35 Sleep Characteristics of Young Alcohol Affected Children: A Quantitative and Qualitative Analysis

Abstract

Fetal alcohol spectrum disorder refers to a group of phenotypic and behavioral anomalies associated with the use of alcohol in pregnancy, including growth retardation, craniofacial anomalies, and central nervous system involvement. Sleep disorders have been identified, but poorly described in fetal alcohol spectrum disorder. To quantitatively describe the sleep characteristics of children with fetal alcohol spectrum disorder, and to qualitatively describe the effects of sleep disruption on the affected child and their family. To develop appropriate sleep management strategies for children with fetal alcohol spectrum disorder and their families. A two part design was used. Nine children and their families were recruited from the Clinic for Alcohol and Drug Exposed Children at Children's Hospital in Winnipeg. Each study child was matched with a non-biologically related healthy control child in the same household. The first part of this research was a qualitative study of sleep using actigraphy to measure sleep disturbance. Actigraphic parameters were correlated with information from a pediatric sleep questionnaire designed for this study, and with a parent-maintained sleep log. The second part of the study consisted of a series of semi-structured interviews with the same families, with thematic analysis of the data. Actigraphic analysis showed significant differences in the mean duration of wake episodes (minutes, p=0.0072) and the mean duration of sleep episodes (minutes, p=0.0064). The differences in the number of wake episodes was also significant (p=0.0241) as was the number of sleep episodes (p=0.0214). These data support observably more restless sleep in alcohol affected children. Questionnaire analysis supports a significant degree of concern among families of these children, who identify disrupted and restless sleep patterns, along with daytime behavioral concerns including daytime fatigue and hyperactivity. Alcohol affected children were described as having five times as many sleep related behaviors as control children. Thematic analysis of the interviews supports a significant impact of sleep disruption in families caring for these children. Actigraphic analysis supports significantly disrupted sleep patterns in alcohol affected children, with frequent wakenings and greater restlessness in sleep. Families are more likely to identify sleep disruption in alcohol affected children, describing excessive movements in sleep with associated daytime fatigue and hyperactivity. While there is a significant impact of sleep disturbance and related behaviors on families caring for these children, appropriate management and understanding of these problems is important to support families who care for these children.