O008 Sleep strategies for children with Neurodisability: development and preliminary outcomes

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.

Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), as are internalizing and externalizing comorbidities. The prevalence of these difficulties and the extent to which they co-exist in children with ADHD could inform clinical practice, but remains unclear. Therefore, we examined the association between sleep problems and internalizing and externalizing comorbidities in children with ADHD. Children aged 5-13 years were recruited from 21 pediatric practices across Victoria, Australia (N = 392). Internalizing and externalizing comorbidities (none, internalizing, externalizing, co-occurring) were assessed by the telephone-administered Anxiety Disorders Interview Schedule for Children IV/Parent version. Sleep problem severity was assessed by primary caregiver report (no, mild, moderate or severe problem). Moderate/severe sleep problems were confirmed using International Classification of Sleep Disorders. Seven specific sleep problem domains (bedtime resistance, sleep anxiety, sleep onset delay, sleep duration, night waking, parasomnias and daytime sleepiness) were assessed using the Children's Sleep Habits Questionnaire. Data were analyzed using adjusted logistic and linear regression models. Compared to children without comorbidities, children with co-occurring internalizing and externalizing comorbidities were more likely to have moderate/severe sleep problems (adjusted OR 2.4, 95 % CI 1.2; 4.5, p = 0.009) and problematic sleep across six of seven sleep domains. Children with either comorbidity alone were not at risk of moderate/severe sleep problems, but at the sleep domain level, children with internalizing alone had more sleep anxiety, and those with externalizing alone had less night waking. In conclusion, children with ADHD experiencing co-occurring internalizing and externalizing comorbidities are at an increased risk of sleep problems.

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.

IntroductionSleep-related problems are common in children with attention-deficit/hyperactivity disorder (ADHD). Sleep disorders are also side effects of all stimulant ADHD medications. Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) is a once-daily treatment approved for patients age 6 years and older with ADHD. In this analysis, sleep behavior was assessed during SDX/d-MPH treatment in children with ADHD.MethodsIn a 12-month, dose-optimized, open-label safety study in 6- to 12-year-old participants (NCT03460652), a secondary endpoint was assessment of sleep behavior based on the Children’s Sleep Habits Questionnaire (CSHQ) consisting of 8 sleep domains (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness). This post hoc analysis examined the individual sleep domains in the 12-month safety study.ResultsOf 282 participants enrolled, 238 were included in the sleep analysis. At baseline, mean (SD) CSHQ total sleep disturbance score was 53.4 (5.9). After 1 month of treatment, the mean (SD) CSHQ total score significantly decreased to 50.5 (5.4); least-squares mean change from baseline was −2.9 (95% CI: −3.5 to −2.4; p < 0.0001) and remained decreased up to 12 months. Mean sleep-score improvements from baseline to 12 months were statistically significant (p < 0.0001) for 5 of 8 sleep domains, including bedtime resistance, sleep anxiety, night wakings, parasomnias, and daytime sleepiness. Parasomnias and daytime sleepiness sleep domains showed the greatest mean improvement from baseline to 12 months. Sleep onset delay and sleep duration scores increased from baseline to 12 months. No statistically significant worsening occurred from baseline in sleep duration and sleep-disordered breathing domains; however, worsening of sleep onset delay was statistically significant.ConclusionIn this analysis of children taking SDX/d-MPH for ADHD, sleep problems did not worsen based on the mean CSHQ total sleep disturbance score. Statistically significant improvements in most CSHQ sleep domains were observed after 1 month and lasted for up to 12 months of treatment.

IntroductionEmotional self-regulation (ESR) skills are vital for mental and physical health. There is growing evidence linking sleep to ESR in school-aged children, but associations in toddlers remain unclear. The current study examined associations between toddlers’ sleep duration and behaviors and ESR. Materials and methodsThis study utilized baseline data from 1358 toddlers (Mage=26±3.9mo) from the Let’s Grow trial. Total sleep duration was calculated by summing parent-reported average nighttime sleep and daytime nap duration. Sleep behaviors (bedtime routine, bedtime resistance, sleep latency, and night waking) were assessed using the Children’s Sleep Habits Questionnaire and Brief Infant Questionnaire. Toddlers’ ESR skills were assessed via a 4-item parent-report scale adopted from the Fast Track Project Child Behaviour Questionnaire, with a lower score indicating better ESR. Linear regression models assessed associations of sleep duration and behaviors with ESR.ResultsToddlers’ average daily total sleep, nighttime sleep, and nap duration were 12.1h, 10.6h, and 1.5h, respectively. Girls and boys had similar nighttime sleep, total sleep, and ESR scores. However, girls had longer naps than boys (1.6h vs 1.4h, t=-3.5, p=0.0004). Total sleep, nighttime sleep, and nap duration were inversely associated with ESR (all p<0.01), indicating that higher sleep duration was associated with better ESR. Sleep behaviors were positively associated with ESR (all p<0.01), with more problem sleep behaviors associated with poorer ESR. ConclusionInitial results suggest that improving sleep duration and behaviors are associated with better ESR in toddlers. Supporting parents to improve their toddlers’ sleep may help foster better ESR skills.

Sleep disturbances in Portuguese asthmatic children-preliminary results

Sleep habits in a pediatric population of a suburban area of Lisbon

Background: Disrupted sleep in children may lead to multiple behavioural problems that affect the individual and the family. The aim of this study was to compare sleep behaviour and sleep disorders in children with VCFS with those of their siblings and to determine the severity and pattern of the sleep problems. Method: Parents completed the Children’s Sleep Habits Questionnaire (CSHQ) (Owens et al., 2000) for 31 children with VCFS (mean age 10 years). This instrument has good psychometric properties and validity. It includes items relating to a number of key sleep domains grouped conceptually into eight subscales reflecting: (1) Bedtime Resistance; (2) Sleep Onset Delay; (3) Sleep Duration; (4) Sleep Anxiety; (5) Night Wakings; (6) Parasomnias; (7) Sleep Disordered Breathing; (8) Daytime Sleepiness. Total Sleep Disturbance Score includes all items of the eight subscales. Higher scores are indicative of more disturbed sleep. Results: The severity of sleep problems in the VCFS group was reported by parents as being significantly higher than in the sibling group (mean score 42.97 and 36.55, respectively; p &lt; 0.001). Values for five of eight sleep subscales including bedtime resistance, sleep anxiety, night waking, parasomnias and daytime sleepiness were significantly (p &lt; 0.001) higher in the VCFS group. Conclusion: Parents report that sleep problems are significantly more severe in children with VCFS compared to their siblings, and that the pattern appears diverse. Sleep problems in children with VCFS require further research and clinical attention.

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.

The sleep patterns of humans are greatly influenced by age and sex and have various effects on overall health as they change continuously during the lifespan. We investigated age-dependent changes in sleep properties and their relation to sex in middle-aged individuals. We analyzed data from 2,640 participants (mean age of 49.8 ± 6.8 years at baseline, 50.6% women) in the Korean Genome and Epidemiology Study, which assessed sleep habits using the Pittsburgh Sleep Quality Index and other clinical characteristics. We analyzed the sleep habit changes that occurred between baseline and a follow-up point (mean interval: 12.00 ± 0.16 years). Associations of age and sex with 9 sleep characteristics were evaluated. Age was associated with most of the sleep characteristics cross-sectionally and longitudinally (P < .05), except for the time in bed at baseline (P = .455) and change in sleep duration (P = .561). Compared with men, women had higher Pittsburgh Sleep Quality Index scores, shorter time in bed, shorter sleep duration, and longer latency at baseline (P ≤ .001). Longitudinal deterioration in Pittsburgh Sleep Quality Index score, habitual sleep efficiency, duration, and latency was more prominent in women (P < .001). The sex differences in these longitudinal sleep changes were mainly noticeable before age 60 years (P < .05). Worsening of Pittsburgh Sleep Quality Index scores, habitual sleep efficiency, and latency was most evident in perimenopausal women. Men presented with greater advancement of chronotype (P = .006), with the peak sex-related difference occurring when they were in their late 40s (P = .048). Aging is associated with substantial deterioration in sleep quantity and quality as well as chronotype advancement, with the degree and timing of these changes differing by sex.

Background Sleep problems in young children are a significant public health concern, disproportionately affecting racial, ethnic, and socioeconomically disadvantaged groups. Poor sleep health is linked to cognitive, behavioral, and emotional difficulties. Parenting practices play a key role in shaping children’s sleep behaviors. Addressing behavior and sleep problems concurrently may enhance intervention outcomes. Objective This study examined the impact of Parent–Child Interaction Therapy (PCIT), a widely used behavioral parent training (BPT) program, on children’s sleep health. It also explored factors contributing to changes in sleep, including parenting practices, treatment dosage, and parenting stress and family conflict levels. Method Participants included 403 children (ages 2–9 at enrollment) and their caregivers enrolled in an 18-week PCIT program at a University-affiliated clinic. Sleep health was evaluated using the Children’s Sleep Habits Questionnaire at pre-, mid-, and post-treatment. Parenting practices, family stress, and child compliance were measured through observational and caregiver-report assessments. Linear mixed-effects models examined sleep problem changes over the course of treatment. Results Significant improvements in children’s sleep were observed at post-treatment, particularly in the areas of caregiver-reported bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night awakenings, and parasomnias. These improvements were most notable during the parent-directed discipline phase of PCIT. Parenting skill acquisition, treatment dosage, and family stress factors did not significantly predict sleep improvements. Greater pre-treatment sleep problems were associated with higher externalizing behavior scores but did not moderate behavioral improvements over time. Conclusions PCIT may improve both behavior and sleep health even without sleep-specific interventions. Findings suggest BPTs could streamline treatment efforts, particularly for families with limited access to care. Future research should explore which BPT components contribute most to sleep improvements and the potential for integrating targeted sleep interventions.

Simple SummarySleep in dogs is a rarely studied but important behaviour. Changes in the pattern and duration of a dog’s sleep can reflect a dog’s wakeful experiences and how comfortable they are in their own environment. Little is known about normal sleep behaviours in dogs under 12 months of age. This study aimed to describe patterns of sleep and sleep-related behaviours (such as where the dog slept, how the dog was settled to sleep, sleep positions, and snoring) based on reports from owners of dogs aged 16 weeks and 12 months. For the statistical analysis, only dogs with data regarding sleep duration at both timepoints were used. Dogs aged 16 weeks slept for significantly longer during the day and in total over a 24 h period, but for less time during the night than dogs at 12 months. At both timepoints, owners most commonly settled dogs to sleep by leaving the dog in a room/area without human company. However, of dogs that did have access to people during the night, more than 86% chose to be around people. Puppies aged 16 weeks were most commonly reported to sleep in a kennel/crate, but dogs aged 12 months most often slept in a dog bed. More research is needed to better understand how the sleep duration and behaviours of dogs change as they age, and how sleep can affect dog health and wellbeing.Sleep is a vital behaviour that can reflect an animal’s adaptation to the environment and their welfare. However, a better understanding of normal age-specific sleep patterns is crucial. This study aims to provide population norms and descriptions of sleep-related behaviours for 16-week-old puppies and 12-month-old dogs living in domestic environments. Participants recruited to a longitudinal study answered questions relating to their dogs’ sleep behaviours in surveys issued to them when their dogs reached 16 weeks (n = 2332) and 12 months of age (n = 1091). For the statistical analysis, subpopulations of dogs with data regarding sleep duration at both timepoints were used. Owners of 16-week-old puppies perceived their dogs to sleep longer during the day and over a 24 h period, but for less time during the night than owners of 12-month-old dogs. At both timepoints, dogs were most commonly settled to sleep by being left in a room/area without human company. However, of dogs that had access to people overnight, 86.7% and 86.8% chose to be around people at 16 weeks and 12 months of age, respectively. The most common sleeping place was in a kennel/crate at 16 weeks (49.1%), and a dog bed at 12 months (31.7%). Future research within this longitudinal study will investigate how sleep duration and behaviours change with age and impact on a dog’s health and behaviour.

Background and objective: This study aims to determine the effects of forest activities, such as forest meditation and forest experience, on young children's sleep and problematic behaviors and to compare the changes that occur according to the type of forest activity.Methods: Fifty-nine five-year-old children from early childhood education institutions in Cheongju City, Korea, participated. The experiment took place over five weeks between May 3 and 31, 2022. Activities were conducted twice a week for a total of eight sessions. The forest meditation and forest experience groups carried out activities in the forest. The control group carried out thematic activities according to the Nuri curriculum followed by early childhood education institutions. The Korean version of the Children's Sleep Habits Questionnaire was used to assess the participants' sleep duration and sleep habits, and the Korean Child Behavior Checklist for Ages 1.5-5 was used to assess problematic behaviors.Results: We found a statistically significant increase in the average sleep duration of the children in the meditation group, as well as a statistically significant decrease in their total sleep habits score and the scores of the bedtime resistance, sleep onset delay, and sleep anxiety subdomains of sleep habits. A statistically significant decrease was observed in the forest experience group's scores for total problematic behaviors and internalizing problems. We also found a statistically significant positive correlation between sleep habits and problematic behaviors.Conclusion: These findings demonstrate that static activities, such as forest meditation activities, increase sleep duration and improve sleep habits, while dynamic activities, such as forest experience activities, improve problematic behaviors and internalizing problems. Providing specific programs that appropriately utilize static and dynamic forest activities can help improve sleep and problematic behaviors in young children.

The present study was designed to evaluate the effect of melatonin on the sleep initiation, duration of sleep, quality of sleep and daily performance in healthy children suffering from insomnia. This study was done as a double blind randomized clinical trial in the sleep clinic of Qods Hospital. Sixty healthy children between 7 and 12 years of age having sleep problems were chosen and randomly divided in interventional and placebo groups. Before the treatment, children`s sleep habits questionnaire (CSHQ) was filled in both groups. Then, both groups were taught about sleep hygiene. Afterwards, the intervention group was treated with 3mg nocturnal dose of melatonin for one month and the other group with a placebo. Then, CSHQ was filled again for both groups. The intervention was Melatonin. The mean analyzed results of the variants in pre-test and post-test were compared and p < 0.05 was regarded as significant. Results showed that Melatonin with no side effect is effective in improving: 1- The initiation and maintenance of sleep, 2- Sleep onset delay, 3- Sleep duration, 4- Sleep anxiety, 5- Nightly awakenings 6- Parasomnias and 7- daily performance; but is ineffective in bedtime resistance and sleep disordered breathing. Our results indicate that melatonin is more effective than placebo in improving the initiation and maintenance of sleep and most of its subscales in primary school aged children.

Objective: Adenoid hypertrophy and nocturnal enuresis, comorbidities that are quite prevalent among children, are both associated with sleep problems. However, limited research has specifically focused on sleep domains and their parameters. In the present study we thus aimed to investigate the impact of adenoid hypertrophy and nocturnal enuresis on sleep, both when the two disorders coexist and when they do not coexist. Methods: We investigated 178 children (mean age: 7.24±1.02 years, range=6-9 years), 50 (28.1%) of whom had only adenoid hypertrophy, 39 (21.9%) of whom had only nocturnal enuresis, 35 (19.7%) of whom had coexistence of adenoid hypertrophy and nocturnal enuresis, and 54 (30.3%) of whom were healthy-control children. Psychiatric disorders were diagnosed by a semi-structured diagnosis interview and the diagnosis of adenoid hypertrophy was confirmed by flexible fiberoptic nasopharyngoscopy. Sleep habits and disturbances were assessed via the Children’s Sleep Habits Questionnaire and Modified Epworth Sleepiness Scale. Results: Our results showed that the comorbid condition was the most severe form in terms of both adenoid hypertrophy and enuresis. Regarding sleep difficulties, the "Sleep-Disordered Breathing", "Night Wakings", "Sleep Onset Delay" and "Sleep Duration" parameters were closely associated with adenoid hypertrophy and its severity, while "Bedtime Resistance", "Parasomnias" and "Sleep Anxiety" domains of sleep were strongly related to nocturnal enuresis. Conclusion: Otorhinolaryngologists, child psychiatrists and pediatricians should be aware of the relationship between enuresis and adenoid hypertrophy, that both diseases are associated with impaired sleep patterns, and that children affected by the comorbidity of the two disorders experience more sleep disturbances.