary school-aged children with inadequate sleep were more likely to report that their child was having problems at school or had a father with fair or poor health. Parents of adolescents with inadequate sleep were more likely to report that their child had an atopic condition, frequent or severe headaches, a parent with less-than-excellent emotional health, or experienced frequent parental anger. Inadequate sleep in both age groups was associated with parental report that their child usually or always displayed depressive symptomatology, family disagreements involved heated arguing, or parental concern that the child was not always safe at home, at school, or in their neighborhood.

CONCLUSIONS

Approximately 15 million American children are affected by inadequate sleep. Primary care providers should routinely identify and address inadequate sleep and its associated health, school, and family factors.