Incidence and remission of sleep related symptoms in children and associations with health-related quality of life; A 7-year follow-up of the TuCASA cohort

Abstract

Introduction Sleep disturbances are common in adolescents; some studies have shown that this may adversely affect their quality of life. However, there is little evidence on incidence and remission of sleep problems from childhood to adolescence and the association with health-related quality of life (QoL). Materials and methods Sleep Screening questionnaires were collected on Hispanic and Caucasian children 6–12 years of age at baseline, and again 7 years after during follow-up, when participants were 12–20 years. Excessive daytime sleepiness (EDS) and difficulty initiating and maintaining sleep (DIMS) were present if they occurred frequently or more. Health-related QoL was assessed at follow-up using the Pediatric Quality of Life Inventory and three summary scores, ranging from 1 to 100, were evaluated: psychosocial health (PS), physical function (PF), and total scale scores (TS). Prevalence, incidence, and remission of sleep symptoms were computed and analyzed for association with health-related QoL. Results The mean ages at baseline and follow-up were 8.8 and 15.4 years. There were 50.2% males and 30.6% Hispanics. Incidence rates of EDS and DIMS were 39.1% and 58.9%, and remission rates were 53.1% and 36.2%, respectively. Separate linear regressions models predicting health-related QoL showed that participants with persistent EDS had lower mean values for TS (coeff. = −9.2, p = .006), PS (coeff. = −8.8, p = .025), and PF (coeff. = −10, p = .002) as compared with participants who never had EDS or those with remittent EDS combined. Participants with persistent DIMS had lower mean values for TS (coeff. = −6.8, p = .001) and PS (coeff. = −8.4, p = .001) as compared with participants who never had DIMS or those with remittent DIMS combined. When participants with persistent DIMS were compared with those with remittent DIMS only, the associations between DIMS and health-related QoL, became non-significant. However, the association between EDS and health-related QoL remained (coeff. = −13.3, p = .02). Conclusion Substantial variability of self-reports of sleep problems exists as children age from childhood to adolescence. Nevertheless, there are a small number of young children who persistently have sleep problems over this age span and these problems are associated with lower health-related quality of life. These associations appear to be driven primarily by EDS. Acknowledgements The TuCASA study was supported by NHLBI grant HL 62373 . Silva, G.E. was supported by NHLBI grant HL 62373-05A2S1 .