Significant Sleep Problems Research Articles

Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol.

A substantial portion of men treated for prostate cancer report clinically significant sleep problems and disturbance in sleep quality constitutes significant risk for the development of depressive symptoms in survivors. Dysregulation in biological stress processes underlies the impact of poor sleep on the onset and/or progression of depressive symptoms, yet few studies have sought to identify potential neurobiological mechanisms (e.g., HPA axis activation) underlying this association in PC survivors. The present study examines the relationships between sleep disturbance, depressive symptoms, and indices of diurnal cortisol patterns among men treated for prostate cancer. In total, 66 men (84.8% White; mean age = 65.8 years, SD = 9.04) treated in the prior 2 years for localized prostate cancer were recruited. They completed questionnaires to measure sleep quality and depressive symptoms at study entry (T1) and 4 months later (T2). They also provided 4 saliva samples per day, over 3 days, at T1. Three cortisol indices were computed: diurnal slope, area under the curve (AUCg), and cortisol awakening response (CAR). Analyses indicate that, controlling for body mass index and age, worse sleep quality at T1 was significantly associated with higher levels of depressive symptoms at T2. Significant indirect effects were observed for cortisol slope (indirect effect = -.17, 95% CI [-.61, -.01]) and AUCg (indirect effect = -.14, 95% CI [-.43, -.01]), but not CAR. Results suggest that dysregulation in HPA activity acts as a neurobiological mechanism of the impact of sleep disruption on depressive symptoms in men with prostate cancer. (PsycINFO Database Record

Pain-related and Psychological Symptoms in Adolescents With Musculoskeletal and Sleep Problems.

Objectives:Two-thirds of adolescents with chronic musculoskeletal pain report a concurrent sleep problem. Both musculoskeletal pain and sleep problems can have deleterious effects on physiological and psychological well-being. We explored the prevalence of sleep problems and musculoskeletal pain, using data on 3568 adolescents from the Avon Longitudinal Study of Children.Materials and Methods:A comprehensive battery of questionnaires was administered to derive clinical phenotypes of musculoskeletal pain. Adolescents with single symptoms were compared with those reporting both musculoskeletal pain and sleep problems. Linear and logistic regression analyses were used to compare groups on pain-related variables and psychological complaints. The association between sociodemographic variables and comorbid musculoskeletal pain and sleep problems was assessed using logistic regression.Results:Over half the sample was female (n=2076, 58.2%) and the majority of European ancestry (n=3174, 97.7%). Only 5.5% (n=196) of participants were identified as having a pain condition, while 21.2% (n=749) reported a significant sleep problem, and 2.8% (n=99) reported comorbid musculoskeletal pain and sleep problems. Adolescents with comorbid problems experienced greater pain intensity and pain-related anxiety. Other psychological complaints were also higher in those who experienced concurrent problems, including depression, fatigue, concentration, and overall severity of psychological symptoms.Discussion:Comorbid sleep and pain problems were associated with a higher incidence of pain-related and psychological symptoms. Sleep problems may therefore be an important modifiable risk factor for alleviating distress in adolescents with musculoskeletal pain.

Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study

Sleep difficulties are common in children with autism spectrum disorders, with wide-ranging effects on the child's daytime behavior. We reviewed data within our Autism Speaks Autism Treatment Network Registry to determine the prevalence of sleep difficulties and patterns of medication use. Data from 1518 children ages 4 to 10 years were analyzed to determine the number of children documented to have sleep difficulties by parent-completed questionnaires and clinician-completed forms and how these findings related to the use of sleep medications. The Children's Sleep Habits Questionnaire total score was ≥41 (associated with clinically significant sleep problems in past research) in 71% of children. The prevalence of sleep diagnoses was less frequent (30% of children aged 4-10 years; P < .0001). Medications for sleep were prescribed in 46% of 4- to 10-year-olds given a sleep diagnosis. The most common medication used for sleep was melatonin followed by α-agonists, with a variety of other medications taken for sleep (anticonvulsants, antidepressants, atypical antipsychotics, and benzodiazepines). Children taking medications for sleep had worse daytime behavior and pediatric quality of life than children not taking sleep medications. Parent concerns about sleep may not be reflected in the information gathered during a clinic visit, supporting the need to develop screening practice pathways for sleep in autism spectrum disorders. Furthermore, many medications taken for sleep have adverse effects, supporting the need for evidence-based interventions in this population.

De novo, heterozygous, loss-of-function mutations in SYNGAP1 cause a syndromic form of intellectual disability.

De novo mutations (DNM) in SYNGAP1, encoding Ras/Rap GTPase‐activating protein SynGAP, have been reported in individuals with nonsyndromic intellectual disability (ID). We identified 10 previously unreported individuals with SYNGAP1 DNM; seven via the Deciphering Developmental Disorders (DDD) Study, one through clinical analysis for copy number variation and the remaining two (monozygotic twins) via a research multi‐gene panel analysis. Seven of the nine heterozygous mutations are likely to result in loss‐of‐function (3 nonsense; 3 frameshift; 1 whole gene deletion). The remaining two mutations, one of which affected the monozygotic twins, were missense variants. Each individual carrying a DNM in SYNGAP1 had moderate‐to‐severe ID and 7/10 had epilepsy; typically myoclonic seizures, absences or drop attacks. 8/10 had hypotonia, 5/10 had significant constipation, 7/10 had wide‐based/unsteady gait, 3/10 had strabismus, and 2/10 had significant hip dysplasia. A proportion of the affected individuals had a similar, myopathic facial appearance, with broad nasal bridge, relatively long nose and full lower lip vermilion. A distinctive behavioral phenotype was also observed with aggressive/challenging behavior and significant sleep problems being common. 7/10 individuals had MR imaging of the brain each of which was reported as normal. The clinical features of the individuals reported here show significant overlap with those associated with 6p21.3 microdeletions, confirming that haploinsufficiency for SYNGAP1 is responsible for both disorders. © 2015 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

The relationship between sleep and behavior in autism spectrum disorder (ASD): a review.

Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.

Pre-treatment insomnia as a predictor of single and combination antidepressant outcomes: A CO-MED report

BackgroundMost patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial. MethodsAdult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia. ResultsOf the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments. ConclusionsInsomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications.

High prevalence of sleep disorders and associated comorbidities in a community sample of children with Down syndrome.

Down syndrome (DS) is a neurodevelopmental disorder characterized by multiple comorbidities. Sleep disorders are common among children with DS and can cause significant distress for families. However, research is limited describing sleep problems and correlates in large population-based samples. Accordingly, we aimed to describe sleep behavior among children with DS and its relationship with medical conditions in this population. We conducted a population-based, cross-sectional study (2009-2011) of sleep disturbances in children and adolescents with DS 7 to 17 years of age (N = 107). We assessed sleep problems using caregiver report on two validated screening tools: the Childhood Sleep Habits Questionnaire (CSHQ) and the Pediatric Sleep Questionnaire (PSQ). The prevalence of sleep problems was compared in children with and without important comorbidities using modified Poisson regression with robust standard errors. 65% of children screened positive on the CSHQ for significant sleep problems in the past month, but their parents often did not report sleeping difficulties in their children. On the PSQ, 46% screened positive for sleep related breathing problems and 21% screened positive for sleep related movement disorders. Children with asthma, autism, and a history of enlarged adenoids and tonsils had more current sleep problems than children without these comorbidities. Our findings suggest that sleep problems may be an important but under-recognized problem in children with DS. Sleep problems appear to be correlated with prevalent comorbidities, which may provide guidance to augment current practice guidelines to evaluate sleep problems in this population.

Self- and parent reported sleep problems in children and youths with epilepsy. Preliminary findings from a study in a tertiary epilepsy center

Introduction Sleep problems are common in childhood epilepsy; however studies are mainly based on parental reports. How children and youths with epilepsy report their sleep, and how self- and parent reports correlate is largely unknown. Studies in typically developing children yield higher frequencies of sleep problems when children are used as informants, with low to moderate correlations between self- and parent reports. Sleep problems in children with epilepsy may exacerbate seizure frequency, impair cognitive and behavioral functioning, and reduce quality of life, thus reliable assessment of sleep is important in this population. Objectives To investigate the prevalence of sleep problems and the correlation between self- and parent reported sleep problems in children and youths with epilepsy. We report preliminary findings from 53 children and youths aged 10–19 years with generalized or focal epilepsy, referred to a tertiary epilepsy treatment center in Norway. They are participants in a larger ongoing study on psychiatric symptoms and executive dysfunction in children and youths with epilepsy. Sleep problems were measured at time of inclusion by self-report on the Sleep Self Report (SSR), and parent report on the Children’s Sleep Habit Questionnaire (CSHQ). 40.5 % of children and youths reported to have “problems with sleep”, while 58.3% of parents reported clinically significant sleep problems (total CSHQ score above 41) in their children. The correlations between corresponding items in the self-report (SSR) and the parent report (CSHQ) were all significant ( p values between 0.03 and <0.001), with the exception of “sleeps too little” and “moves to someone else’s bed”. Mean correlation coefficients (Spearman’s rho) for significant correlations were 0.55 (range 0.37–0.69). Sleep problems were commonly reported by both children and parents. There were significant correlations between self- and parent reports on the majority of sleep problems. Our findings suggest a stronger agreement between self-and parent reports in children and youths with epilepsy compared to typically developing children. The study was financed by Oslo University Hospital and grants from the Norwegian branch of the International League Against Epilepsy (ILAE) .

The silence of sleep disorders. High prevalence of insomnia and obstructive sleep apnea symptoms in chronic hepatitis C infection

Introduction Fatigue is the leading patient reported symptom in chronic hepatitis C infection. Although the fatigue is recognized as an important patient reported outcome measure in hepatitis C research trials, it is rarely addressed in clinical settings. Sleep disorders are commonly associated with fatigue, yet the prevalence of specific sleep disorders and their contribution to fatigue in hepatitis C infection is unknown. The objective of this study was to determine the prevalence of clinical insomnia and obstructive sleep apnea and their association with fatigue in patients with hepatitis C infection treated at a tertiary liver clinic. Materials and methods Treatment seeking participants with chronic hepatitis C infection ( N =115; 36% females; mean age=56) were enrolled in a mixed design study on fatigue. Participants completed questionnaires on their fatigue, sleep, fatigue specific cognitions, depression and anxiety. Medical data were retrieved from hospital charts. Fatigue was assessed with the Fatigue Severity Scale (FSS), insomnia was assessed with the Insomnia Severity Index (ISI), excessive daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS) and the risk for obstructive sleep apnea was determined with the STOP-BANG questionnaire. Results Almost 60 % of the total sample (56.9% of males and 64.3% of females) obtained a score indicating severe fatigue C related functional impairment (FSS i‘Ý 4). The median FSS score was 4.67 (interquartile range=2.92). More than one third of the sample (30.1% of males and 43% of females) scored above the ISI cut- off indicating moderate or severe clinical insomnia. Seventy-one percent of the sample (80.9% of males and 54.8% of females) scored at or above the cut-off score of 3 on the STOP-BANG questionnaire indicating a 70%- 86% likelihood of obstructive sleep apnea. Only 7% of the total sample had been diagnosed with sleep apnea. A one way ANOVA and post hoc tests indicated that participants with clinical insomnia only and those with a combination of clinical insomnia and potentially moderate/severe sleep apnea reported significantly higher fatigue than those without a clinically significant sleep problem or with a possible sleep apnea only. The mean ESS was above the cut-off for excessive daytime sleepiness only in the group with a combination of clinical insomnia and obstructive sleep apnea. Conclusion Clinically significant insomnia and obstructive sleep apnea Cseparately and in combination – may affect 50% of patients with chronic hepatitis C infection treated in tertiary liver centers. Obstructive sleep apnea is severely underdiagnosed and treated in this group. Patients with insomnia or a combination of insomnia and obstructive sleep apnea report the most severe fatigue related functional impairment. Excessive daytime sleepiness is not a sensitive marker of sleep disorders in this group, as only those with comorbid sleep disorders reported abnormal level of sleepiness. Screening for insomnia and obstructive sleep apnea and effective treatment of these disorders may alleviate the burden of fatigue of a significant proportion of patients with chronic hepatitis C infection.

Sleep disturbance in adopted children with a history of maltreatment

This study aimed to investigate whether children with a history of maltreatment and current behaviour problems demonstrate greater sleep disruption than controls; and also whether sleep disturbances are associated with these behavioural problems using standardised carer report measures. Sixty-three participants were assessed using the Children’s Sleep Habits Questionnaire (CSHQ) (Owens, Spirito and McGuinn, 2000) and the Strengths and Difficulties Questionnaire (SDQ) (Goodman, et al., 2003). Thirty-four participants aged 5–12 years were recruited via Adoption UK – Scotland. Inclusion criteria included a history of maltreatment (confirmed from social work documents) with associated social/behavioural problems. Twenty-nine controls with no psychiatric or maltreatment history, also aged 5–12 years, were recruited from two general practices.Mean CSHQ total sleep difficulty scores were significantly higher in maltreated children than in controls (48.9 vs 23.6, P &lt; 0.001). Rates of clinically significant sleep problems (total sleep score&gt;41) were also higher in the maltreatment group at 50% compared to 12% in controls (P = 0.002). There was a significant association between high scores on the CSHQ and the SDQ (P &lt; 0.000). Overall, this study suggests that behaviourally disturbed children with a history of maltreatment experience significant sleep disruption, which is in turn associated with their behavioural disturbance. This has clear implications for both clinical assessment and intervention with this vulnerable group and is worthy of further research.

Sleep in family caregivers of patients admitted to hospice: A pilot study

Caring for a dying family member is known to interfere with sleep, yet little is known about caregiver sleep once the patient is admitted to hospice. The aim of this pilot study was to describe the sleep of partners and other family caregivers of patients in hospice. The pilot study used a cross-sectional, descriptive, and comparative design. Participants included the primary family caregivers of patients recently admitted to a hospice in Norway. Caregiver sleep during the prior month was measured with the Pittsburgh Sleep Quality Index (PSQI). During the patient's hospice stay, caregiver sleep was measured using wrist actigraphy for four nights and three days. Twenty family caregivers (12 partners and 8 other relatives) completed the study protocol without difficulty. On the PSQI, most caregivers (n=13) reported clinically significant sleep problems during the prior month. Once the patient was admitted to hospice, actigraphy indicated that 10 caregivers had clinically significant sleep disruption (≥15% wake after sleep onset) and six averaged <7 hours of sleep per night. Partner caregivers reported more trouble falling asleep, and less sleep medication use, in the prior month than other types of family caregivers. However, once the patient was admitted to hospice, and after adjusting for caregiver age, partner caregivers experienced less sleep disruption than other caregivers. Findings demonstrate feasibility of the study protocol and indicate that sleep problems are common for caregivers of dying patients, even after the patient is admitted to hospice. The caregiver's relationship to the patient may be an important factor to consider in future studies.

PTU-063 Assessment of Sleep Impairment in Patients With Crohn’S Disease: Results from the Ustekinumab Certifi Study

IntroductionTo describe the extent of sleep impairment reported in CERTIFI (Ph2 evaluating UST in inducing & maintaining clinical response & remisison)using Jenkins Sleep Evaluation Questionnaire (JSEQ) & establish a clinically...

Sa1211 Assessment of Sleep Impairment in Patients With Crohn's Disease: Results From the Ustekinumab Certifi Study

Introduction To describe the extent of sleep impairment reported in CERTIFI (Ph2 evaluating UST in inducing & maintaining clinical response & remisison)using Jenkins Sleep Evaluation Questionnaire (JSEQ) & establish a clinically meaningful improvement threshold for JSEQ. Methods Pts with moderate-to-severe CD(CDAI ≥220 & ≤450) who had previously failed or were intolerant to ≥1 anti-TNF were randomised to PBO/UST induction at wk0. Primary endpt was clinical response (≥100-pt reduction in CDAI from BL) at wk6. Sleep impairment assessed using JSEQ (total score 0–20; higher scores indicate greater sleep impairment) at BL&wk6. Relationships between BL sleep impairment, clinical disease activity (CDAI), & HRQoL impact(IBDQ) evaluated using Pearson correlation. Clinically meaningful improvement threshold of JSEQ was established with the anchor-based [clinical response by reduction in CDAI of ≥70-pt or clinically meaningful improvement (≥16-pt) in IBDQ] & distribution-based (change by one-half of the standard deviation [SD] of BL JSEQ score) methods. Prop of pts who achieved clinically meaningful improvements in JSEQ at wk6 was determined & compared. Results At BL,both grps(n = 526) experienced similar degree of moderate sleep impairment, with JSEQ scores (mean±SD) of 11.0 ± 4.30(PBO)&11.0 ± 4.59(UST),resp. About 60% were “waking up feeling tired and worn out”; about 30–35% of pts had trouble falling asleep, staying asleep,& woke up several times during the night for 15–30 days in the previous month. At BL, JSEQ was correlated with CDAI (r = 0.19, p 2 or > 3 points from BL JSEQ score at wk6) were derived. More pts who received UST induction achieved both thresholds at wk6(Table). Conclusion Pts experience significant sleep problems as measured by JSEQ; magnitude of impairment correlates with disease activity. Both anchor- &distribution-based methods derive similar thresholds representative of clinically meaningful improvements in JSEQ. UST induction resulted in a greater proportion of pts achieving clinically meaningful improvements in sleep impairments. Disclosure of Interest C. Gasink Employee of: Janssen R&D, LLC, D. Chan Employee of: Janssen R&D, LLC, L.-L. Gao Employee of: Janssen R&D, LLC, B. Schenkel Employee of: Janssen Scientific Affairs, LLC, C. Han Employee of: 3. Janssen Pharmaceutical Services

Sleep and Behavioral Problems in Rolandic Epilepsy

Although patients with benign childhood epilepsy with centrotemporal spikes exhibit a benign course of the disease, some of them display sleep and behavioral problems. Sixty-one patients with rolandic epilepsy, aged 6-11 years, were included in this study. The patients were divided into two subgroups according to the presence of seizures over the preceding 6 months. The control group comprised 25 patients without epilepsy and with similar characteristics in terms of age and sex. All patients underwent evaluation of sleep (Sleep Disturbance Scale for Children) and behavior (Lithuanian version of the Child Behaviour Checklist). Only patients who had had seizures over the preceding 6 months displayed significantly higher scores for sleep problems (disorders of excessive daytime sleepiness, disorders of sleep-wake transition, and scores for total sleep problems), worse sleep quality (longer sleep-onset latency), and behavioral problems (anxiety/depression, social problems, thought problems, attention problems, and aggressive behavior) than the patients of the control group. Our data add to evidence that active epilepsy has an impact on sleep and behavior. Clinically significant sleep problems were related to the higher risk of behavioral problems. Parents' ratings for existing sleep problems were sensitive to Sleep Disturbance Scale for Children scores above normal values.

Effect of mindfulness-based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients

The prevalence of sleep disturbance is high among cancer patients, and the sleep problems tend to last for years after the end of treatment. As part of a large randomized controlled clinical trial (the MICA trial, NCT00990977) of the effect of mindfulness-based stress reduction (MBSR) on psychological and somatic symptoms among breast cancer patients, the aim of the current study was to evaluate the effect of MBSR on the secondary outcome, ‘sleep quality’. Material and methods. A total of 336 women operated on for breast cancer stage I–III 3–18 months previously were randomized to MBSR (n = 168) or treatment as usual (n = 168); both groups received standard clinical care. The intervention consisted of an eight-week MBSR program (psycho-education, meditation and gentle yoga). Sleep quality was assessed on the Medical Outcome Study sleep scale at baseline, after the intervention and at six- and 12-months’ follow-up. Results. The mean sleep problem scores were significantly lower in the MBSR group than in controls immediately after the intervention. Quantile regression analyses showed that the effect was statistically significant only for the participants represented by the lower percentile of change between baseline and post-intervention, i.e. those who had more sleep problems; the MBSR group had a significantly smaller increase in sleep problems than the control group. After the 12-month follow-up, there was no significant between-group effect of MBSR on sleep quality in intention-to-treat analyses. Conclusion. MBSR had a statistically significant effect on sleep quality just after the intervention but no long-term effect among breast cancer patients. Future trials in which participation is restricted to patients with significant sleep problems are recommended for evaluating the effect of MBSR on sleep quality.

Food allergy and anaphylaxis – 2062. “Allergic gastroenteropathy” in UK children

Results 24 of the children (80%) exhibited symptoms of gastrooesophageal reflux disease, 28 children (93%) had lower GI symptoms and 23 children (77%) had significant sleep problems. 19 out f the 30 children (63%) had other atopic disorders. The most common food trigger was cow’s milk others included egg, soya, wheat, fish, and nuts. Family history of atopy was seen in 24 children (80%). Skin prick tests were positive in only 7 children (23%) suggesting this is a non-IgE mediated phenomenon. Management of these children included diet exclusion, anti-reflux and anti-allergy medication. 12 children (44%) responded poorly to treatment and required steroids and 8 (30%) required biopsies. In families with more than one child with allergic gastroenteropathy, diagnosis and treatment with anti-reflux, diet exclusion and anti-allergy medication was started much earlier (2m-2yrs) in the younger sibling.

Troublesome Triad: Trauma, Insomnia, and Alcohol

The objective of this study was to examine the relationships between combat related trauma, insomnia, and alcohol misuse. The author reviewed the standardized tests results from 39 active duty service members, all of whom had recent deployments to either Iraq or Afghanistan. The battery of self-test instruments assessed the effects of military trauma, anxiety, depression, alcohol use, and insomnia. Among the study subjects, the entire group reported significant sleep problems, with bedtime arousals impeding sleep initiation. Male subjects' reported an average AUDIT score of 8.62. Service members with higher trauma scores also reported greater misuse of alcohol. The high trauma scores also correlated with specific pre-sleep cognitive and somatic factors. The findings of this study lend support for the use of standardized instruments for assessing sleep problems, along with similar tests for trauma and substance misuse, which together should help identify high risk military patients.

Sleep Problems in Children with Fetal Alcohol Spectrum Disorders

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.

Association of Sleep and Co-Occurring Psychological Conditions at 1 Year After Traumatic Brain Injury

Fogelberg DJ, Hoffman JM, Dikmen S, Temkin NR, Bell KR. Association of sleep and co-occurring psychological conditions at 1 year after traumatic brain injury. ObjectivesTo compare individuals' sleep 1 year after traumatic brain injury (TBI) with that of a healthy comparison group, and examine the relationship between sleep, co-occurring conditions, and functional status in those with TBI. DesignLongitudinal assessment of a prospectively studied sample of individuals with moderate to severe TBI. Assessment of sleep occurred at 1 year after TBI. SettingInpatient acute rehabilitation for TBI and community follow-up at 1 year postinjury. ParticipantsIndividuals with TBI (N=174) were recruited from consecutive admissions to an inpatient rehabilitation unit and enrolled into the TBI Model Systems study. Participant mean age was 38, and mean Glasgow Coma Scale score on admission was 9.3. Seventy-eight percent of the sample were men. InterventionsNone. Main Outcome MeasuresSleep was assessed with the Pittsburgh Sleep Quality Index (PSQI). Depression, anxiety, and pain were measured with the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 Scale, and an analog pain rating scale, respectively. ResultsParticipants with TBI reported significantly greater sleep difficulties than the healthy comparison group. Forty-four percent of participants with TBI reported significant sleep problems (PSQI>5). Participants with 1 or more co-occurring conditions (depression, pain, or anxiety) had significantly worse sleep than those without such a condition. The highest level of sleep problems was reported by participants with multiple co-occurring conditions. Sleep problems were also associated with poor functional status. ConclusionsSleep difficulties are a frequent problem at 1 year after TBI, and often co-occur with depression, anxiety, and pain. Assessment and treatment of sleep difficulties should be included in clinical practice. Future research on the potential causal relationship among co-occurring conditions may assist in additional intervention planning.

Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients

Among adult liver transplant recipients (LTRs), sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower health-related quality of life (HRQOL). The aim of this cross-sectional study was to determine the impact of sleep problems on the HRQOL of pediatric LTRs using validated measures. Participants included 47 LTRs. Mean age of the LTRs was 10.9 ± 4.6 years, and mean time since transplantation was 6.2 ± 3.9 years. The primary indication for transplantation was biliary atresia (51%). According to parent reports, pediatric transplant recipients had symptoms of sleep-disordered breathing, excessive daytime sleepiness, daytime behavior problems, and restless legs; 40.4% of parents and 43.8% of children reported significantly lower total HRQOL for the recipients. Age, time since transplantation, and health status were not significantly related to the quality of life. Hierarchical regression analyses revealed that the sleep-disordered breathing subscale of the Pediatric Sleep Questionnaire accounted for significant variance in parent-proxy reports on the Pediatric Quality of Life (PedsQL) summary scales measuring children's psychosocial health (R(2) = 0.36, P < 0.001), physical health (R(2) = 0.19, P = 0.004), and total HRQOL (R(2) = 0.35, P < 0.001). Also, the sleep-disordered breathing subscale accounted for significant variance in the child self-reported school functioning scale (R(2) = 0.18, P = 0.03). Clinically significant sleep problems were more common among children with low total HRQOL. In conclusion, sleep problems were common in this cohort of pediatric LTRs and predicted significant variance in HRQOL. Prospective larger scale studies are needed to assess factors that contribute to sleep difficulties and low HRQOL in this population. The detection and treatment of significant sleep problems may benefit the HRQOL of pediatric LTRs.