Children's Sleep Habits Questionnaire Research Articles

Sleep disturbance in pediatric intracranial hypertension.

There is a well-established association between headache disorders and sleep disturbances in children, but it is unknown whether sleep disturbance plays a role in pediatric intracranial hypertension. The objective of this study was to examine sleep issues related to pediatric intracranial hypertension. Patients with intracranial hypertension in the Pediatric Intracranial Hypertension Clinic were recruited between July 2017 and September 2018. Demographic data were collected from the electronic medical record in addition to patient and parent completed questionnaires. Information on sleep behaviors was gathered using the Children's Sleep Habits Questionnaire, and control data were obtained from patient siblings. Statistical analyses were performed using paired t tests or two-sample t tests, as appropriate. Sixty-two pairs of patients and matched sibling controls were compared. We found a statistically significant difference in total sleep disturbance score (control mean, 44.3; patient mean, 48.1; n = 33 pairs, t = -2.2, P = .035), as well as subscale scores of sleep onset delay (control mean, 1.4; patient mean, 1.7; n = 52 pairs, t = -2.53, P = .014), parasomnias (control mean, 8.5; patient mean, 9.5; n = 42 pairs, t = -2.59, P = .013), and sleep-disordered breathing (control mean, 3.1; patient mean, 3.4; n = 44 pairs, t = -2.61, P = .013). No difference was found in bedtime resistance, sleep duration, sleep anxiety, night awakenings, and daytime sleepiness subscales. Furthermore, no difference was found in total sleep disturbance score between patient subsets, including primary vs secondary intracranial hypertension, body mass index, pubertal status, presence of headaches, or intracranial hypertension treatment. This observational study suggests that pediatric intracranial hypertension is associated with a modest increase in sleep disturbances.

Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics.

The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.

Characterization of sleep habits and medication outcomes for sleep disturbance in children and adults with Angelman syndrome.

The objectives of this study were to characterize the sleep habits of 50 clinically referred individuals with Angelman syndrome (AS) and to retrospectively compare the effectiveness/tolerability of the three most commonly prescribed sleep medications in the sample. An experienced physician assigned a Clinical Global Impressions-Severity scale (CGI-S) score for each subject's AS-specific symptoms. Caregivers completed the Child Sleep Habits Questionnaire (CSHQ; screen for sleep problems in school-aged [4-10 years] children), a screening assessment for sleep problems. Caregivers provided information about medication trials targeting disturbed sleep, with the physician assigning a CGI-Improvement scale (CGI-I) score for each trial. Linear regression showed significant negative association between age and CSHQ score. In their lifetime, 72% of participants had taken a medication for sleep, most commonly melatonin, clonidine and trazodone. The majority continued these for 6 months or longer. With these medications, many demonstrated significant improvement in sleep disturbances, with no difference in odds of improvement between medications. Disturbed sleep was common in this cohort and significantly worse in younger-aged participants. The majority received at least one medication trial for disturbed sleep and each of the most commonly prescribed medication was effective for a substantial percentage of participants. Most participants remained on medication for at least 6 months, suggesting favorable tolerability.

166-LB: Participants with KATP-Related Neonatal Diabetes (KATP-NDM) Experience More Sleep Disruption than Sibling Controls

Background: Neonatal diabetes is rare, but most commonly caused by activating heterozygous mutations in either of the KATP channel genes KCNJ11or ABCC8. While a large fraction of those with KATP-NDM exhibit a spectrum of neurodevelopmental difficulties, patients and families also describe difficulties with sleep that has not been well-characterized. Methods: To assess sleep duration and quality, all participants wore an actigrapher (Actiwatch® 2) for at least 7 full days and completed sleep questionnaires based on age: parents of 0-11 years old participants completed the Children’s Sleep Habits Questionnaire (CSHQ), while participants 12+ years completed the Pittsburgh Sleep Quality Index (PSQI) themselves. Results: 12 affected individuals and 5 sibling controls completed all components of the study: 0-11 yo: 7 affected, 3 controls; 12+ yo: 5 affected, 2 controls. Affected participants had significantly less total sleep time of 433.4 minutes/night, compared to 506.2 minutes/night in controls (p = 0.003). All affected 0-11 yo individuals exhibited sleep disturbance on CSHQ (qualified as a score greater than 41). In contrast, affected 12+ yo individuals did not report significantly greater global sleep scores on the PSQI compared to controls; however, those with R201H/C mutations reported a sleep disturbance score that trended towards being significantly greater than those with V59M/A mutations (55 vs. 46; p = 0.0525). Conclusion: Objective total sleep time was reduced in KATP-NDM, with parents reporting greater sleep difficulties than self-reported measures by older affected individuals. Neurodevelopmental supports in individuals with KATP-NDM should include assessment of sleep, but more study is required to further characterize specific disruptions that may depend on age and/or specific mutations. Disclosure P. Tian: None. S. Choppara: None. A. Harris: None. L.R. Letourneau-Freiberg: None. S.W. Greeley: None. Funding American Diabetes Association (1-17-JDF-008 to S.A.W.G.); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104942, P30DK0205950); National Center for Advancing Translational Sciences (UL1TR002389)

0962 Sleep and Daytime Functioning in Gifted and Twice Exceptional Children

Abstract Introduction Gifted (G) children display an asynchrony between intellectual development and social and emotional development. Twice exceptional (2e) children are G children with a neuropsychological disability. We compared the sleep and daytime behavior of G, 2e and typically developing (TD) children and we sought for group-specific relationships between sleep and daytime behavior. Methods 23 children were recruited: seven G (8.7 years old, SD = 1.7), six 2e (9.8 years old, SD = 1.8) and 10 TD children (10.0 years old, SD = 2.2). Giftedness was diagnosed with neuropsychological tools. The Children’s Sleep Habits Questionnaire (CSHQ) assessed sleep quality, the Child Behavior Checklist (CBCL) assessed daytime functioning. Sleep quality and its impact on daytime functioning was measured with a MANCOVA, with the CBCL’s three main factors as dependent variables (internalizing problems, IP; externalizing problems, EP and total problems, TP), children group as the independent variable and the CSHQ total score as the covariate. Results G, 2e and TD groups scored 39.86, 39.17 and 39.70 on the CSHQ, respectively (n.s.). The three groups were not different on the CBCL, with respective mean T scores of 57.86, 50.33 and 48.60 for IP, 56.43, 55.67 and 47.80 for EP and 55.29, 53.83 and 46.40 for TP. Pillai’s trace statistics disclosed a significant relationship between CSHQ and CBCL scores regardless of groups (p = 0.04) but the influence of sleep quality did not differ among the groups for any of the three factors. The CSHQ total score was positively and significantly related to IP (p = 0.03, r = 0.47); relationships were not significant for EP (p = 0.96, r = -0.01) and TP (p = 0.17, r = 0.31). Conclusion Sleep quality influences internalizing problems in children, without group-specific relationships, but this association does not seem to differ between gifted, twice exceptional and TD children. Support N/A

0955 Does Primary Caregiver Influence Sleep in Preschoolers? Evidence from a Large-Scale Longitudinal Study in China

Abstract Introduction The aim of the study is to characterize sleep disturbances and sleep patterns in preschoolers, and to examine the potential role of primary caregivers and particularly its transition on children’s sleep in a large-scale cohort study in China. Methods A representative sample of 20324 newly enrolled preschoolers(age 3-4 years) were recruited in Shanghai,China at 2016.11. Sleep disturbances were examined at 3 timepoints from age 3-4 years to 5-6 years by the Children’s Sleep Habits Questionnaire(CSHQ). Data on bedtime, onset time and offset time were included, along with primary caregivers derived from each follow-up. Prevalence and trend estimates of sleep disturbances and sleep patterns were presented. Multivariable logistic regression and propensity score-adjusted models for sleep disturbances at wave3 on different caregiving models were analysed adjusting for demographics, socioeconomic status, family characteristics, maternal mental health and CSHQ total score at baseline. Results Prevalence of global sleep disturbances (CSHQ total score&amp;gt;41) steadily fell from 84.2% to 73.8%. Specifically, behavioral sleep problem domains of “Bedtime besistance”and “Sleep anxiety” decreased from 66.4% to 47.3% and 53.4% to 37.8%, respectively. Meanwhile, Bedtime gradually delayed from 21:04(SD=0:37) to 21:20(SD=0:33) while offset time changed slightly from 7:13(SD=0:29) to 7:17(SD=0:27). Compared with counterparts in western countries, children slept for a shorter nocturnal sleep duration (NSD) with 9.51(SD=0.57) hours at wave1, 9.42(SD=0.57) hours at wave2 and 9.42(SD=0.52) hours at wave3. Different caregiving models were independently associated with sleep disturbances at wave3. Taking “Predominant parental care” as reference, “Predominant grandparental care” and “Transition from parental to grandparental care” were associated with higher odds of sleep disturbances (OR=1.32, 95% CI [1.17, 1.48], p&amp;lt;0.001 and OR=1.25, 95% CI [1.03, 1.52], p=0.020, respectively). While “Transition from grandparental to parental care” has no significant effect(OR=1.04, 95%CI [0.94, 1.15], p=0.436). Conclusion Grandparental care is associated with increased risk of sleep disturbances among preschoolers in China. Parenting and Grandparenting factors should be considered when assessing and treating sleep disturbances and optimizeing sleep health in preschoolers. Support Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81728017); Ministry of Science and Technology (2016YFC1305203); Shanghai Science and Technology Commission (17XD1402800, 18695840200, 2018SHZDZX05, 18JC1420305);

0971 Mother’s Parenting Style As A Moderator In The Relationship Between Temperament And Sleep Problems In Children With Obesity

Abstract Introduction Based on past studies, a child’s temperament and parenting style greatly affect a child’s sleep. However, there are limited studies that have investigated how parenting styles and a child’s temperament interact and affect the child’s sleep in obese children. Thus, this study investigated parenting styles as a moderator in the relationship between temperament and sleep in obese children. Methods Seventy-seven obese children (male=66.2%, average BMI = 27.35±2.78) participated in the study. The mean age of the participants was 10.82(± 1.00) years. The primary caregiver (mother) of the participants completed the Junior Temperament and Character Inventory (J-TCI), and Parents as Social Context Questionnaire (K-PSCQ), and Children’s Sleep Habits Questionnaire (CSHQ). Among the different subscales, only Novelty Seeking (NS) and Reward Dependence (RD) were used for analysis among Junior Temperament and Character Inventory (J-TCI) components. Results In this sample, 66 children (85.7%) reported significant levels of sleep problems based on the CSHQ. Novelty seeking (NS) and reward dependence (RD) significantly predicted sleep problems (B=-.771, p&amp;lt;.05, B=-.683, p&amp;lt;.01). Additionally, mother’s negative parenting style moderated the relationship between NS and the child’s sleep problem [B=.03, 95% CI=.007, .049] and the relationship between RD and the child’s sleep problem [B=.031, 95% CI=.013, .049]. The more negative mother’s parenting style, the higher the child’s NS or RD scores had a negative effect on sleep. Conclusion The results of this study show that obese children experience high levels of sleep disturbance. Additionally, the mother’s negative parenting style moderated the relationship between temperament and sleep problems in obese children. The results suggest that sleep interventions for obese children should include the mother, especially in children with high novelty seeking and reward dependence. Support This work was supported by Korea Centers for Disease Control and Prevention &amp; Korea National Research Institute of Health (2019020660E-00)

0931 Parenting Stress Can Be Predicted by Parent and Child Sleep, and Can Be Reduced by an Intervention Targeting Child Sleep in Vulnerable Families

Abstract Introduction Studies suggest that family intervention programs should consider different sources of parenting stress (PS). Knowing that child sleep has an impact on PS, this study aimed to examine if a child sleep intervention can affect PS in vulnerable families. Methods In a first study, parent and child sleep habits along with PS were assessed using Parenting Stress Index-Short Form, Pittsburgh Sleep Quality Index and homemade questions assessing child sleep. Measures were administered to 138 community mothers (children 3-79 months). Multiple linear regression analyses examined mothers and child sleep associations to PS, controlled by family income. Following results of this first study, 11 vulnerable mothers (children 39-68 months) participated in a child sleep intervention specifically developed for vulnerable families. Measures administered were the same as for study 1, but in this study, the Child Sleep Habits Questionnaire was used to assess the child sleep. Wilcoxon’s t-test compared pre and post-intervention measures. Results In the first study, sleep onset latency (SOL; β= -.25; p= .003), waketime (β= -.28; p= .003) and sleep aids (β= -.19; p= .048) explained 23.6% of PS variance. When child sleep variables were added to the model, only bedtime resistance was significant (β= -.23; p= .023) and increased the explained variance to 30.6%. Following the child sleep intervention, no significant changes in parent sleep were observed. However, results show improvement of child bedtime resistance (Mpre=10.73; Mpost=8.36; p= .027) and PS (Mpre=3.50; Mpost=3.82; p= .05). Conclusion Our results suggest that higher PS is explained by greater struggles in parents sleep (higher SOL, later waketime and higher use of sleep aids) as well as bedtime resistance behaviors in children. Furthermore, PS can be reduced by an intervention improving child bedtime resistance, even if parent sleep is not improved. Support

0969 Early Life Sleep Disturbance Among Children With Autism Spectrum Disorders: A Questionnaire-based Retrospective Study

Abstract Introduction Autism spectrum disorders(ASD) and sleep has hand to hand relationship and few recently published studies have shown that, disturbed infant sleep is associated with Attention deficit hyperactive disorder and Autism. The aim of the study is to evaluate the sleep disturbance in first year of life among the children with ASD. Methods In this case control study, pre-diagnosed ASD children between 3-12 year of age (group 1) and controls; sibling of autistic children and community dwelling children(group 2), were enrolled in between June 2014 to November 2017. After giving consent every child underwent, Detailed Clinical [Childhood Autism rating scale-2(CARS-2)] and Sleep evaluation [Brief Infant sleep Questionnaire (BISQ) - Retrospectively, Child sleep habits questionnaire (CSHQ)]. Results Sixty children in group1 and 60 in group 2 were enrolled and both groups were age [Median 7(2.5-12) vs. 8.5 (2.5-12), p = 0.14] and sex [53(88.33%) vs. 45(75.00 %), p=0.15] matched. On CHSQ poor sleepers are more common among the group 1[40(66.66%) vs. 20(33.33%), p=.003, respectively]. On BISQ children had severe sleep problems during infancy were significantly more among the group 1 [46(76.66%) vs. 6(10%), p=&amp;lt;.001, respectively]. Duration of nocturnal awakening was significantly correlated (r=0.87, p=.001) with the T score of the CARS-2. Conclusion Sleep is significantly disturbed since infancy among children with autism spectrum disorder and duration of nocturnal awakenings during infancy is strongly correlated with severity of autism. Support NA

0990 Evaluating Components Of Sleep Quality And The Sleep-Quality Of Life Relationship For Children With Acute Lymphoblastic Leukemia

Abstract Introduction Poor sleep quality is associated with reduced health-related quality of life (HRQL) for children with Acute Lymphoblastic Leukemia (ALL). Research has yet to evaluate how components of child sleep quality uniquely contribute to HRQL beyond demographic characteristics. This study evaluates features of sleep and the relationship between sleep and HRQL for children in the maintenance phase of ALL treatment. Methods 89 caregivers (ages 20-52, M=35.95, SD=7.10) of children with ALL (ages 3-12, M=5.73, SD=2.21; 13.76 months from diagnosis) completed demographic questionnaires and reports of child sleep quality (Child Sleep Habits Questionnaire; CSHQ), and 64 caregivers reported on child HRQL (Pediatric Quality of Life Inventory). Descriptive statistics were calculated. T-tests compared CSHQ subscales to ratings of healthy normative values. Pearson correlations evaluated associations between sleep and overall HRQL. Hierarchical regression assessed whether CSHQ subscales uniquely predicted HRQL beyond demographic characteristics. Results This sample reported greater bedtime resistance [t(88)=6.413, p&amp;lt;.001], sleep onset delay [t(88)=3.180, p=.002], sleep anxiety [t(88)=4.271, p&amp;lt;.001], night awakenings [t(88)=6.031, p&amp;lt;.001], parasomnias [t(88)=3.900, p&amp;lt;.001], and daytime sleepiness [t(87)=1.781, p=.078] than normative values, although sleep duration [t(88)=1.781, p=.078] and sleep disordered breathing (SDB) [t(88)=-.061, p=.951] did not differ. HRQL was related to SDB (r=-.289, p=.021), bedtime resistance (r=-.263, p=.036), and total sleep score (r=-.34, p=.006). The regression model with SDB and bedtime resistance explained 24.2% of variance but was not significant [F(6,31)=1.651, p=.167]. Conclusion Caregiver ratings showed greater sleep impairments for children in this sample than of norms. Sleep subscales were associated with HRQL, but did not predict HRQL beyond demographic factors. Caregiver reports of child sleep and HRQL may vary depending on when during the monthly chemotherapy cycle questionnaires were completed. SDB did not differ from normative values but was related to HRQL, suggesting the need to screen for SDB symptoms to potentially improve child outcomes. Support This study was supported by funding from the American Cancer Society PF-13-238-01-PCSM (PI: Daniel).

0972 Persistence, Remission, Acquisition Of Sleep Disturbances Contributes To The Transition Of Emotional/behavioral Problems In Preschool Children

Abstract Introduction Cross-sectional and longitudinal studies have consistently reported associations between sleep disturbances and emotional/behavioral problems in children. However, few studies have examined whether the remission, acquisition of sleep disturbances contribute to the transition of emotional and behavioral problems during preschool years. Methods This study used data from the Shanghai Children’s Health, Education and Lifestyle Evaluation-Preschool (SCHEDULEA-P), a prospective, population-based cohort study of newly enrolled preschoolers in Shanghai kindergartens in Nov. 2016. In total, 17182 children with complete data on parent-reported Strength and Difficulties Questionnaire (SDQ) both at school enrollment(wave 1) and the third year(wave 2) were included in the study. Children’s sleep disturbances were measured using Children Sleep Habit Questionnaire (CSHQ) at both waves. Results The 17182 participants included 8935(52.0%) males, with a mean (SD) age of 3.73(0.29) years at wave 1. 66.9%, 7.2%, 17.4% and 8.5% of these children were divided into persistent sleep disturbance, acquired, remitted group and persistent normal sleep group, respectively. The proportion of persistent, acquired, remitted emotional/behavioral problems and normal group was 13.7%, 9.4%, 21.1%, 55.8%. SDQ scores of acquired sleep disturbances group stayed high at wave 3, while SDQ scores of remitted sleep disturbances group decreased sharply during the preschool years. After adjusted for confounding factors, the odds of remission from emotional/behavioral problems among children who experienced remission of sleep disturbances, who had persistent normal sleep were both much higher compared to those who had persistent sleep disturbances (OR=2.53(2.12-3.01), p&amp;lt;0.001; OR=2.74(2.01-3.75), p&amp;lt;0.001). Meanwhile, the odds of acquisition of emotional/behavioral problems at wave 2 among subjects who newly acquired sleep disturbances at wave 2 and who had persistent sleep disturbances was similarly higher than those who never have sleep disturbances(OR= 2.75, P&amp;lt;0.001 VS OR=2.77, P&amp;lt;0.001). Besides, those who experience remission of sleep disturbances still have 1.48 times the odds of acquisition of emotional / behavioral problems(P=0.006). Conclusion The remission of sleep disturbances contributed to the remission of emotional/behavioral problems, while the emergence of sleep disturbances throughout preschool years increased the risk of the acquisition of emotional/behavioral problems. Support Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81602870, 81601162, 81602868)

0965 The Association Between Liquid Consumption and Sleep Patterns in School Children

Abstract Introduction Liquid consumption is essential for daily function and may also play a role in sleep regulation. The aim of this study was to assess 1) the association between the frequency of liquid consumption and sleep patterns; and 2) the different types of liquids on the association between liquid consumption and sleep. Methods Participants included 597 children ages 9-13 years old from the China Jintan Child Cohort Study. To assess child liquid intake, children self-reported the types of liquids consumed and the frequency these liquids were consumed. To assess sleep patterns, both parents and children reported sleep patterns using the parent-reported Child Sleep Habit Questionnaire (CSHQ) and a child self-reported questionnaire. Descriptive statistics and independent sample t-tests analyses were performed to examine the differential effects of liquid consumption frequency and sleeping habits. Results Overall, a slight dose-dependent relationship between liquid consumption and sleep quality was observed. Less sleep problems and improved sleep quality were observed for water (bedtime resistance, sleep anxiety, night awakenings, parasomnias, sleep-disordered breathing, daytime sleepiness; p&amp;lt;0.05) and milk (parasomnias, sleep-disordered breathing, p&amp;lt;0.05) consumption. Caffeinated soda tended to increase sleep problems (sleep-disordered breathing, p&amp;lt;0.05). Sleep onset delay had a different pattern from that of other subscales, in which water increased sleep problems and caffeinated soda decreased sleep problems. There was some discrepancy between parent- and self-reported parasomnias, but sleep disordered breathing showed consistent patterns. Conclusion Children who consumed more liquid, especially water and milk, were more likely to experience less sleep problems. However, caffeinated soda consumption may be linked to increased sleep problems. Findings suggest that school children may need consume more healthy liquids for better sleep patterns. Future randomized-controlled trial studies are needed to verify these findings. Support This study was funded by the National Institutes of Environmental Health Sciences and the National Institutes of Health (R01-ES-018858, K02-ES-019878, and K01-ES015877).

Children’s Sleep Habits Questionnaire (CSHQ): адаптація на українській вибірці

The aim of the article is to describe and analyze Children’s Sleep HabitsQuestionnaire (CSHQ), to consider the problem of sleep disturbances of typicalchildren and children with autism spectrum disorders and to present the resultsof adaptation and approbation of the Children’s Sleep Habits Questionnaire(CSHQ) in a sample of Ukrainian children using parent reports.Methods. To achieve the aims of the article, we used methods of theoreticalanalysis of modern research on the topic of the article, methods for assessingpsychometric data using statistical criteria. To calculate the points, the Excel 2016was used, and to check the psychometric characteristics of the questionnaire,the statistical program IBM SPSS Statistics 23 was used.The results of the research. The results of adaptation and approbation of theChildren’s Sleep Habits Questionnaire (CSHQ) in a sample of Ukrainian childrenare presented. The scale was translated into Ukrainian from the original language(English) by a professional translator. In the adaptation of the questionnaire theparents of 506 children took part (293 typical children and 213 children withautism spectrum disorders), who filled in a questionnaire about their children’ssleep patterns. To check the psychometric characteristics of the questionnairethe determination of indicators of reliability (reliability as internal consistencyand reliability of repeated testing) and validity (apparent validity, criterionvalidity and constructive validity) were carried out. Psychometric characteristicsshowed a high and sufficient level. The procedure and interpretation of thestudy results were standardized. The frequency distribution was calculated bythe general indicator and additionally by age groups to determine the severityof sleep disturbances in children and adolescents. According to the results offrequency distribution, it was determined the overall distribution of scores,which gave the possibility to determine the presence and severity of the sleepdisorders among children.Conclusions. According to the objectives of the article, the problem of sleepdisturbances of typical children and children with autism spectrum disorderswas consided, the original questionnaire of Childhood Habits Questionnaire(CSHQ) was analyzed, translated into Ukrainian, and successfully adapted,tested and standardized on a sample of Ukrainian children and adolescents withand without autism.

Sleep habits of children diagnosed with attention/ deficit/ hyperactivity disorder and effects of treatment on sleep related parameters.

This study aimed to evaluate the baseline sleep habits of children with ADHD and the effects of treatment with methylphenidate (MPH) and atomoxetine (ATX) on sleep parameters. Treatment naive children with clinically normal intelligence diagnosed with ADHD were enrolled in the study. Children were treated naturalistically with MPH and ATX. Treatments were started at 0.5 mg/ kg/ day and titrated weekly to a maximum of 1.2 mg/ kg/ day. The daily equivalent dose was calculated according to clinician toolkits of Utah Academy of Child and Adolescent Psychiatry. DSM-IV Based Screening and Assessment Scale for Disruptive Behavior Disorders- Parent form (DBSASDBD) and Clinical Global Impression Scale were used to assess ADHD symptoms and Children's Sleep Habits Questionnaire (CSHQ)- Short Form was used to assess the sleep habits and problems before and after the treatment. Both MPH and ATX reduced symptom severity of ADHD in all domains and also reduced total CSHQ scores with similar effect sizes. (0.7 for MPH vs. 0.8 for ATX). The rate of clinically significant sleep problems at baseline was 93.5 %. At the end-point, 83.9 % of the sample still displayed clinically significant sleep problems while none of the children were judged to have moderate-severe sleep problems. Our results suggest that both ATX and MPH may selectively improve different sleep domains in children with ADHD. Studies using standardized dosing schemes for longer durations and evaluating sleep with objective measurements may clarify the differential effects of treatments on sleep among children with ADHD.

Sleep disturbance as a predictor of anxiety in children with Fetal Alcohol Spectrum Disorders and typically developing children

BackgroundHigh levels of anxiety and sleep problems are common features of Fetal Alcohol Spectrum Disorders (FASD). The strong association between sleep and anxiety has been documented in typically developing (TD) populations and is thought to be bidirectional. The association between sleep and anxiety in children with FASD has not yet been examined. MethodsCaregivers of children with FASD (n = 91) and TD children (n = 103) aged 6–16 completed the Children’s Sleep Habits Questionnaire (CSHQ), Spence Children’s Anxiety Scale (SCAS), and a background questionnaire. Hierarchical multiple regression analyses, group comparisons and ANCOVA interaction models were used to test the associations between sleep and anxiety within and between the two groups. ResultsSleep disturbances and anxiety were at clinical levels for the majority of the FASD group, and significantly higher in the FASD group than the TD group. After controlling for age and sex, 27 % of the variance in anxiety scores in TD children was attributable to sleep problems, and 33 % in children with FASD. ConclusionThis study highlights associations between parent-reported sleep and anxiety in FASD. Sleep disturbances were significant predictors of anxiety in both children with FASD and in TD children. Given the importance of sleep to healthy neurodevelopment, there is a pressing need for sleep intervention studies in children with FASD. Early identification and intervention for sleep problems in this condition should be a therapeutic priority.

Children's Sleep May Depend on Maternal Sleep Duration During Pregnancy: A Retrospective Study.

BackgroundAnimal studies suggested that maternal sleep during pregnancy was associated with sleep pattern in offspring; however, it has not been clear in human populations.AimOur study discusses the relationships of maternal sleep duration with sleep characteristics in their offspring through an epidemiological study.MethodsA retrospective cross-sectional study including 6236 mother–child dyads was conducted in 31 preschools in May 2019, in Shanghai, China. Information regarding maternal sleep duration in three trimesters of pregnancy was collected retrospectively. Children's current sleep characteristics were evaluated through the Children's Sleep Habits Questionnaire (CSHQ). Linear regressions and logistic regression models were applied to estimate β and adjusted odds ratios with 95% confidence intervals (95% CI).ResultsMaternal sleep duration was positively associated with childhood sleep duration, which was shown in the first (β=0.113), second (β=0.131), and third trimesters (β=0.088). Meanwhile, insufficient maternal sleep duration could increase the risk of children's short sleep duration (first trimester: AOR=1.25; second trimester: AOR=1.33; third trimester: AOR=1.33). Maternal sleep duration was also associated with childhood CSHQ score: β=−0.308, −0.392, and −0.300 for the first, second, and third trimesters, respectively. Similarly, insufficient maternal sleep duration could predict childhood sleep disturbance as AOR=1.28 in the second trimester and AOR=1.26 in the third trimester.ConclusionOur findings established a relationship between maternal sleep during pregnancy and their children's sleep pattern through a population-based epidemiology study. Poor childhood sleep was found when their mother experienced less sleep duration during pregnancy, especially in the second and third trimesters.

Uncovering sleep in young males with Duchenne muscular dystrophy.

Sleep health in rare disease is often overlooked due to the complex nature of the disease. For males with Duchenne muscular dystrophy, sleep assessment is typically focused on pulmonary function and identification of sleep disordered breathing. Unfortunately for young boys with Duchenne muscular dystrophy, sleep assessment is often neglected, resulting in a dearth of knowledge on sleep health in this population. This study describes sleep quantity and quality in both younger (4-9 years) and older (10-17 years) males with Duchenne muscular dystrophy (n=19) and compares these characteristics with sleep characteristics of unaffected peers (n=17). This study was a longitudinal, observational study. Sleep measures were collected using the parent-proxy Children's Sleep Habits Questionnaire-Abbreviated version and objective sleep measures from actigraphy (sleep efficiency, awakenings, and awakening duration) over 30 days for all participants. Means and standard deviations were examined, and effect sizes were computed to quantify the magnitude of difference between the Duchenne muscular dystrophy and unaffected groups. Overall, boys with Duchenne muscular dystrophy were found to experience worse sleep than their unaffected peers as measured by parent report and actigraphy. Effect sizes of both measures demonstrated moderate to large magnitudes of difference in many of the sleep variables. Parents of boys with Duchenne muscular dystrophy reported higher scores (indicating worse sleep) in all subsections and total score of the Children's Sleep Habits Questionnaire - Abbreviated version. Actigraphy data indicated that the Duchenne muscular dystrophy group had lower percent sleep efficiency, more night awakenings and longer duration of night awakenings than their unaffected peers. Our findings offer a novel look into sleep in young boys with Duchenne muscular dystrophy. Both parent-report and actigraphy data indicate poor sleep health in this population compared with age-matched unaffected peers. Actigraphy was found to align with parent-report of sleep in this population, supporting the use of these two different ways to measure sleep in Duchenne muscular dystrophy. Results from this study should encourage clinicians and researchers alike to further explore sleep and its impact on disease in young boys with Duchenne muscular dystrophy.

Sleep problems and solution seeking for children with cerebral palsy and their parents.

Sleep problems are common in school-aged children with cerebral palsy (CP). Despite the significant impact of sleep disturbance and deprivation, there is a paucity of research in the area. The aims of this study were to (i) investigate the frequency of sleep problems in children with CP and their parents and (ii) understand what happens when parents ask for help with sleep problems from their health-care professionals. This was a prospective cohort study using an online survey sent to parents/primary care givers of children with CP aged 6-12 years recruited through the Victorian Cerebral Palsy Register. The following sleep assessment tools: The Children's Sleep Habits Questionnaire, the Pittsburgh Sleep Quality Index and the Gross Motor Function Classification System Parent Rating Tool were administered along with custom-designed questions that were informed by a preceding qualitative scoping study. Complete data sets were received from 126 parents/care givers. Almost half (46%) of the parents reported their child had sleep problems. Of the 64 parents who reported seeking help for a child's sleep problem, only 21 indicated that their attempt was successful. If a child had poor sleep, the parent was more likely to have a sleep problem than parents who did not report poor child sleeping. Sleep problems are common in children with CP and their parents. Parents do not always seek help, and those who do may not find an effective solution. Future research should explore how sleep problems can be effectively prioritised for children with CP and their parents/care givers.

SENS-U: continuous home monitoring of natural nocturnal bladder filling in children with nocturnal enuresis – a feasibility study

Enuresis is a common problem in children. One treatment option is a wetting alarm that provides an alarm when incontinence occurs. A drawback of this approach is that the child is still awakened by wet sheets. Recently, a wearable, wireless ultrasonic bladder sensor became available, the SENS-U, which has the potential to prevent the enuretic event by waking up the child before the bladder is full. In this first feasibility study, the aim is to perform a night-time, home-based evaluation of the SENS-U in children with monosymptomatic nocturnal enuresis (MNE). In this study, children (6-12years) with MNE were included for a one-night monitoring session. During the night, the SENS-U continuously (i.e. every 30s) estimated the filling status [notifications were deactivated]. In addition, urine volume was collected in a measurement cup (or diaper weight). The total measured natural nocturnal bladder filling (NNBF) cycles was analyzed by descriptive statistics. Before and after the measurement, sleep behavior was assessed by a selection of the Children's Sleep Habits Questionnaire. Fifteen patients (boys/girls: 13/2) [mean age: 8.6±1.5years] have been enrolled. One patient was excluded due to inadequate sensor-to-skin contact. For 14 children, 18 NNBF cycles were recorded (voiding diary) of which three patients (21%) had more than one NNBF cycle. The SENS-U was able to successfully detect 83% of the NNBF cycles. The three missed NNBF cycles had a voided volume ≤30ml, which was at the lower limit of the sensor's detection range. The SENS-U had no effect on sleeping behavior. The SENS-U was able to monitor the natural nocturnal bladder filling successfully in children with monosymptomatic nocturnal enuresis at home, without disturbing their sleep. Future research focuses on investigating the usability of the SENS-U for both diagnostic - and treatment purposes.

Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems

ObjectiveThe aim of this study was to longitudinally characterize in children with epilepsy the objective and subjective sleep quality and the relationship between increased physical activity and sleep as well as measures of psychosocial well-being. MethodsBaseline physical activity and sleep were established in children with epilepsy over four weeks, prior to a 12-week exercise intervention (weekly meeting with exercise counselor). Participants continuously wore a wrist pedometer (Fitbit Flex®) to capture daily number of steps, sleep efficiency, and total sleep time. The Early Childhood Epilepsy Severity Scale (E-Chess) assessed baseline epilepsy severity. Subjective sleep quality (Children's Sleep Habits Questionnaire, CSHQ), quality of life (KIDSCREEN-27; Pediatric Quality of Life Inventory, PedsQL™, 4.0 Core), fatigue (PedsQL™ Multidimensional Fatigue Scale), depression (Children's Depression Inventory-Short), and anxiety (Multidimensional Anxiety Scale for Children) were assessed pre- and post-interventions. ResultsOur cohort of 22 children with epilepsy aged 8–14 years was similarly active to peers (11,271 ± 3189 mean steps per day) and displayed normal sleeping patterns (mean sleep efficiency: 87.4% ± 3.08 and mean total sleep time: 521 ± 30.4). Epilepsy severity assessed by E-Chess was low to moderate (median baseline E-Chess score of 6, interquartile range: 5–7). Study outcomes did not change with the intervention. Older children and those with lower baseline activity were more likely to increase their activity during the intervention. Changes in physical activity were not associated with changes in sleep outcomes when accounting for age, sex, and baseline E-Chess score. Subjective sleep quality marginally improved with the intervention (CSHQ total score: 44.5 ± 5.8 at baseline and 41.6 ± 7.2 at the end of study, p = 0.05). Quality of life, fatigue, depression, and anxiety did not change with the intervention (p = 0.55, 0.60, 0.12, and 0.69, respectively). SignificanceChildren with epilepsy who are as active as peers without epilepsy have good objective measures of sleep despite self-reported fatigue and parent-reported sleep problems. The physical activity of initially less active and older children with epilepsy may benefit from an exercise counseling intervention.