Delayed Sleep Onset Research Articles

WIDE AWAKE Mediates the Circadian Timing of Sleep Onset

How the circadian clock regulates the timing of sleep is poorly understood. Here, we identify a Drosophila mutant, wide awake (wake), that exhibits a marked delay in sleep onset at dusk. Loss of WAKE in a set of arousal-promoting clock neurons, the large ventrolateral neurons (l-LNvs), impairs sleep onset. WAKE levels cycle, peaking near dusk, and the expression of WAKE in l-LNvs is Clock dependent. Strikingly, Clock and cycle mutants also exhibit a profound delay in sleep onset, which can be rescued by restoring WAKE expression in LNvs. WAKE interacts with the GABAA receptor Resistant to Dieldrin (RDL), upregulating its levels and promoting its localization to the plasma membrane. In wake mutant l-LNvs, GABA sensitivity is decreased and excitability is increased at dusk. We propose that WAKE acts as a clock output molecule specifically for sleep, inhibiting LNvs at dusk to promote the transition from wake to sleep.

Assessment of sleep problems in children with familial Mediterranean fever

This study aimed to investigate sleep patterns, sleep disturbances and possible factors that are associated with sleep disturbances among children with familial Mediterranean fever (FMF). Fifty-one patients with FMF and 84 age- and sex-matched healthy controls were enrolled in the study. The patients who had an attack during the last 2weeks were not included. Demographic data, FMF symptoms, disease duration, dose of colchicine, disease severity score, number of attacks in the last year, MEFV mutation and serum C-reactive protein (CRP) levels were recorded for each patient. A Children's Sleep Habits Questionnaire was performed. The total sleep scores of the patients with FMF were significantly higher than the control group. Total sleep durations were similar between FMF patients and controls. Children with FMF had significantly higher scores regarding sleep-onset delay, sleep anxiety, night wakings and sleep-disordered breathing when compared to healthy controls. There was a significant positive correlation between number of attacks in the last year and sleep onset delay, night wakings and sleep disordered-breathing. Disease severity score and CRP levels were not associated with any of the subscale scores. The patients with exertional leg pain had significantly higher total sleep scores than the ones without. Furthermore, patients with exertional leg pain had significantly higher subscale scores regarding sleep onset delay, parasomnias and sleep-disordered breathing. This study showed for the first time that children with FMF had more sleep disturbances than their healthy peers. Higher numbers of attacks and exertional leg pain were associated with poor sleep quality. In conclusion, this study underlines the need to assess and manage sleep problems in children with FMF.

Behavioral sleep problems and internalizing and externalizing comorbidities in children with attention-deficit/hyperactivity disorder

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

Autism spectrum disorders and sleep disturbances in a pediatric patient

INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often presents before the child enters the educational system and is characterized by developmental deficits with impairments in three main areas [1] personal, [2] social, and [3] academic or occupational functioning. The neurodevelopmental disorders represent a group of conditions with an onset early in the developmental period. Sleep disorders are commonly reported by parents of children with an ASD diagnosis with between 50% to 80% of parents reporting sleep problems with their children. Problems can be categorized into dyssomnias (problems falling and/or remaining asleep) and parasomnias (abnormal and/or unnatural movements, behaviors, emotions, perceptions, and dreams).

Delayed sleep onset in depressed young people.

BackgroundThe circadian abnormality of delayed sleep phase has been suggested to characterise a subgroup of depressed young adults with different risk factors and course of illness. We aim to assess the prevalence and factors, particularly substance use, associated with such delay in a large help-seeking cohort of young people with mental health problems.MethodsFrom a consecutively recruited sample of 802 help-seeking young people, 305 (38%) had at least moderate depressive symptoms (QIDS-C16 >10), sleep data and did not have a chronic severe mental illness. Demographic and clinical characteristics were evaluated through self report and clinical interview. Delayed sleep phase was defined as a sleep onset between the hours of 02:00 a.m. – 06:00 a.m. and the characteristics of this group were compared to normal phase sleepers.ResultsDelayed sleep onset was reported amongst 18% (n = 56/305) of the depressed group compared to 11% of the non-depressed young people. Amongst the depressed group, delayed sleep onset was associated with tobacco, alcohol and cannabis misuse and short sleep duration (x̅: 5.8 hrs vs. x̅: 7.8 hrs). There were no differences in demographic factors, personality traits or symptoms. Tobacco smoking was very common: In logistic regression analyses only tobacco use (OR 2.28, 95% CI: 1.04 - 5.01) was associated with delayed sleep onset. There was no interaction with age.ConclusionsDelayed sleep onset was twice as common in depressed young people as the general population and young people with other mental health problems, and is a potential marker for a subgroup of mood disorders. Those with delayed sleep onset were not more severely depressed but had short sleep duration, a risk for chronic psychological ill health, and higher levels of tobacco use. Nicotine use was common in this group, has biological evidence as a sleep disrupter, and requires specifically addressing in this population.

Disturbances in melatonin secretion and circadian sleep–wake regulation in Parkinson disease

ObjectiveUsing salivary dim light melatonin onset (DLMO) and actigraphy, our study sought to determine if Parkinson disease (PD) patients demonstrate circadian disturbance compared to healthy controls. Additionally, our study investigated if circadian disturbances represent a disease-related process or may be attributed to dopaminergic therapy. MethodsTwenty-nine patients with PD were divided into unmedicated and medicated groups and were compared to 27 healthy controls. All participants underwent neurologic assessment and 14days of actigraphy to establish habitual sleep-onset time (HSO). DLMO time and area under the melatonin curve (AUC) were calculated from salivary melatonin sampling. The phase angle of entrainment was calculated by subtracting DLMO from HSO. Overnight polysomnography (PSG) was performed to determine sleep architecture. ResultsDLMO and HSO were not different across the groups. However, the phase angle of entrainment was more than twice as long in the medicated PD group compared to the unmedicated PD group (U=35.5; P=.002) and was more than 50% longer than controls (U=130.0; P=.021). The medicated PD group showed more than double the melatonin AUC compared to the unmedicated group (U=31; P=0.001) and controls (U=87; P=.001). There was no difference in these measures comparing unmedicated PD and controls. ConclusionsIn PD dopaminergic treatment profoundly increases the secretion of melatonin. Our study reported no difference in circadian phase and HSO between groups. However, PD patients treated with dopaminergic therapy unexpectedly showed a delayed sleep onset relative to DLMO, suggesting dopaminergic therapy in PD results in an uncoupling of circadian and sleep regulation.

Sleep onset delay and night awakenings in preschool children: the Generation XXI birth cohort

Introduction Previous studies have shown that sleep onset delay and night awakenings are frequent in childhood and are associated with negative effects on children’s development. However, associations between maternal and children’s characteristics and these sleeping problems in young children remain unclear. Thus, we aimed to estimate the prevalence of sleep onset delay and night awakenings in preschool ages and their main associated factors. Materials and methods This study based in a Portuguese population-based birth cohort, Generation XXI, included 5631 singleton children, with 4/5 years of age. Data on demographic and socioeconomic characteristics, children’s health, daytime activities and sleeping habits were collected using structured questionnaires. Sleep onset delay was defined when children experienced difficulty in falling asleep in 20 min and night awakenings were considered when occurred at least once every night. Odds ratios and respective 95% confidence intervals (CI) were estimated using multivariate unconditional logistic regression. Results Sleep onset delay and night awakenings were identified in 28.8% (95%CI: 27.6–30.0) and 15.1% (95%CI: 14.2–16.1) of the children, respectively. Both sleeping problems were more frequent in younger ages but no differences were observed regarding sex. Sleep onset delay was inversely associated with maternal age and educational level and presence of siblings in the household. It was more frequent in children with rhinitis and allergy diagnosis, with longer screen- based media use, in children that took naps in the afternoon, who slept in the parents’ bedroom and who needed a relative’s presence at bedtime and reading stories before fall asleep. Night awakenings were associated with unemployed mothers, rhinitis diagnosis, overweight and obesity, napping in the afternoon, a relative’s presence at bedtime and were less frequent in children with single, divorced or widow mothers and with higher family income. Longer maternal sleep duration was inversely associated with both sleep problems. Conclusion Sleep onset delay and night awakenings are common conditions in preschool children. This study showed that sleeping problems in this age strata are linked to a multi-factorial set of maternal and children’s characteristics. Due to the modifiable characteristic of most of these associated features, early interventions can promote adequate sleeping patterns, with gains in children’s development. Acknowledgements This work was supported by the Portuguese Foundation for Science and Technology (F- COMP-01–0124-FEDER-01108; PTDC/SAU- ESA/105033/2008). We want to thank all members of the research team and staff of Generation XXI for their essential daily work.

Sleep disturbances in Portuguese asthmatic children-preliminary results

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Nighttime respiratory symptoms constitute one of the criteria of disease control, but other sleep disturbances exist in patients with asthma. The aim of this study was to screen for sleep disturbances in children with asthma. Outpatients with asthma were evaluated with two sleep screening questionnaires. Parents of children aged between 4 and 10 years with asthma were asked to answer Children Sleep Habits Questionnaire (CSHQ-PT). Their children aged between 7 and 10 years answered Sleep Self Report (SSR-PT). Asthma control was assessed according to ICON Guidelines. We compared the obtained results with a group of 574 healthy children studied previously for the validation of both questionnaires for the Portuguese population (control group). The total score of both questionnaires and the 8 subscales of CSHQ-PT, bed time resistance (BTR), sleep onset delay (SOD), sleep duration (SD), sleep anxiety (SA), night wakenings (NW), parasomnias (PS), sleep disorder breathing (SDB), day time sleepiness (DTS) were analyzed. We obtained data from 23 children (mean age 7.7 years ± 1.7), 52.2% male. Considering ICON Guidelines, only in 5 (21.7%), asthma was totally controlled. Sleep habits evaluation showed mean sleep duration of 9.6 h/day ± 1.4, median of 10 h (6.30–12.30 h) with a difference of sleeping time between week and week-end of 1 h ± 0.76. The CSHQ-PT mean total score in this sample was 54.7 ± 10.9 and in the control group was 43.8 ± 6.1. Comparing both groups using Mann Whitney U test, the total score showed a z score of −3.91 ( p .000). Regarding the subscales, z score was statistically significant in SDB, PS, SD, SOD and ranged from −5.36 (p.000) in SDB to −3.55 ( p .000) in SOD. SSR-PT had a mean score of 36.4 ± 6.1 in the asthma group and of 34.9 ± 5.7 in the control group. These are the preliminary results of the evaluation of sleep disturbances in a sample of asthmatic children with sleep screening questionnaires validated for Portuguese population. The obtained results alert for the need of performing the screening of sleep disturbances in asthmatic children, since besides SDB these children have other sleep disturbances presumably related with sleep deprivation and anxiety, namely altered sleep duration, sleep onset delay and the existence of parasomnias. Pediatric Department of HFF.

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

Sleep disorders (SD) are among the most common complaints in childhood, often undervalued by clinicians. Extrinsic and intrinsic factors influence sleep, particularly socio-cultural environment. It is known that poor sleep hygiene has physical, educational and social consequences. In Portugal there are few published studies about sleep habits in children and rarely based on validated questionnaires. The aim of this study is to determine the prevalence of SD and associated factors in an outpatient pediatric population of a primary health care center (PHCC). Observational study of 4–10 year-old children admitted to a medical appointment at a PHCC of a suburban area of Lisbon during a 4 month period. Children Sleep Habits Questionnaire validated for the Portuguese population (CSHQ-PT) for the screening of SD (cut-off = 44 points) with 8 subscales (bedtime resistance (BTR), sleep onset delay (SOD), sleep duration (SLD), parasomnia (PS), night wakings (NW), sleep anxiety (SA), sleep disordered breathing (SDB) and daytime sleepiness (DTS)) was applied to parents or legal guardian, as well as an inquiry with demographic, anthropometric and health information. Body Mass Index (BMI) z -score was determined by Center for Disease Control growth charts. Non-parametric Mann–Whitney, Chi-squared and exact Fisher¡ ∣ s tests were used. A level of significance f Ñ = 0.05 was considered. From 128 children, 57.8% were male; mean age was 6.5 (¡Ó2.1). Mean of cohabitants was 4.0 (¡Ó1.1). 21.1% live in a single-parent family. Median BMI z- score was 0.4 (min −6.2; max 3.4). From CSHQ-PT, 59.4% scored above the cut-off, with the following subscales score: DTS - 43.8%; BTR - 25.8%; SA - 20.3%; PS - 14.8%; SLD - 10.9%; NW – 7%; SOD – 4.7%. Mean duration of sleep was 9h57m (¡Ó1h6m). Data showed that children living in a single-parent family had more SD ( p = 0.048), particularly PS ( p = 0.019). Children with SDB showed higher BMI z -scores ( p = 0.055) and more DTS ( p = 0.012). The prevalence of SD found was higher than reported in medical literature. Subscales related with behavioral SD were the most relevant in this population. The study suggests that family structure influences children¡ ∣ s sleep hygiene. Early intervention on family is needed to overcome this issue. Regarding SDB, early identification of Ear, Throat, Nose disorders and an approach towards an adequate nutritional status are crucial to healthy sleep hygiene and therefore better performance in children daily life activities. Patients Primary Health Care Center.

A taxometric analysis of the children’s sleep habits questionnaire

Sleep problems characterized by later bedtimes, insomnia and excessive daytime sleepiness occur in different populations. Sleep problems are highly prevalent, affecting approximately 20–30% of children, and they influence multiple domains of child and family functioning as proven studies using different methods. Sleep problems are connected with many psychiatric disorders, including ADHD, autism, cognitive functioning problems, and behavior problems et al. There is an old important issue in the psychopathology field as to whether the latent construct is dimensional or taxometric. This study examined the latent structure of the sleep problems measured by the Childrens Sleep Habits Questionnaire (CSHQ). Participants We took the cluster-stratified sampling procedure, and chose 4 districts in Shenzhen. In each district, a primary school was chosen, and in each school, one class was chosen in each grade. 950 parents of the selected children participated in the paper-and-pencil survey during parents’ meetings held at the schools between late February and early March in 2011. Finally, we had 912 questionnaires available. The sample population consisted of 912 children aged 6–14 years inclusive, including 495 boys (54.3%), 413 girls (45.3%) and 4 missing values about gender (0.4%), with a mean age of 8.9 years (SD = 1.9). The children were comprised of first through sixth grade and they came from schools in Shenzhen City, which is located in the south of China mainland. The number and the portion of each grade are as follows: the first grade 235 (25.8%), the second grade 135 (14.8%), the third grade 155 (17.0%), the fourth grade 133 (14.6%), the fifth grade 136 (14.9%), and the sixth grade 118 (12.9%). There were 170 missing values in total, and we took the expectation maximization (EM) method to replace them. Measures The CSHQ is a sleep questionnaire for children designed for screening a wide range of sleep problems among school age children. According to recall of a recent typical week, parents rated the occurrence of 33 sleep habits or sleep problems on a 3-point scale:3 = usually (5–7 times/week),2 = sometimes (2–4 times/week),1 = rarely (0–1 times/week). The questionnaire yields a total score and eight subscale scores: Bedtime Resistance, Sleep Onset Delay, Sleep Duration, Sleep Anxiety, Night Wakings, Parasomnias, Sleep Disordered Breathing and Daytime Sleepiness. The higher the score, the more likely to have sleep problems. A total score above 41 is considered to have a serious sleep problem. The CSHQ has demonstrated adequate reliability (coefficient alpha 0.68–0.78, testC¨retest reliability 0.62–0.79) and validity. In this study, we took the Chinese language version of the CSHQ. Reliability (coefficient alpha 0.71) and validity (content and construct) of the Chinese version of CSHQ are good. In order to identify the latent structure of CSHQ, we used three independent taxometric procedures: MAMBAC (mean above minus below a cut), MAXEIG (maximum eigenvalue) and L-Mode (latent-mode factor analysis). We applied three taxometric procedures to analysis our data and used Ruscio’s taxometric R program(http://www.tcnj.edu/∼ruscio/taxometrics.html) to get taxometric plots and ran all calculations. Sleep problems were measured by three main factors£ – we called F1–F3 (bad sleep habit⧹problems about sleep discords⧹problems about sleep time and daynapping). We took three taxometric analysis procedures (MAMBAC⧹MEIGN⧹LMODE) to apply in the latent structure analysis of the CSHQ. Three indicators were used in the taxometric analysis procedures, which have enough wide range and proper Skewness and Kurtosis. The correlations between indicators were around 0.3. Most of the Cohen’s d values except one are larger than 1.25SD, indicating the indicators deemed appropriate for taxometric analysis. The present study indicates that the latent structure of the CSHQ is dimensional. It aids in better understanding of the latent structure of CSHQ-measured sleep problems among Chinese school-aged children. The authors thank the lovely children and their parents and teachers. We also appreciate the efforts of Rui Ma (Nanshan Xuefu Primary School, Shenzhen, China), Lin Lin and her three classmates (Shenzhen University, China) for their help with data collection and entry.

Dissonance Between Parent‐Selected Bedtimes and Young Children's Circadian Physiology Influences Nighttime Settling Difficulties

Nighttime settling difficulties (i.e., bedtime resistance, sleep-onset delay) occur in about 25% of young children and are associated with attentional, behavioral, and emotional problems. We examined whether the timing of internal (endogenous) circadian melatonin phase (i.e., dim light melatonin onset; DLMO) and its relationship with parent-selected bedtimes were related to nighttime settling behaviors. Fourteen regularly napping preschoolers (8 females; 30-36 months) participated in a 6-day protocol (parent-report of nighttime settling, actigraphic assessment of sleep onset latency, evening salivary DLMO). Average DLMO clock time was 07:40 p.m. ± 00:48 minutes, occurring 29 minutes ± 32 minutes prior to bedtime (lights-out). Children with later DLMOs had longer sleep-onset latencies (r = .62) and poorer success in falling asleep (r = -.59). Children whose bedtimes were closer to their DLMO had longer sleep-onset latencies (r = .72) and increased bedtime resistance (r = -.54). We conclude that dissonance between parent-selected bedtimes and children's circadian physiology may contribute to the development of nighttime settling difficulties in early childhood.

Sleep and its relationship to pain, dysfunction, and disease activity in juvenile idiopathic arthritis

The objective of this study was to determine the sleep abnormalities that may exist in Moroccan children with juvenile idiopathic arthritis (JIA) and their relationship to pain, dysfunction, and disease activity. Case control study including 47 patients diagnosed with JIA, according to the criteria of the International League of Associations for Rheumatology (ILAR), and 47 healthy children, age and sex matched. Sleep was assessed by Children's Sleep Habits Questionnaire (CSHQ). All parents have filled the 45 items of the CSHQ and grouped into eight subscales: bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, sleep-disordered breathing, night awakenings, parasomnias, and morning awakening/daytime sleepiness. The disease activity was assessed by the number of painful joints, swelling joints, erythrocyte sedimentation rate, c-protein reactive, and Juvenile Arthritis Disease Activity Score (JADAS). Functional assessment was based on the value of Childhood Health Assessment Questionnaire. Pain was assessed by visual analog scale pain. Forty-seven patients were included, with 28 males (59.6%). Children with JIA had a total score of CSHQ significantly higher than the control cases (p < 0.0001); significant differences were also found in the subscale sleep onset delay, sleep anxiety, sleep-disordered breathing, night awakenings, and parasomnias with a p value of <0.0001, 0.034, <0.0001, 0.001, and 0.00, respectively. Significant association was found between the CSHQ total score and visual analog scale (VAS) physician activity (p = 0.016) and JADAS (p = 0.05). There was a correlation between the sleep-disordered breathing and JADAS (p = 0.04). Sleep onset delay was associated with VAS patient pain (p = 0.05), as nocturnal awakenings and VAS patient pain (p = 0.016). Finally, parasomnias and physician's VAS activity (p = 0.015) and VAS patient pain (p = 0.03) were also correlated. This study suggests that sleep abnormalities are common in children with JIA. Strategies to improve sleep should be studied as a possible tool of improving the quality of life of children with rheumatic disease.

Case Reports of Sleep Phenotypes of ADHD

Objective: Five sleep ADHD phenotypes have been hypothesized: (a) the hypo-arousal state of the “primary” form of ADHD, (b) the sleep phase advanced disorder, (c) sleep disordered breathing (SDB), (d) restless legs syndrome and/or periodic limb movements disorder (PLMD), and (e) epilepsy. Method: Five case reports are presented; each child but one underwent video-polysomnography. Results: The first case report is an example of ADHD and SDB, with improvement of hypersomnolence after resolution of sleep apnea. The second case shows the impact of delayed sleep onset latency in the pathogenesis of ADHD, and the efficacy of melatonin. The third case report describes the association with PLMD, with amelioration after iron supplementation. The other two cases are examples of ADHD and epilepsy, with clinical improvement after antiepileptic treatment was started. Conclusion: A diagnostic and therapeutic algorithm should be designed to find the best first-line treatment for ADHD and sleep problems/epilepsy.

Parent-Based Sleep Education for Children with Autism Spectrum Disorders

This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2-10years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and 1month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children's Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group versus individualized education did not affect outcome.

AB0698 Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis.

ObjectivesTo determine what sleep abnormalities may exist in children with juvenile rheumatoid arthritis (JRA), and their relationship to pain, dysfunction, and disease activityMethodsCase control study including 47 patients diagnosed with...

High incidence of sleep problems in children with developmental disorders: Results of a questionnaire survey in a Japanese elementary school

Objective: The aim of the present school-based questionnaire was to analyze the sleep problems of children with developmental disorders, such as pervasive developmental disorder and attention deficit hyperactivity disorder. Methods: The sleep problems of 43 children with developmental disorders were compared with those of 372 healthy children (control group). All children attended one public elementary school in Kurume, Japan; thus, the study avoided the potential bias associated with hospital-based surveys (i.e. a high prevalence of sleep disturbance) and provided a more complete picture of the children’s academic performance and family situation compared with a control group under identical conditions. Children’s sleep problems were measured with the Japanese version of the Children’s Sleep Habits Questionnaire (CSHQ). Results: Children with developmental disorders had significantly higher total CSHQ scores, as well as mean scores on the parasomnias and sleep breathing subscales, than children in the control group. The total CSHQ score, bedtime resistance, sleep onset delay, and daytime sleepiness worsened with increasing age in children with developmental disorders; in contrast, these parameters were unchanged or became better with age in the control group. In children with developmental disorders, there was a significant association between a higher total CSHQ score and lower academic performance, but no such association was found in the control group. For both groups, children’s sleep problems affected their parents’ quality of sleep. There were no significant differences in physical, lifestyle, and sleep environmental factors, or in sleep/wake patterns, between the two groups. Conclusions: Children with developmental disorders have poor sleep quality, which may affect academic performance. It is important for physicians to be aware of age-related differences in sleep problems in children with developmental disorders. Further studies are needed to identify the association between sleep quality and school behavioral performance.

Sleep patterns and sleep disturbances among Chinese school-aged children: Prevalence and associated factors

The study aimed to (1) characterize sleep patterns and sleep disturbances among Chinese school-aged children, (2) determine the prevalence of their short sleep duration and sleep disturbances based on clinical cutoffs, and (3) examine possible factors (socio-demographic factors and emotional/behavioral problems) that are associated with sleep disturbances. A large representative sample of 912 children aged 6-14years was recruited from Shenzhen, China. Their parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). The mean bedtime was 9:45pm (SD=1h 11min), mean wake-up time was 7:03am (SD=31min), mean sleep duration was 9h 14min (SD=46min), and 23.8% of the children had sleep duration <9h. Overall, 69.3% of the children suffered from global sleep disturbances (CSHQ total score >41). Bedtime resistance (22.9%), sleep anxiety (22.1%), sleep duration (21%) and daytime sleepiness (20%) were the most prevalent sleep disturbances; followed by sleep disordered breathing (12.1%), parasomnias (9.4%), sleep onset delay (6.9%), and night waking (5.2%). The prevalence of specific sleep disturbances ranged from 3.2% (falling asleep while watching television) to 81.9% (awakening by others in the morning). Correlations between most domains of sleep disturbances and emotional/behavioral problems were statistically significant (p<0.05 or p<0.01). Hierarchical multiple regression analysis revealed that gender (β=0.10, p<0.01), school grade (β=-0.09, p<0.05), co-sleeping (β=0.25, p<0.01), emotional symptoms (β=0.24, p<0.01), conduct problems (β=0.09, p<0.05), and hyperactivity (β=0.17, p<0.01) accounted for significant variance in CSHQ total score. Short sleep duration and sleep disturbances are prevalent among Chinese school-aged children. Sleep disturbances are associated with gender, school grade, co-sleeping, emotional symptoms, conduct problems, and hyperactivity.

Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD.

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems.MethodsAfter initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7–11 years (mean age 8.61 years, SD 1.27 years) participated in the present study.ResultsIn both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident.ConclusionsSleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ.

Detection of Sleep Disordered Breathing and Its Central/Obstructive Character Using Nasal Cannula and Finger Pulse Oximeter

To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied. Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHI(auto)) was calculated using both signals, and a respiratory disturbance index (RDI(auto)) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring. Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m(2)) were included in the analysis. AHI(manual) (19.4 ± 18.5 events/h) correlated highly significantly with AHI(auto) (19.9 ± 16.5 events/h) and RDI(auto) (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of -0.5 ± 6.6 and -1.0 ± 6.1 events/h. The automatic analysis of AHI(auto) and RDI(auto) detected sleep apnea (cutoff AHI(manual) ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of -4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively. Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep.

Children With Autism

Relationships between the specific sleep problems and specific behavioral problems of children with autism were evaluated. Mothers’ reports of sleep habits and autism symptoms were collected for 109 children with autism. Unlike previous research in this area, only children diagnosed with autism without any commonly comorbid diagnoses (e.g., intellectual disability, epilepsy) were included in the analysis. Consistent with prior work, a positive correlation between the severity of sleep problems and the severity of autism symptoms was obtained. Sleep onset delay and sleep duration were positively correlated with autism symptoms and autism severity. Sleep onset delay was the strongest predictor of communication deficit, stereotyped behavior, and autism severity. These results provide support for specific sleep problem and symptom relationships that are unique to autism and suggest the importance of including the treatment of sleep problems as part of a comprehensive behavioral intervention for children with autism.