Predictors of Sleep Habits in Premature Infants: A Cross-Sectional Study

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.

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.

Questionnaire Helps Identify Children's Sleep Disorders

IntroductionAllergic rhinitis is associated with several complications, including sleep disorders. The Children's Sleep Habits Questionnaire has been recently translated and validated in Portuguese for the evaluation of sleep disorders in children. ObjectiveTo assess sleep disorders in children with moderate to severe persistent allergic rhinitis and to correlate the findings with disease severity markers. MethodsWe evaluated 167 children (4–10 years), 112 with allergic rhinitis and 55 controls. Parents/guardians of the children answered the Children's Sleep Habits Questionnaire, consisting of 33 questions divided into eight subscales, which refers to the previous week. Patients with rhinitis were also evaluated regarding the score of nasal and extra-nasal symptoms related to the previous week and the peak nasal inspiratory flow. ResultsThere were no significant differences between groups of different age. All patients with rhinitis were being treated with nasal topical corticosteroids. The total Children's Sleep Habits Questionnaire score was significantly higher among children with rhinitis than in controls (median 48 vs. 43, p<0.001). Significantly higher values were also observed for the parasomnia (9 vs. 8), respiratory disorders (4 vs. 3) and daytime sleepiness (14 vs. 12) subscales. Among the patients with rhinitis, no significant correlation was observed between the total Children's Sleep Habits Questionnaire score and disease activity variables, but moderate correlations were observed for the respiratory distress subscale vs. nasal symptom score (r=0.32) and vs. extra-nasal symptom score (r=0.32). ConclusionChildren with moderate to severe persistent allergic rhinitis, even when submitted to regular treatment, have a higher frequency of sleep disorders than controls, particularly concerning nocturnal breathing disorders, daytime sleepiness, and parasomnias. The intensity of sleep disorders found in some subscales was correlated with objective markers of allergic rhinitis severity.

BackgroundChildren with autism spectrum disorders (ASDs) suffer from sleep disorders to a considerable degree; however, there is no safe and effective treatment available in clinical practice. The objective of the trial is to assess the clinical effectiveness of auricular plaster therapy (APT) in treating sleep disorders in children with ASD.MethodThis is a single-center, patient-assessor blind, randomized controlled trial. A total of 44 preschool children with sleep disorders with ASD will be included in this study. Eligible participants will be randomly assigned to either the auricular plaster group or the sham auricular plaster group in a 1:1 ratio. Participants in the different groups will receive APT or sham APT, respectively, for a total of 30 sessions over 30 days. The primary outcome includes the Children's Sleep Habits Questionnaire (CSHQ), while secondary outcomes include the Autism Behavior Checklist (ABC) and polysomnography (PSG) for total sleep time, sleep latency, awakening duration, and sleep structures. The CSHQ and ABC will be assessed at baseline, 10, 20, 30, 60, 90, and 120 days after randomization, whereas PSG will be assessed at baseline and 30 days after randomization. The follow-up period will be scheduled to be 60, 90, and 120 days after randomization.DiscussionThe results of this study may provide evidence of the efficacy of APT, as well as offer new alternatives for the treatment of sleep disorders in children with ASD.Trial registrationCHiCTR.org.cn (ChiCTR2100048257). Registered on July 5, 2021.

Background: Poor sleep quality in school children can negatively impact their neurocognitive abilities and academic achievement. Increased screen time was shown to interfere with children’s sleep habits and disrupts their sleep pattern. This study aimed to understand the sleep patterns and sleep disorders in school children and the influence of screen time on sleep in children during the COVID-19 pandemic. Methods: This cross-sectional observational school-based study was done on 443 children aged 6-12 years. Data was collected through parent filled online questionnaire having a proforma and child sleep habit questionnaire (CSHQ), a validated questionnaire to assess sleep disorders in children Results: Out of 443 children studied, the average sleep duration of the study population was 9:06 hours ±42:18 min and, 34.3% of the children slept less than 9 hours per day. The prevalence of sleep disorders was found to be 76.52%. Significant screen time after 8 PM was observed in 65.9% and 62.2 % of children had a total screen time of more than 2 hours. Increased screen time after 8 PM, delayed bedtime and wake-up time in children and also contributed to sleep disorders. Bedtime resistance and daytime sleepiness were more commonly observed in children with increased screen time. Conclusions: Sleep disorders in children are more predominant than sleep deprivation. Increased screen time before bed was found to alter sleep patterns in children and increases bedtime resistance, daytime sleepiness, and sleep disorders.

The relationship between sleep disturbances and exposure to environmental tobacco smoke (ETS) in children is a growing health concern. This study aimed to evaluate the association between ETS exposure and sleep disorders in healthy children, and to determine whether there is a difference in this relationship between secondhand smoke (SHS) and thirdhand smoke (THS) exposure. Healthy children aged 4-12 years who presented to the pediatric outpatient department were consecutively enrolled in this cross-sectional study. Plasma cotinine levels were measured to validate the exposure. The Children's Sleep Habits Questionnaire was used to assess sleep disorders in all children. Of the 203 children we evaluated, with a median (Q1-Q3) age of 8.3 (6-10) years, 99 (49.8%) were female. Children exposed to ETS had significantly more sleep disturbances than children who were not exposed to ETS (p = 0.042). However, there was no significant difference in the plasma cotinine levels (p = 0.239) or the prevalence of sleep disorders (p = 0.648) between children exposed to SHS and those exposed to THS. Exposure to both SHS and THS is associated with an increase in plasma cotinine and a higher prevalence of sleep disorders in children. These findings highlight the importance of reducing children's exposure to all forms of ETS to promote healthy sleep and overall well-being.

The Portuguese version of the Children's Sleep Habits Questionnaire showed adequate psychometric properties in a community sample but the American cut-off seemed inadequate. This study aimed to validate this questionnaire in clinical populations of children with sleep disorders and with attention deficit/ hyperactivity disorder. The study sample included 148 Portuguese children aged 2 to 10 years old that where divided in 3 groups: 1. Clinical group with sleep disorders (behavioral insomnias, parasomnias or sleep-related breathing disorders); 2. Clinical group with attention deficit/ hyperactivity disorder; 3. The sleep habits and sleep problems were evaluated using the Children's Sleep Habits Questionnaire. Sleep-related disorders were confirmed by polysomnography. The questionnaire's internal consistency (Cronbach α) in the clinical sample (sleep disorders and attention deficit/ hyperactivity disorder) was 0.75 and ranged from 0.55 to 0.85 for the subscales. Children with sleep disorders and attention deficit/ hyperactivity disorder had a higher sleep disturbance index (full scale score) compared to the control group. The subscales presented significant differences between the subgroups with different sleep disorders showing discriminative validity. The receiver operating characteristic analysis of the sleep disturbance index comparing the sleep disorder and control sample determined a cut-off of 48 (sensibility 0.83; specificity 0.69). Children with sleep disorders and attention deficit/ hyperactivity disorder evidenced higher Sleep Disturbance Index (full scale score) comparing to the control group. The subscales presented significative differences between the subgroups with different sleep disorders showing discriminative validity Conclusion: The Portuguese version of the Children's Sleep Habits Questionnaire showed adequate psychometric properties for children with sleep disorders and/or attention deficit/ hyperactivity disorder. The cut-off value 48 is better adjusted for the Portuguese population.

Children's sleep habits are profoundly affected by socio-economic, cultural, and environmental factors. We aim to describe the sleep habits of pediatric sub-populations from Cape Verde and Mozambique using the Children's Sleep Habits Questionnaire, and to ascertain the determinants of the questionnaire's score. We conducted cross-sectional surveys in surveillance appointments in Cape Verde and in a school in Maputo (Mozambique). The Cape Verde sample included 206 children (mean age: 6.5) and the Mozambique sample 454 children (mean age: 8). The Portuguese version of the Children's Sleep Habits Questionnaire was used to evaluate the children's sleep habits. The distributions of the questionnaire's scores across different levels of the demographic variables were compared using the Mann-Whitney and the Kruskal-Wallis tests. We used regression models to quantify the relationship between the demographic variables and the questionnaire's scores. Cape Verde sample: Questionnaire median score: 50 (range 36 - 81). Prevalence of sleep problems: 29.9% (cut-off = 56). Prevalence of parent-reported sleep problems: 22.8%. Co-sleeping: 63%. Bedtime television: 30%. Daytime nap: 63%. Questionnaire scores are associated with the mother's educational level, the children's age group, and with the frequency of daytime napping. Mozambique Sample: Median Questionnaire score: 48 (range 35 - 77). Prevalence of sleep problems: 28.4% (cut-off: 52). Percentage of parent-reported sleep problems: 6.9%. Co-sleeping: 29%. Bedtime television: 33%. Daytime nap: 23%. Questionnaire scores are associated with the mother's nationality, the father educational level, and with the frequency of bedtime television. Parents tend to overestimate the quality of their children's sleep. The prevalence of sleep disturbances and the cut-off values are higher than observed in previous studies, which may be due to the existence of different standards and cultural expectations across populations. Bedtime television, typically associated with more disturbed sleep, is frequent in both samples. Co-sleeping and daytime napping are frequent in the Cape Verde sample; wetting the bed is common and more prevalent than in previous studies. Bed-sharing increases the parents' awareness of their children's sleep quality, contributing to the high prevalence of parent-reported sleep problems. Parent-reported sleep problems underestimate the Children's Sleep Habits Questionnaire results. This is not necessarily indicative of more disturbed sleep and might reflect differences in sleep behavior, childcare practice, and cognitions and attitudes towards the concept of 'normal' sleep.

Sleep disorders are prevalent in children, particularly those with chronic illnesses such as epilepsy, where they disrupt sleep quantity, quality, or timing. The aim of this study was to analyze factors associated with sleep disorder among epileptic children admitted to Haji Adam Malik General Hospital, Medan, Indonesia. The study employed cross sectional design, recruiting 49 children (4–10 years old) with epilepsy at Haji Adam Malik General Hospital from February to June 2024. Data collection was carried out using the Children's Sleep Habit Questionnaire (CSHQ) questionnaire. Further, data on Anti-Epileptic Drugs (AED) intake and history and type of seizures were collected. Pearson’s Chi-square test was employed to analyze the association of the demographic, seizure characteristics, and AED with sleeping disorder. The findings suggest that sleep disorder in children with epilepsy was prevalent (n=26, 53.1%), mostly occurring in boys (32.7%) and those receiving valproic acid (n=9, 34.6%) and its combination with levetiracetam (n=8, 30.8%). Chi-square test results showed that seizure history intake (p&lt;0.001), AEDs intake (p&lt;0.001), and type of AED (p=0.010) were significantly associated with sleep disorder. In conclusion, seizure management strategies and AED regimens can influence sleep disorders in children with epilepsy. Therefore, revisiting and modifying AED treatments may be required to improve both seizure control and sleep quality in affected patients.

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.

Background: To examine the relationship between childhood sleep disorders and neurodevelopmental outcomes in early adolescence. Methods: A cross-sectional study was carried out at the Department of Pediatrics, Mardan Medical Complex, Mardan, from January 2022 to January 2023. A total of 72 participants aged 10–14 years were enrolled. Sleep patterns were assessed using a structured questionnaire adapted from the Children’s Sleep Habits Questionnaire (CSHQ). Cognitive and behavioral outcomes were evaluated with standardized tools, including subtests of the Wechsler Intelligence Scale for Children, Conners’ Rating Scale, and the Strengths and Difficulties Questionnaire. Demographic, lifestyle, and health-related data were also recorded. Statistical analysis was performed using chi-square and independent t-tests, with p &lt; 0.05 considered significant. Results: Sleep disorders were identified in 47.2% of participants, with insomnia (30.6%) and sleep-disordered breathing (25.0%) being most common. Children with sleep disorders had significantly lower mean IQ scores (93.8 ± 10.2 vs. 101.5 ± 9.8, p = 0.01) and higher rates of attention deficits, academic underachievement, and emotional difficulties compared to peers without sleep problems. Daytime sleepiness and irregular sleep schedules were also significantly associated with poorer cognitive and behavioral outcomes. Lifestyle factors, including longer screen time and reduced physical activity, further contributed to poor sleep quality. Conclusion: Childhood sleep disorders are strongly associated with impaired neurocognitive and behavioral outcomes in early adolescence. Early identification and intervention strategies, including parental guidance on healthy sleep routines and clinical management of sleep-related breathing disorders, are essential to improve developmental trajectories. Keywords: Childhood sleep disorders, Neurodevelopment, Insomnia, Sleep-disordered breathing, Adolescence, Cognitive function

Background: Functional constipation (FC) is a common problem in childhood worldwide. This disorder can lead to various physical and behavioral problems and ultimately reduce the quality of life. Sleep disorders are also among the complaints of patients with FC. Objectives: In this study, we aimed to investigate the prevalence of sleep disorders in children with chronic FC. Methods: This cross-sectional study was conducted on 140 children aged 5 to 12 with chronic FC referred to the specialized pediatrics clinic of Amirkabir Hospital of Arak, Iran. The functional constipation was diagnosed based on Rome ΙV criteria. Children and their parents were requested to complete the Children’s Sleep Habits Questionnaire (CSHQ). Data analysis was performed in SPSS version 22 using the chi-square and Mann-Whitney tests to find significant associations at the significance level of 5%. Results: The mean (SD) age of the participants was 7.36 ± 1.6, and most participants were boys (65.7%). The prevalence of sleep disorders in children with chronic FC was 62.9% (95% CI: 54.5 - 70.2). Sleep resistance and sleep apnea were the most common minor sleep disorders. The prevalence of sleep disorders was significantly higher in girls (81.3%) than in boys (53.3%) with chronic FC (P = 0.001). There was no significant difference in the prevalence of sleep disorders in children with chronic FC aged 5 to 8 and 9 to 12. Conclusions: In the present study, the results showed that the prevalence of sleep disorders in children with chronic FC was significant, and it was higher compared to other studies conducted on healthy children, and also it was found that girls had a significantly higher rate of sleep disorders than boys.

Autism spectrum disorder (ASD) is often associated with sleep disorders, although the neurophysiological reasons behind these issues are poorly understood. In this cross-sectional study, functional near-infrared spectroscopy (fNIRS) was used to compare differences in brain functional connectivity (FC) in children with ASD and sleep disorders and those with ASD that was not complicated by sleep disorders. A total of 88 children (4-9 years old, either sex) were included in the study. The children were divided into three groups: those with ASD and sleep disorders (ASD with sleep disorder group; n = 29), those with ASD and no sleep disorders (ASD without sleep disorder group; n = 29), and those with typical development (TD group; n = 30). All children with ASD met the diagnostic criteria for the "Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V)." The ASD group with sleep disorders showed typical sleep disorder symptoms, with a total score of ≥41 on the Children's Sleep Habits Questionnaire. All children were assessed using the Autism Diagnostic Observation Scale, the Vineland Adaptive Behavior Scale, third edition, the Social Response Scale, and the Children's Sleep Habits Questionnaire. The fNIRS detection was conducted in a quiet environment. The fNIRS data revealed that under resting-state conditions, the supramarginal gyrus [SMG:Cohen's f = 0.981(L)f = 0.467(R)], inferior frontal gyrus [IFG:Cohen's f = 0.415(L)f = 0.443(R)], frontopolar area [FPA:Cohen's f = 0.620(L)f = 0.634(R)], dorsolateral prefrontal cortex [DLPFC:Cohen's f = 0.593(L)f = 0.547(R)], and visual association cortex [VAC:Cohen's f = 0.500(L)f = 0.524(R)] of the brain showed lower activity in ASD with sleep disorder group compared with the TD group (p < 0.01). The FC values for the SMG [Cohen's f = 0.981(L)f = 0.467(R)], RFPA (Cohen's f = 0.634), DLPFC [Cohen's f = 0.593(L)f = 0.547(R)], and VAC [Cohen's f = 0.500(L)f = 0.524(R)] were also lower in the ASD with sleep disorder group than the ASD without sleep disorder group (p < 0.01). The FC values of the LIFG showed a mild negative correlation with social affect scale scores (r = -0.34, p = 0.07), while FC values in the RDLPFC were negatively correlated with restricted repetitive behavior (RRB) (r = -0.41, p = 0.03). The Children's Sleep Habits Questionnaire scores showed a positive correlation with FC values in the RIFG region of the brain (r = 0.37, p = 0.05). The results indicate that FC in the resting brain of children with ASD complicated with sleep disorders was weaker than that of children with ASD without sleep disorders. Both groups showed weaker FC compared with the TD group. However, due to the limited sample size, the generalizability of the findings requires further validation in multicenter, large-sample studies.

Purpose - to determine the prevalence of sleep disorders in children with epileptic encephalopathies and autism spectrum disorder (ASD); to evaluate the effectiveness of neuroadaptogenic «Silenta» in the treatment of sleep disorders in children in this group. Materials and methods. We examined 50 children with clinical manifestations of ASD aged 2 to 8 years (mean age was 4.3 years±1.5), including 31 boys and 19 girls. The examination included anamnesis to clarify the features of the pre- and perinatal period, clinical and neurological examination, video EEG monitoring during night sleep for 8 hours, survey of parents on the quality of sleep in children using the Children’s Sleep Habits Questionnaire (CSHQ). All children were divided into 2 groups depending on clinical features: Group 1 - 28 children with ASD who had epileptic seizures at the time of examination or in the anamnesis (children with epileptic encephalopathies); Group 2 - 22 children with ASD without clinical epileptic seizures. Children from the 1st group were prescribed neuroadaptogen «Silenta» for 30 days. Results. Children with ASD and epileptic seizures had higher sub-scales «Difficulty falling asleep», «Parasomnia» and the overall score on the CSHQ-A scale. The results indicate a negative impact of epileptic seizures in children with ASD on sleep quality and the frequency of paroxysmal sleep disorders. The overall prevalence of sleep disorders in children with ASD was determined using the CSHQ-A questionnaire before and after treatment. The incidence of sleep disorders in children with ASD and epileptic seizures after treatment decreased from 85.7% to 53.6%, and in children with ASD without epileptic seizures - from 63.6% to 22.7%. In both groups statistically significant reduction in the proportion of children with sleep disorders after a course of treatment with neuroadaptogen «Silenta». Conclusions. It is shown that the frequency of sleep disorders in children with ASD and epileptic seizures is 85.7%, and in children with ASD without epileptic seizures - 63.6%. In children with ASD and epileptic seizures the incidence of sleep disorders during 30 days of the neuroadaptogen «Silenty» decreased to 53.6%, and in children with ASD and without epileptic seizures the incidence of sleep disorders decreased to 22.7%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.