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PubMed2003

Medication for sleep-wake disorders.

Medication is indicated for only a limited number of children's sleep disorders. However, correctly chosen and supervised, pharmacological treatment may be justified and helpful. For a given sleep problem it is important to identify the underlying cause (or sleep disorder) which often calls for treatment of a non-medication type. Where medication is appropriate, cautious use and careful review of the child's physical and psychological state is essential in view of the limited information available on effectiveness and possible short and long term effects. It follows that much further research is required to establish the part medication can play in the care of children with sleep disorders, and also to define the possible effects on sleep and wakefulness of other drugs used in clinical practice.

Child↗

PubMed2002

Caregivers' descriptions of sleep changes and depressive symptoms.

PURPOSE/OBJECTIVES: To describe caregiver sleep and depression using caregiver narratives. To compare qualitative descriptions with quantitative scores. DESIGN: Descriptive, one-time, open-ended interview followed by structured sleep and depression questions. SETTING: Interview conducted in person or via telephone at caregiver's preference. SAMPLE: 47 caregivers of patients with advanced stage cancer. Caregivers had a mean age of 54 years, and most were female (81%), Caucasian (82%), and spouses (61%). They provided care for a mean of 24 months. Patients' diagnoses were lung cancer (36%), colorectal cancer (13%), or recurrences (51%). METHODS: Two cancer care sites in southern California provided participants. After consent, the researcher conducted interviews. The Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiological Studies-Depression (CES-D) instruments were administered following interviews. MAIN RESEARCH VARIABLES: Sleep pattern changes and depression levels over time as defined by caregivers. FINDINGS: Caregivers described severe fluctuations in sleep patterns over time and how these changes affected caregiver depressive symptoms. PSQI and CES-D scores matched narrative comments. CONCLUSIONS: Caregivers' narratives suggest they suffer progressive sleep deprivation that affects their emotions and ability to continue as caregivers. IMPLICATIONS FOR NURSING: Nurses must recognize the severe sleep problems experienced by caregivers and respond with interventions to increase sleep quality and decrease depression.

Anecdotes as Topic↗

PubMed2000

Problem behaviors associated with 15q- Angelman syndrome.

Caregivers of persons with Angelman syndrome completed the Aberrant Behavior Checklist and Reiss Screen for Maladaptive Behavior. Seventy-three replies were received, and comparisons were made with other published data. Responses indicated that 15q- Angelman syndrome is associated with such problems as lack of speech, overactivity, restlessness, and eating and sleep problems. Episodes of inappropriate laughter were only reported for 57%, despite being considered a cardinal feature of the syndrome; eating problems (64%) and a fascination with water (68%) were reported more frequently. Overactivity was more of a problem for children; Aberrant Behavior Checklist Factor IV (Hyperactivity) was negatively correlated with age. Scores were mostly lower than for previously studied etiological groups. Therapeutic effort should be put into programs to address these problems.

Adolescent↗

PubMed2000

Factors affecting sleep disturbances in children and adolescents.

Objective: To determine factors affecting sleep disturbances in children.Background: Factors affecting sleep disturbances have been studied extensively in adults, but relatively few studies have been done in children.Methods: As part of the twelfth survey of the Tucson Epidemiologic Study of Obstructive Airways Disease (TESOAD, 1991-1992), children, ages 3-14, of adult cohort members were administered a health questionnaire which contained items related to sleep problems as well as items related to respiratory diseases and symptoms. Participants were classified as having sleep disturbances if they reported disorders of initiating and maintaining sleep (DIMS), excessive daytime sleepiness (EDS) or snoring. Potential factors affecting sleep included age, gender, obesity, asthma, other bronchial problems, cough and sputum production, wheezing and rhinitis.Results: The overall prevalence rates were 16.8, 4 and 22.9% for DIMS, EDS, and snoring, respectively. We found a significantly higher prevalence of DIMS in 11-14-year-old girls (30.4%) and snoring (32.3%) in 3-6-year-old boys. Certain respiratory factors were more prevalent in children with sleep disturbances. Multivariate analysis revealed that risk factors for DIMS included female gender, age 11-14 and wheezing. The risk for EDS was increased in those children with cough and sputum production. Cough and sputum production also were risk factors for snoring as was rhinitis and age 3-6.Conclusions: We conclude that in children as in adults, respiratory symptoms are associated with sleep disturbances. Further, the increased insomnia seen in adult women may begin in early adolescence.

Journal Article↗

PubMed2000

Cluster randomised trials in maternal and child health: implications for power and sample size.

BACKGROUND: Interventions based in the community can be evaluated by randomising clusters, such as general practices, rather than individuals, as in conventional randomised trials. This increases the sample size needed because of intracluster correlation. AIMS: To estimate sample size requirements for cluster randomised trials of interventions based in general practice directed at common health problems affecting mothers and infants. METHODS: Data were collected from a pilot trial of the effect of Citizen's Advice Bureau services involving six general practices. Outcome measures included the Edinburgh postnatal depression score, the Warwick child health and morbidity profile, number of visits to the general practitioner, and two questionnaires delivered at the beginning and end of the study. Intracluster correlation coefficients and inflation factors (the ratio of the sample size required for a cluster randomised trial to that required for an individually randomised trial) were calculated. RESULTS: Intracluster correlation coefficients ranged from 0 (sleeping problems, accidental injury, hospitalisation) to 0.09 (maternal smoking), with most being < 0.04 (for example, maternal depression, breast feeding, general health, minor illness, behavioural problems, and visits to the general practitioner). Assuming 50 cases/practice, cluster randomised trials require sample sizes up to 3 times greater than individually randomised trials for most health outcomes measured. CONCLUSIONS: These data enable sample sizes to be estimated for cluster randomised trials into a range of maternal and child health outcomes. Using such a design, approximately 40 practices would be sufficient to evaluate the effect of an intervention on maternal depression, sleeping, and behavioural problems, and non-routine visits to the general practitioner.

Analysis of Variance↗

PubMed1995

Family practice residents' maternity leave experiences and benefits.

BACKGROUND: A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. METHODS: Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. RESULTS: Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. CONCLUSIONS: Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

Adult↗

PubMed2002

Circadian preference, sleep and daytime behaviour in adolescence.

The aim of this study was to determine the relationship between circadian preferences, regularity of sleep patterns, sleep problems, daytime sleepiness and daytime behaviour. As a part of an epidemiological survey on sleep in a representative sample of Italian high-school students, a total of 6631 adolescents, aged 14.1-18.6 years, completed the School Sleep Habits Survey, a comprehensive questionnaire including items regarding sleep, sleepiness, substance use, anxiety and depressed mood, use of sleeping pills, school attendance and a morningness/eveningness scale. The sample consisted of 742 evening-types (315 males and 427 females; mean age 17.1 years) and 1005 morning-types (451 males and 554 females; mean age 16.8 years). No significant sex differences were found for morningness/eveningness score. Eveningness was associated with later bedtime and wake-up time, especially on weekends, shorter time in bed during the week, longer weekend time in bed, irregular sleep-wake schedule, subjective poor sleep. Moreover, evening types used to nap more frequently during school days, complained of daytime sleepiness, referred more attention problems, poor school achievement, more injuries and were more emotionally upset than the other chronotype. They referred also greater caffeine-containing beverages and substances to promote sleep consumption. Our results suggest that circadian preference might be related not only to sleep pattern, but also to other adolescent behaviours.

Adolescent↗

PubMed2001

Sleepiness in a population of Italian shiftwork policemen.

The aim of this study was to evaluate the effects of shiftwork on sleepiness, sleep disorders and sleep related accidents in a population of policemen. Data concerning age and physical characteristics, working conditions, sleep problems and accidents were collected by a questionnaire. Sleepiness was evaluated by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SD-score) drawn from indicators of insomnia, breathing disorders, periodic limb movements-restless leg syndrome and hypersomnia. The effects of age, gender, body mass index, working condition and seniority on ESS, SD-score and accidents were analysed by linear and logistic regression. Participants were 1280 policemen: 611 shiftworkers and 669 non-shiftworkers. The ESS scores were not higher in shiftworkers than in non-shiftworkers, but the SD-score was found to be significantly influenced by shiftwork condition and seniority. The occurrence of sleep-related accidents was found to have been significantly increased for shiftworkers and related to the presence of indicators of sleep disorders. The sleepiness could be underestimated or even overcome by the influence of stressing conditions. However our data should alert occupational health physicians for the diagnosis and prevention of possible lurking intrinsic sleep disorders likely to influence health problems and risk of accidents in shiftworkers.

Accidents, Occupational↗

PubMed1997

Sleep benefit in Parkinson's disease.

Sleep benefit (SB) In Parkinson's disease (PD) is not well characterized. To determine SB frequency, as well as to characterize and correlate it with other disease variables, we evaluated prospectively a consecutive series of 312 PD patients by means of a structured questionnaire: 55% reported having SB and 35% reported that awakening was their best time of the day. Because of SB, 21% of the entire population were able to skip or delay medication. The mean duration of the phenomenon was 85.4 +/- 67 min. Patients with SB were significantly older (p < 0.0002), had disease longer (p < 0.05), and were often men (chi 2 = 3.5, df 1, p = 0.05). Patients with SB took sleep medication with similar frequency as those without SB. There were no differences in hours of sleep or sleep latency. Sleep problems such as nightmares or somnambulism, but not the number of sleep awakenings, were similar in both groups. In conclusion, SB is a frequent phenomenon, especially in men, elderly patients, and patients with longer disease duration. SB enables the morning L-dopa dose to be postponed in approximately 50% of patients.

Aged↗

PubMedDate not supplied

Current treatment practices in obstructive sleep apnea and snoring.

PURPOSE: To determine current management strategies of otolaryngologists involved in the treatment of sleep-disordered breathing. MATERIALS AND METHODS: Survey of practitioners regarding their workup and treatment of patients suspected of obstructive sleep apnea. RESULTS: Of 305 respondents, 280 actively treated patients with obstructive sleep apnea or snoring, form the basis for this study. Respondents were from assorted practice settings, from a diverse geographic background, and varied length of time in practice. Although 48% see more than 3 new outpatients a week for snoring or obstructive sleep apnea, only 46% routinely ask their patients about sleep problems, and 49 % fail to ask all of their patients with sleep apnea about sleep-related automobile accidents. Although most regularly use nasopharyngoscopy, a significant proportion seldom uses the Müller maneuver. Most tend to rely predominantly on whole-night polysomnography, rather than split night or home testing. Half of respondents offer their patients with simple snoring more than 1 method of treatment. Although many different surgical procedures are offered by most, only 28% of respondents offer patients any procedure aimed at airway obstruction at the base of tongue level. CONCLUSIONS: Otolaryngologists, with their unique expertise in airway management, need to be more vigilant for patients with sleep-disordered breathing. The hypopharynx fails to be frequently addressed by the respondents and could lead to inadequate treatment of obstructive sleep apnea. Further research should seek to develop an evidence-based standard of care such that this disorder might be most effectively managed in the future.

Adult↗

PubMed2001

Melatonin rhythm abnormalities and sleep disorders in the elderly.

Biological aging is often associated with sleep problems and daytime napping. Complaints of difficulty in initiating and maintaining sleep, as well as daytime drowsiness, are more common in the elderly than in any other age group. This report reviews evidence that impaired melatonin secretion is associated with sleep disorders in old age. Circulating melatonin levels have been found to be significantly lower and onset and peak times have been delayed in elderly insomniacs as compared to age-matched control subjects. In view of these findings, we investigated the effects of melatonin treatment on melatonin-deficient insomnia in the elderly. From the results of our study, it seems likely that melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep in this population.

Journal Article↗

PubMed2000

Sleep and circadian phase characteristics of adolescent and young adult males in a naturalistic summertime condition.

Our aim was to compare the circadian phase characteristics of healthy adolescent and young adult males in a naturalistic summertime condition. A total of 19 adolescents (mean age 15.7 years) and 18 young adults (mean age 24.5 years) with no sleep problems took part in this study. Two-night polysomnographic (PSG) sleep recordings and 24h secretion patterns of urinary 6-sulfatoxymelatonin were monitored in all 37 subjects. Sleep-wake patterns were initially assessed at home using a standard sleep diary. Circadian assessment included the measure of dim light melatonin offset (DLMOff) and the morningness-eveningness (M/E) questionnaire. As expected, compared to young adults, adolescents habitually spent more nocturnal time in bed and spent more time (and percentage) in delta sleep. No difference was found between adolescents and young adults on multiple sleep latency test (MSLT) sleep onset latencies, M/E, melatonin secretion measures (24h total, nighttime, daytime, and night ratio), and DLMOff. For the subjects as a whole, correlational analyses revealed a significant association between the DLMOff and M/E and between both these phase markers and habitual bedtimes, habitual rising times, and melatonin secretion measures (daytime levels and the night ratio). No association was found between phase markers and daytime sleepiness or sleep consolidation parameters such as sleep efficiency or number of microarousals. These results together indicate that adolescents and young adults investigated during summertime showed similar circadian phase characteristics, and that, in these age groups, an evening phase preference is associated with a delayed melatonin secretion pattern and delayed habitual sleep patterns without a decrease in sleep consolidation or vigilance.

Adolescent↗

PubMed2006

A survey of the health, sleep, and development of children adopted from China.

The health, development, and sleeping patterns of 240 children adopted from China were examined using a survey research approach. Eighty percent of the children were 18 months of age or younger when adopted, and 98 percent of the children were girls. Sixty-two percent of the children were reported to have been developmentally delayed at the time of adoption; of this number, 91 percent were reported to have had delays in motor development. Of the families, 52 percent reported that children experienced sleep problems, but only 9 percent of the total sample experienced significant sleep difficulties. Implications for social workers are also discussed.

Adoption↗

PubMed1998

Attention deficit disorder with developmental coordination disorders.

AIMS: To analyse the contribution of certain social, familial, prenatal, perinatal, and developmental background factors in the pathogenesis of deficits in attention, motor control, and perception (DAMP). METHODS: A population based case-control study was carried out with 113 children aged 6 years, 62 diagnosed with DAMP and 51 controls without DAMP. The children's health and medical records were studied and their history with regard to background factors was taken at an interview with the mother using a standardised schedule. Familial factors, possible non-optimal factors during pregnancy (including smoking), developmental factors (including early language development), and medical and psychosocial data were scored in accordance with the reduced optimality method. RESULTS: Low socioeconomic class was common in the group with DAMP. Familial language disorder and familial motor clumsiness were found at higher rates in the DAMP group. Neuropathogenic risk factors in utero were also more common in the children with DAMP. Maternal smoking during pregnancy appeared to be an important risk factor. Language problems were present in two thirds of the children with DAMP. Sleep problems and gastrointestinal disorders, but not atopy or otitis media, were significantly more common in the DAMP group. CONCLUSIONS: Prenatal familial and neuropathogenic risk factors contribute to the development of DAMP. Primary prevention, such as improved maternal health care and early detection or treatment, or both, of associated language problems appear to be essential.

Attention Deficit Disorder with Hyperactivity↗

PubMed1999

Sleep hygiene and migraine in children and adolescents.

Although sleep problems are a common complaint in migraine patients, the role of sleep habits and hygiene as triggering factors of head pain attacks has been poorly analyzed. The aim of this study was to evaluate the effect of modifying bad sleep habits across several headache parameters. Based on our previous study, we selected 70/164 migraineurs (42.7%) with poor sleep hygiene and randomly assigned them to two groups: group A migraineurs, who were instructed to follow directions to improve sleep hygiene; and group B migraineurs who were not given instructions on improving sleep hygiene. Mean duration and frequency of migraine attacks were significantly reduced at follow-up in group A, while group B showed only an insignificant initial reduction. No differences were found in the severity of migraine attacks that seemed related to a higher prevalence of nocturnal symptoms such as bedtime struggles, hypnic jerks, nightmares, and restless sleep. Our study is an alternative approach to the treatment of migraine, i.e. treatment through a simple modification of sleep behavior without recurring to pharmacological treatment.

Adolescent↗

PubMed1982

Maternal health and health care in 150 Auckland mothers.

One hundred and fifty Auckland mothers of preschoolers were interviewed about their mental health, child rearing problems and the medical care sought for these. There was a high level of satisfaction with motherhood, and with the quantity and quality of family medical care. However, stress and psychosomatic symptoms were common, though frank depression unusual. Only occasionally was medical care sought and psychotropic drugs prescribed for these problems which were handled by stoicism, extended family and community support. Sleep problems in children were common and often resulted in medical consultation and prescription of antihistamines. Except in this respect there was no evidence of medical overtones.

Child, Preschool↗

PubMed1993

Sleep in the elderly patient.

Sleep problems in the elderly are extraordinarily common. The authors discuss normal sleep, changes in sleep with normal aging, and sleep disorders in the elderly, focusing on sleep-disordered breathing. In addition, nocturnal myoclonus and rapid-eye movement behavior disorder are reviewed.

Aged↗

PubMed2004

Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul.

STUDY OBJECTIVES: Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems. DESIGN, SETTING, AND SUBJECTS: A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited. RESULTS: The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well. CONCLUSIONS: Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.

Adolescent↗