Does poor sleep affect cognition differently across ages? Insights from a national cohort.

Children with overweight or obesity are more likely to experience sleep disorders, although the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pretreatment insomnia severity and global sleep problems and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment. Participants included 1,133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age-adjusted and sex-adjusted body mass index Z-score. Among adolescents, regression analyses found that higher body mass index Z-score modestly predicted baseline insomnia severity (P = .021) and worse sleep hygiene (P < .001). For children, higher body mass index Z-score was modestly associated with baseline total sleep problems (P = .006) but not insomnia severity (P = .792). Across ages, body mass index Z-score predicted neither treatment status nor insomnia improvement (P > .05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight. Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status. Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med. 2022;18(4):1083-1091.

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.

Managing Sleep Problems After Traumatic Brain Injury

BackgroundSleep 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.MethodsThis 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).ResultsOf 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.ConclusionThe results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.

Sleep disturbances in young and middle-aged adults - Empirical patterns and related factors from an epidemiological survey

Introduction: Sleep problems are common during adolescence. Additional impacts from congenital heart disease (CHD) may contribute to negative outcomes. Studies among adolescents with CHD have described a link between diagnosed sleep disorders, cognitive challenges, cardiovascular risk factors, and mental health problems. Less is known about the association between subjective sleep problems, cognitive function, and general health. Research Question: What are the associations between sleep problems (quality, disturbance, daytime sleepiness), cognitive function, and general health among adolescents with CHD? Methods: Adolescents with CHD (n = 87; age 13-19 years) were recruited via the Children’s Hospital of Philadelphia electronic health record system. General health, cognitive functioning, and sleep disturbances were assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric short form measures. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). PROMIS and PSQI cut points were used to classify scores as within or above normal limits. Spearman’s rank correlation assessed bivariate correlations among key measures. Wilcoxon rank-sum test and the Kruskal-Wallis rank-sum test compared mean age across CHD severity, sex, and age groups. Chi-square and Fisher’s exact tests evaluated group differences in sex, CHD severity, and age based on PROMIS and PSQI cut points. Results: Nearly 39% of adolescents scored above the normal limit on PROMIS Global Health (24%); Cognition (37%) and Sleep Disturbance (39%). A majority also scored above normal on the PSQI (62%). Mean ESS-CHAD scores indicated average levels of daytime sleepiness (6.6 ± 4.0). Sleep disturbance was negatively correlated with cognition (r=-0.28) and global health (r=-0.47), and positively with ESS-CHAD (r=0.27) and PSQI (r=0.59) (p&lt;0.05). No significant group differences were observed by CHD severity, age, or gender. Conclusion: Poor sleep was significantly associated with decreased cognition and general health among adolescents with CHD, with no significant differences across age, sex, and CHD severity. These findings highlight the prevalence of sleep problems, their association with cognitive function and overall health, and underscore the need for further investigation among adolescents with CHD.

Sleep disturbances and problems are increased in ankylosing spondylitis (AS). But much is not known in a quantitative way about sleep problems and effect of treatments on AS. This study is aimed first, to investigate sleep disturbances in AS and secondly, to evaluate the effects of anti-TNF treatment on SD in AS. One hundred seventy-one (Female/male: 90/81) AS patients fulfilling modified New York criteria and 86 (F/M: 56/30) age- and gender-matched controls without inflammatory diseases were included into the study. Demographic data and disease activity and treatments were recorded using The Bath Ankylosing Spondylitis Functional Index (BASFI) and The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The Medical Outcomes Study (MOS) Sleep Questionnaire was used for evaluating sleep and problems of sleep. AS patients had higher sleep disturbance scale (SDS) and sleep problem index (SPI) II scores. Group A (patients using NSAID and/or DMARD, 53.2% of patients) had higher BASDAI and BASFI compared with Group B (Patients using anti-TNF treatments) (4.29 ± 2.38 vs. 2.46 ± 2.32, p < 0.001; 1.95 ± 2.15 vs. 0.93 ± 1.31, p < 0.001, respectively). Whereas Group A had higher scores of SDS, awaken short of breath or headache, somnolence, and SPI-II than controls, none of the sleep parameters were statistically different between patients on anti-TNF treatments and controls. BASDAI was positively correlated with SPI-I, SPI-II, SDS, and somnolence scale. AS patients had increased sleep problems and disturbances compared with controls. Anti-TNF agents improve significantly these problems. Sleep problems are significantly correlated with the disease activity.

We retrospectively analyzed sleep time and sleep disturbance symptoms in 399 healthy, non-demented elderly (NDE) and 263 persons with a diagnosis of possible (n = 53) or probable (n = 210) Alzheimer's disease (AD). Our primary objective was to determine differences in subjective sleep disturbance between these samples. Secondary objectives were to determine if subjects with time in bed (TIB) < or =6 h per night reported more sleep disturbance and whether sleep complaints were associated with more severe cognitive and/or functional impairment. The prevalence of 'sleep problems' (a single item) was significantly lower in NDE (18.3%) than AD (27.6%), and the proportions of each cohort reporting TIB < or =6 h per night were very low (NDE: 6.0%; AD: 3.5%) and not significantly different. Less TIB was correlated with better cognitive function for AD (P < 0.01), and cognition and function were significantly worse for AD subjects with estimates of >6 h of TIB compared with those with estimates of < or =6 h (P < 0.05). Greater sleep disturbance was correlated with greater functional impairment in both cohorts; but only in AD did greater estimated TIB also correlate with greater functional impairment (all P < 0.05). In general, estimated TIB was not associated with mood in either cohort; however, in both cohorts depression was significantly associated with sleep disturbance symptoms and was significantly worse in those who reported having 'sleep problems'. There was no association between subjective perception of 'sleep problems', the number and frequency of sleep disturbance symptoms, and estimated TIB in either group.

IntroductionPremature birth is associated with a higher risk of sleep problems and neurodevelopmental disabilities (NDD). We examined relationships between sleep problems and cognitive, motor, and sensory functions in a national cohort of five-year-old children born extremely preterm (EPT) with the purpose of identifying possible means of improving developmental outcomes.MethodsThis study was part of a national cohort study of all children born extremely preterm, defined here as gestational age less than 28 completed weeks, or birth weight below 1,000 g, born in Norway in 1999 and 2000. Parents completed a structured retrospective questionnaire at age five to assess sleep problems from ages two to five years. We assessed cognitive function using the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), evaluated motor function with the Movement Assessment Battery for Children (M-ABC) and classified cerebral palsy (CP) according to the Gross Motor Function Classification System (GMFCS). NDD was graded from no NDD (no disabilities) to NDD 2 and 3 (moderate and severe disability).ResultsOf 372 eligible children, 253 (68%) participated. Parents reported that 28.5% had general sleep problems from ages two to five years. Prevalences of specific problems were 21.7% for nighttime awakenings, 17.8% for difficulty falling asleep, 5.9% for early morning awakening and 1.6% for late morning awakening. Children with Full scale IQ < 85 were at increased risk of general sleep problems (adjusted odds ratio - aOR 1.8), as well as nighttime awakenings (aOR 2.8), and early morning awakenings (OR 2.9), but not for difficulty falling asleep compared to those with higher IQ levels.EPT children with moderate to severe NDD (NDD 2 and 3) showed a higher prevalence of general sleep problems [adjusted odds ratio (aOR) 3.9], nighttime awakenings (aOR 4.8), and early morning awakenings (OR 7.9) compared to those with no NDD (NDD 0).ConclusionGeneral and specific sleep problems were associated with low cognitive function and moderate to severe NDD. Our findings underscore the importance of addressing sleep within a comprehensive care framework for EPT children and highlight the need for addressing and target interventions for sleep problems.

This study examined the gender differences in sleep problems among older adults in India. We also examined the role of socioeconomic status in determining the gender differences in sleep. Individuals aged 50 years and above (N = 6560) from the first wave of WHO’s Study on global Ageing and Adult Health (SAGE) – 2007 were studied using bivariate analysis and multivariate logistic regression. In the fully adjusted regression model, older women in India were 46% more likely to report sleep problems than men. Educated and wealthier older adults had fewer sleep problems compared to their counterparts. Further, the gender difference in sleep problems is largely driven by lower socioeconomic status. There are no gender differences in sleep problems among older adults in 6–9 and 10+ years of schooling as well as middle, fourth and fifth wealth quintile (richest) categories. Gender differences could be explained further with women’s mental health (cognitive function, depressive symptoms, stress etc.) and managing their overall physical health and multiple roles demands at the household level in India. Interventions focusing on women in lower socioeconomic strata will be beneficial to reduce the sleep problems in the context of the population ageing in India.

Individuals with opioid use disorder (OUD) may experience worsening sleep quality over time, and a subset of individuals may have sleep disturbances that precede opioid use and do not resolve following abstinence. The purpose of the present study was to (1) collect retrospective reports of sleep across the lifespan and (2) identify characteristics associated with persistent sleep disturbance and changes in sleep quality in persons with OUD. Adults with OUD (n = 154) completed a cross-sectional study assessing current and past sleep disturbance, opioid use history, and chronic pain. Repeated-measures analysis of variance was used to examine changes in retrospectively reported sleep quality, and whether changes varied by screening positive for insomnia and/or chronic pain. Multivariate linear regression analyses were used to identify additional correlates of persistent sleep disturbance. Participants reported that their sleep quality declined over their lifespan. Changes in reported sleep over time varied based on whether the individual screened positive for co-occurring insomnia and/or chronic pain. In regression analyses, female sex (β = 0.16, P = .042), a greater number of treatment episodes (β = 0.20, P = .024), and positive screens for chronic pain (β = 0.19, P = .018) and insomnia (β=0.22, P = .013) were associated with self-reported persistent sleep disturbance. Only a portion of participants who screened positive for sleep disorders had received a formal diagnosis. OUD treatment providers should routinely screen for co-occurring sleep disturbance and chronic pain. Interventions that treat co-occurring OUD, sleep disturbance, and chronic pain are needed. Ellis JD, Mayo JL, Gamaldo CE, Finan PH, Huhn AS. Worsening sleep quality across the lifespan and persistent sleep disturbances in persons with opioid use disorder. J Clin Sleep Med. 2022;18(2):587-595.

Disturbances in sleep could affect normal growth as well as behavior of children. It could also impair their cognitive development. Sleep problems have been increasing over the past few years. However, there is a gap regarding information about sleep practices and sleep problems among Indian children. A sleep questionnaire was designed and validated to assess the frequency of sleep practices and sleep problems in 500 children. The study was conducted in 5 local schools in South Kanara district by administering the questionnaire to the parents/caretakers under the guidance of a trained investigator. We also sought to examine the association of demographics, medical/behavior/academic performance, sleep patterns, and home environment to sleep problems in these children. Descriptive statistics were recorded as mean and standard deviation for quantitative data and in frequency and percentage for qualitative data. We found a high prevalence of bedroom sharing (92.4%) and bed-sharing (91.2%). 46.4% of the children exhibited at least one sleep problem, the most prevalent being bed-wetting (17%). Sleep problems were considerably greater in older children and in children with behavioral problems. Practices such as watching TV and using computer after 8 pm/at bedtime were significantly associated with all sleep problems. Our study revealed definite and significant presence of sleep problems in the children of South Kanara. Strong associations were observed between certain sleep practices and problems.

The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

AimSleep is essential for infant development. We assessed the prevalence of sleep problems in infants at 6, 12 and 24 months, investigated the relationship between infants’ sleep problems and development, and determined to what extent sleep problems at 6 months were related to changes in the developmental course.MethodsInfant sleep problems were measured by a parent‐reported sleep questionnaire. The Ages and Stages Questionnaires were used to measure developmental skills in a sample of 1555 infants recruited from 9 well‐baby clinics in Norway. ASQ scores were compared between infants with and without sleep problems by using two‐sample t‐tests. The relationship between infant sleep problems at 6 months and changes in Ages and Stages Questionnaires scores over time was investigated using linear mixed‐effects models.ResultsThe prevalence of infant sleep problems were 14.6% at 6 months, 7.4% at 12 months and 3.3% at 24 months. There was no clear evidence of differences in ASQ or ASQ:SE scores by sleep problems from 6 to 24 months, but communication and problem‐solving scores for infants with sleep problems increased faster.ConclusionPrevalence of sleep problems decreased with age. There was no clear evidence of early sleep disturbance and later development problems.