O007 Unseen sleep burden in children with Neurodisability: MSPSQ Findings

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.

Background: Research indicates that parental caregivers of children with chronic illnesses have reported sleep disturbance and poor sleep quality, possibly due to nighttime caregiving, frequent monitoring, disturbance of the child's sleep, and emotional distress. Among chronic illnesses, Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer and the maintenance phase is the third and longest phase of treatment, often requiring caregivers to be vigilant advocates and care providers. However, despite the high prevalence of ALL and the attending demands of caregiving, knowledge of the impact of worry and child sleep disturbance on sleep quality among this specific population of caregivers is limited. Therefore, the aim of this informative pilot study was to describe overall subjective sleep quality and disturbance among caregivers of children in the maintenance phase of ALL, as well as to examine the relationship between subjective sleep quality, child sleep disturbance, and worry of caregivers in order to inform the literature and the development of future quantitative studies. The current study was part of a larger study which aimed to prospectively describe the impact of corticosteroids on sleep patterns and health-related quality of life of 128 children with ALL over a 28-day period in maintenance treatment. Method: At a single time point, 32 caregivers of children with ALL ages 3 to 12 receiving care at The Children's Hospital of Philadelphia (CHOP) and St. Christopher's Hospital for Children completed measures of demographic information, caregiver worry, and subjective sleep quality of the past month, as well as measures regarding the child's developmental history and sleep habits and disturbance of the past week. Results: Participants were 28 mothers and 4 fathers (75% married, 81.3% Caucasian, 12.5% Hispanic) ranging in age from 21 to 67 years old. No significant relationship was found between higher levels of caregiver subjective sleep quality, child sleep disturbance and caregiver worry. However, caregivers were nearly evenly divided between good and poor sleepers, as 43.8% were found to be poor sleepers and scored >5 on the PSQI. Conclusions: Though limited, the findings provide a description of the subjective sleep quality and disturbance of this distinct caregiver population and highlight the need for further research and support of caregivers of children with pediatric illnesses, particularly sleep patterns, quality, and sources of sleep disturbance over time.

Grandparental care and sleep disturbances in preschool children: a population-based prospective cohort study

This study aimed to explore the association between family function and sleep disturbances in preschool children in rural areas of China. Caregivers of preschool children completed sociodemographic questionnaires, the Children’s Sleep Habits Questionnaire (CSHQ), the Self-rating Anxiety Scale (SAS) and the Family APGAR scale. Using sleep disturbances in children as the dependent variable, family function and other related factors as independent variables, binary logistic regression analyses were performed to examine associations between family function and sleep disturbances in children. A total of 3,636 caregivers of preschool children were enrolled in our study, and the prevalence of sleep disturbances among their preschool children was 89.4%. In our study, lower family function was associated with higher risk of sleep disturbances among preschool children. After adjusting for age (years), education level of mother, discipline attitudes of father and mother, only child status and caregivers’ anxiety, the associations were statistically significant both in families of which caregivers of children are their parents or other relatives. (AOR for parents = 1.487, 95% CI:1.152–1.919, P = 0.002; AOR for other relatives = 1.963, 95% CI:1.302–2.958, P = 0.001). Our study results indicated that family function was associated with sleep disturbances in preschool children, and future high-quality cohort studies are needed to explore this topic in more detail.

Sleep is essential for brain development and overall health, particularly in children with neurodevelopmental disorders (NDDs). Sleep disruptions can considerably impact brain structure and function, leading to dysfunction of neurotransmitter systems, metabolism, hormonal balance and inflammatory processes, potentially contributing to the pathophysiology of NDDs. This Review examines the prevalence, types and mechanisms of sleep disturbances in children with NDDs, including autism spectrum disorder, attention-deficit hyperactivity disorder and various genetic syndromes. Common sleep disorders in these populations include insomnia, hypersomnia, circadian rhythm disorders, sleep-related breathing disorders and parasomnias, with underlying factors often involving genetic, neurobiological, environmental and neurophysiological influences. Sleep problems such as insomnia, night awakenings and sleep fragmentation are closely linked to both internalizing symptoms such as anxiety and depression, and externalizing behaviours such as hyperactivity and aggression. Assessment of sleep in children with NDDs presents unique challenges owing to communication difficulties, comorbid conditions and altered sensory processing. The Review underscores the importance of further research to unravel the complex interactions between sleep and neurodevelopment, advocating for longitudinal studies and the identification of predictive biomarkers. Understanding and addressing sleep disturbances in NDDs is crucial for improving developmental outcomes and the overall quality of life for affected individuals and their families.

Background Sleep disturbances (SDs) in childhood can negatively impact behavioral and emotional control, which can lead to an increase in risky behaviors, such as substance use, including alcohol. Methods Data from 2,132 subjects who participated in the French TEMPO cohort from 1991 to 2018 were used. Sleep disturbances observed from ages 3 to 16 years defined our exposure. Alcohol use in adulthood was measured by alcohol consumption trajectories ascertained by using Group-Based Trajectory Modeling (GBTM) and constitutes our outcomes. The association between sleep disturbances in childhood and alcohol consumption trajectories was studied using multinomial logistic regression. Results Sleep disturbances at ≤ 16 years were observed in 26.7% of participants. Three alcohol use trajectories were defined: “light-drinkers”, “moderate-drinkers”, and “heavy-drinkers”. Accounting for many confounders, we found statistically significant associations between sleep disturbances and alcohol use trajectories. Using “light-drinkers” trajectory as reference, we found that compared to children with no sleep disturbances, those with sleep disturbances had a higher likelihood to be in the “moderate-drinkers” (ORa = 1.51; 95% CI = 1.09–2.10) and “heavy-drinkers” trajectory (ORa = 2.34; 95% CI = 1.27–4.34). Conclusion This study suggests that sleep disturbances in childhood are associated with an increased risk of higher alcohol consumption in adulthood and highlights the importance of healthy sleep, particularly in children and adolescents, to prevent the onset of certain risky behaviors.

The association between caregivers’ anxiety and sleep disturbances among preschool children in rural areas of China: The moderating effect of resilience

Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.

Sleep disturbances in children with multiple disabilities

Comparison of sleep questionnaires in the assessment of sleep disturbances in children with autism spectrum disorders

The present review examines the relations between sleep disturbance and anxiety in children and adolescents. The review begins with a detailed discussion of normative developmental trends in sleep, and the relation between sleep quality and emotion dysregulation in children. The extant literature on sleep disturbance in clinically anxious children with a focus on subjective versus objective measures of sleep is then summarized in detail. Finally, a review of the reciprocal relationship between sleep and emotion regulation is provided. The available research suggests that sleep disturbance is quite prevalent in children with anxiety disorders, although the directionality of the association between sleep disturbance and anxiety in children remains unclear. Despite this limitation, a reciprocal relationship between sleep quality and anxiety appears to be well established. Research using objective measures of sleep quality (e.g. polysomnography, sleep actigraphy, sleep bruxism) is warranted to better understand this relation. Further, complicating factors such as the environment in which sleep quality is measured, the developmental stage of participants, varying severity of anxiety and the timeframe during which assessment takes place should all be considered when examining sleep disturbance in this population.

Fetal alcohol spectrum disorder (FASD) describes a combination of developmental, cognitive, and behavioral disabilities in children with prenatal exposure to alcohol. The literature suggests that there are higher rates of sleep disturbances in these children. Few studies have investigated sleep disturbances in relation to common comorbidities of FASD. We examined the prevalence of disturbed sleep and the relationship between parent-reported sleep problems in different FASD subgroups and comorbidities like epilepsy or attention-deficit hyperactivity disorder (ADHD) and impact on clinical functioning. In this prospective cross-sectional survey, caregivers of 53 children with FASD completed the Sleep Disturbance Scale for Children (SDSC). Information about comorbidities was collected, and EEG and assessment of IQ, daily-life executive and adaptive functioning were performed. Group comparisons and ANCOVA interaction models were used to test the associations between different sleep disturbances and clinical factors that could interfere with sleep. An abnormal sleep score on the SDSC was very common, affecting 79% of children (n= 42) with equal prevalence in all FASD subgroups. Difficulty falling asleep was the most common sleep problem, followed by difficulty staying asleep and waking early. The incidence of epilepsy was 9.4%, with an abnormal EEG seen in 24.5%, and a diagnosis of ADHD in 47.2% of children. The distribution of these conditions was equal in all FASD subgroups. Children with signs of sleep disturbance had poorer working memory, executive function, and adaptive functioning. Children with ADHD had a greater prevalence of sleep disturbance than those without ADHD (OR 1.36; 95% CI 1.03 to 1.79). Problems with sleep are very common in FASD children and seem independent of FASD subgroup and the presence of epilepsy or a pathological EEG finding, while those with ADHD had more sleep problems. The study underscores the importance of screening for sleep disturbances in all children with FASD as these problems may be treatable.

To formulate a rational approach to the pharmacologic treatment of pediatric insomnia, and to develop clinical guidelines regarding indications, target populations, and parameters for the use of these medications, especially by community-based pediatricians. A multidisciplinary task force developed under the auspices of the American Academy of Sleep Medicine, which included experts in pediatric sleep medicine, psychiatry, pharmacology, neurology, and general pediatrics. Review of existing data regarding current use of over-the-counter and prescription medications for pediatric insomnia in the primary care practice setting, and of empirical data on the pharmacology, safety, efficacy, and tolerability of medications commonly used for the treatment of pediatric insomnia. Group consensus definition of pediatric insomnia and clinical guidelines; working group recommendations regarding special populations and future directions. Use of medications for pediatric insomnia should be diagnostically driven, and should be implemented in conjunction with empirically-based behavioral treatment strategies and adequate sleep hygiene. Specific target populations include children with neurodevelopmental disorders, pervasive developmental disorders, chronic medical conditions, and psychiatric disorders. Additional research, including clinical trials, is critically needed to provide an evidence-based approach to the use of these medications in clinical practice.

BackgroundSleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress.MethodsHundred children with a diagnosis of ASD (mean age: 66.7 months, SD: 27.4, range: 24.7–152.1 months, n = 79 males) were included in the study. We collected data on sociodemographic, clinical, genetic and instrumental variables as well as comorbid conditions. Parents filled out the Questionnaire on sleep behavior in the first years of life, the BEARS questionnaire, and the Parenting Stress Index Short Form. From the analysis on sleep characteristics, we excluded 25 children treated with melatonin.ResultsFifty-seven (57%) out of 100 children met the criteria for insomnia. Sleep disorders were associated with developmental or cognitive delay, emotional and behavioral problems (such as anxiety problems and aggressive behaviors) and absence of strategies for inducing sleep after nocturnal awakenings. From parents' reports, sleep disorders had diurnal repercussions on their offspring; however, we found no statistical correlation between disturbances and family stress. Also, no significant correlation was found between sleep disturbances and epilepsy. Finally, a statistical correlation was found between the regular intake of melatonin and the resolution of insomnia.ConclusionsMultifactorial variables may be associated to insomnia that could have an impact on the children' behavior. Clinicians need to be aware of the value of screening for sleep disturbance in children with ASD to integrate sleep interventions in the treatment plan.

Background: Sleep plays an important role in brain function, impacting critical periods of brain development and maturation. Sleep disturbances in children must be addressed, as they increase the risk of emotional disturbances. Sleep quality has been associated with melatonin levels. However, evidence of the association between sleep quality, emotional disturbance, and melatonin levels in children is still lacking. Objectives: The present study aimed to assess the association between sleep and emotional disturbances with melatonin levels in children experiencing online learning. Methods: This analytical cross-sectional study involved 82 elementary school students aged 6 - 12 years in Banyumas Regency, West Java, Indonesia, from August to September 2022. Subjects with major depressive disorder and attention deficit hyperactivity disorder (ADHD) were excluded to minimize potential bias. Salivary melatonin levels were measured using enzyme-linked immunosorbent assay (ELISA). Sleep disturbance was assessed using the Sleep Disturbance Scale for Children (SDSC), and emotional disturbance was measured by the Strengths and Difficulties Questionnaire (SDQ). The Mann-Whitney test with α < 0.05 was applied to test the difference in melatonin levels among various groups of children with sleep and emotional disturbances. Results: Of the 82 subjects, 7 children (8.5%) experienced sleep and emotional disturbances. The melatonin levels varied widely, with a median of 301.9 pg/mL. No significant difference was found in melatonin levels between children with sleep disturbance compared to those without sleep disturbance (P = 0.67), as well as for children with emotional disturbance compared to those without emotional disturbance (P = 0.79). Conclusions: Sleep and emotional disturbances were not associated with variations in melatonin levels in children experiencing online learning.