Sleep assessment in aging adults with type 2 diabetes: agreement between actigraphy and sleep diaries

ObjectiveActigraphy and sleep diaries have been widely used to evaluate various sleep parameters. However, their agreement in diabetes patients remains unclear. The objective of this study was to examine the agreement between sleep outcomes measured by actigraphy and sleep diaries in aging adults with type 2 diabetes (T2D).MethodsA convenience sample of 53 T2D adults (aged 50–76 years) were enrolled. Participants wore a wrist ActiGraph and filled out a daily sleep diary for eight days. Total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) were obtained from the actigraphy and sleep diaries. Bland–Altman plots were conducted to examine the agreement between each sleep outcome.ResultsThe differences for TST and SE assessed by actigraphy and sleep diaries were 11.3 min (SD 65.3) and 0.2% (SD 10.5). Bland–Altman plots revealed wide limits of agreement between actigraphy- and diary-measured TST (95%CI: −139.3 min, 116.7 min) and SE (95%CI: −20.9%, 20.4%). Systematic biases were present for WASO and SOL: compared to actigraphy, sleep diaries underestimated WASO and overestimated SOL. As the SOL and WASO increased, the agreement became lower.ConclusionOverall, the agreement between actigraphy and sleep diaries is poor across all measures in aging adults with T2D patients. Findings from this study highlight the need for sleep researchers and clinicians to consider the method used for sleep assessment when developing interventions or interpreting study findings.     

Actigraphy data in pediatric research: the role of sleep diaries

BackgroundWhen assessing children's sleep using actigraphy, researchers usually rely on a sleep diary completed by a parent as an aid in scoring actigraphic data. However, parental nonadherence in completing the sleep diary may significantly reduce the amount of available data. The current study examined the agreement between actigraphic data scored with and without a sleep diary to evaluate the impact of not using a sleep diary when studying children's sleep with actigraphy.MethodsSixty children (aged 6–10 years; 36 girls) wore an actigraph for three to seven consecutive nights, and mothers were asked to complete a diary of their child's sleep during the same period. Actigraphy data were scored under two conditions (with and without diary) rated independently for each child by two different research assistants, who each scored 50% of the files in each condition.ResultsGroup-level analyses and intraclass correlations revealed very strong convergence between the two scoring conditions: on all sleep variables (sleep duration, wake duration, and sleep efficiency), average mean differences were very small and intraclass correlations very high. Bland and Altman’s (1999) approach allowed for a child-by-child examination of agreement between the two conditions and revealed that, although they cannot be considered interchangeable, the two conditions produce quite minimal differences in the estimation of sleep variables.ConclusionsThe findings suggest that it is possible to use some actigraphy data for which no corresponding diary data are available, although this approach should be used sparingly.     

What keeps low-SES children from sleeping well: the role of presleep worries and sleep environment

ObjectivesChildren in families of low socioeconomic status (SES) have been found to have poor sleep, yet the reasons for this finding are unclear. Two possible mediators, presleep worries and home environment conditions, were investigated as indirect pathways between SES and children's sleep.Participants/MethodsThe participants consisted of 271 children (M (age) = 11.33 years; standard deviation (SD) = 7.74 months) from families varying in SES as indexed by the income-to-needs ratio. Sleep was assessed with actigraphy (sleep minutes, night waking duration, and variability in sleep schedule) and child self-reported sleep/wake problems (eg, oversleeping and trouble falling asleep) and sleepiness (eg, sleeping in class and falling asleep while doing homework). Presleep worries and home environment conditions were assessed with questionnaires.ResultsLower SES was associated with more subjective sleep/wake problems and daytime sleepiness, and increased exposure to disruptive sleep conditions and greater presleep worries were mediators of these associations. In addition, environmental conditions served as an intervening variable linking SES to variability in an actigraphy-derived sleep schedule, and, similarly, presleep worry was an intervening variable linking SES to actigraphy-based night waking duration. Across sleep parameters, the model explained 5–29% of variance.ConclusionsSleep environment and psychological factors are associated with socioeconomic disparities, which affect children's sleep.     

The relationship between actigraphically defined sleep disturbance and REM sleep behaviour disorder in Parkinson's Disease

Aim

In this study, we sought to evaluate the utility of actigraphy for examining symptoms of rapid eye movement sleep behaviour disorder (RSBD).

Methods

Twenty-two patients with idiopathic Parkinson's Disease (mean age = 63.4 years, SD = 7.5) underwent neurological assessment and completed sleep diaries, self-report sleep questionnaires and 2-weeks of actigraphy. They also completed the rapid eye movement sleep behavior disorder questionnaire and were classified as screening negative (RSBD−, n = 9) or positive (RSBD+, n = 13) for RSBD according to published criteria. Key outcome data were the number of wake bouts and duration of arousals during the sleep interval as determined by actigraphy.

Results

Patients classified as RSBD+ demonstrated a higher number of wake bouts than those who were RSBD− (p = 0.011).

Conclusions

These results suggest that actigraphy may be a viable tool to assist in the early identification of RSBD. In turn, this could guide early intervention approaches.     

The association between sleep disturbances of children with anxiety disorders and those of their mothers

ObjectivePrevious research has demonstrated a link between childhood anxiety and sleep problems, but little is known about the link between these difficulties and parental sleep disturbances. The purpose of the current study was to explore the association between anxious children's sleep difficulties and those of their mothers.MethodA total of 101 children aged 8–18 years and their mothers participated in this study. The clinical group included 66 children (mean age = 11.45 years, standard deviation = 2.79 years) diagnosed with anxiety disorders, and the control group included 35 age- and sex-matched normal healthy controls. Mothers completed questionnaires assessing their child's anxiety and sleep, as well as their own sleep. Children completed questionnaires assessing anxiety, sleep, depression, and obsessive symptoms.ResultsBoth children and mothers in the clinical group exhibited more sleep difficulties compared to controls. A regression analysis revealed that pre-sleep arousal negatively predicted children's sleep. Furthermore, children's anxiety level was associated with parental levels of sleep disturbances. This link was fully mediated by the children's sleep disturbances score.ConclusionMothers of children with anxiety disorders exhibit higher levels of sleep disturbances than controls. These difficulties are linked to children's anxiety and sleep problems. When treating children with anxiety, it is therefore important to assess their overall sleep disturbances, as well as parental sleep difficulties, and when appropriate to add a specific sleep intervention component.     

Agreement between sleep diary and actigraphy in a highly educated Brazilian population

ObjectiveThis study evaluated the agreement between a sleep diary and actigraphy on the assessment of sleep parameters among school teachers from Brazil.MethodsA total of 163 teachers (66.3% women; aged 45 ± 9 years) filled out a sleep diary and wore a wrist actigraph device for seven consecutive days. Data were collected from August 2014 to March 2015 in Londrina, a large city in southern Brazil. Intraclass correlation coefficients (ICC) and Pearson correlation coefficients (r) were used to compare self-reported and actigraphic data.ResultsSelf-reported total sleep time (TST), sleep onset latency (SOL), and sleep efficiency were higher than measured by actigraphy (mean difference: 22.6 ± 46.9 min, 2.6 ± 13.3 min, and 7.3± 5.7%, respectively). Subjective total time in bed (TIB) and wake-up time were lower than measured by actigraphy (mean difference: −10.7 ± 37.6 and −19.7 ± 29.6, respectively). Moderate or good agreement and correlation were found between the sleep diary and the actigraphic data for TST (ICC = 0.70; r = 0.60), TIB (ICC = 0.83; r = 0.73), bedtime (ICC = 0.95; r = 0.91), sleep start time (ICC = 0.94; r = 0.88), and wake-up time (ICC = 0.87; r = 0.78). However, SOL (ICC = 0.49; r = 0.38) and sleep efficiency (ICC = 0.16; r = 0.22) showed only fair or poor agreement and correlation.ConclusionIn this highly educated population, the sleep diary and the actigraphy showed moderate or good agreement to assess several sleep parameters. However, these methods seemed to measure different dimensions of sleep regarding sleep onset latency and efficiency. These findings moderately varied according to the individual's subjective sleep quality.     

Sleep habits and weight status in Brazilian children aged 4–6 years of age: the PREDI study

ObjectivesTo evaluate the association of sleep habits with the weight status of children aged 4–6 years.MethodsData were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.ResultsOf the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4–6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4–5 years (OR = 1.42, 95% CI: 1.09–1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06–1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit “separation affect” was inversely associated with the child's BMI in boys (β = −0.005, 95% CI: −0.010–0.000, p = 0.037).ConclusionsIn the present study, rhythmicity problems were associated with increased odds of girls aged 4–6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.     

Sleep in adults with Autism Spectrum Disorder: a systematic review and meta-analysis of subjective and objective studies

Background/ObjectiveSleep problems are commonly reported by individuals with Autism Spectrum Disorder (ASD). However, to date, no quantitative evidence synthesis of available studies has been performed to quantify sleep alterations in adults with ASD. We performed a systematic review and meta-analysis of objective (ie, based on actigraphy or polysomnography [PSG]) and subjective (ie, based on sleep diaries/questionnaires) studies comparing sleep parameters in adults with ASD and in a typically developing (TD) control group.MethodsPubMed, OVID databases and Web of Knowledge were systematically searched up to February 2019 with no language restrictions. Original studies including adults with a diagnosis of ASD according to DSM, ICD, or based on standard diagnostic tools (eg, ADOS), and a TD control group were included. Random-effects models were used. Study quality was evaluated with the Newcastle Ottawa Scale (NOS). Analyses were conducted using Comprehensive Meta-Analysis.ResultsFrom initial pool of 1948 references, 14 publications including 8 datasets, (194 ASD and 277 controls) met the inclusion criteria. Compared to controls, individuals with ASD were significantly more impaired in six out of 11 subjective parameters, including lower sleep efficiency (SE, SMD = −0.87, CI = −1.14 – 0.60) and in 10 out of 17 objective outcomes, including longer sleep onset latency (PSG) (SMD = 0.86, CI = 0.29–1.07) and wake after sleep onset (WASO, actigraphy) (SMD = 0.57, CI = 0.28–0.87). The mean NOS score was 4.88/6.ConclusionsIndividuals with ASD demonstrated impaired sleep compared to controls in most subjective and objective measures.     

Sleep and development in adolescence in the context of socioeconomic disadvantage

IntroductionSleep problems are associated with negative developmental outcomes in youth, and identification of vulnerability and protective factors is needed to explicate for whom and under which conditions adolescents may be most at risk. Towards this end, we examined socio-economic status (SES) as a moderator of associations between multiple sleep parameters and adolescents’ socio-emotional adjustment and cognitive functioning.MethodsParticipants were 272 adolescents (M age = 17.3 years; 49% girls) and their parents, residing in the Southeastern U.S.A. The sample was socioeconomically diverse and included 41% Black/African American and 59% White/European American youth. Using a cross-sectional design, adolescents' sleep was assessed with actigraphy (total sleep minutes; efficiency indicated by % of time asleep from sleep onset to wake time) and self-reports of sleep quality (sleep-wake problems). Mothers reported on youths’ internalizing and externalizing symptoms, and cognitive functioning was assessed with a standardized test battery.ResultsModeration effects were found and illustrated that, for youth from families with lower SES, shorter and less efficient sleep and subjective sleep problems were associated with higher levels of internalizing and externalizing symptoms as well as lower cognitive performance. Conversely, longer and better-quality sleep protected against socio-emotional and cognitive difficulties otherwise observed for socioeconomically disadvantaged youth. Fewer relations between sleep and adjustment emerged for adolescents from families with higher SES.ConclusionsResults reinforce a growing literature indicating that the relation between sleep and adjustment is stronger for youth from families with lower SES, who may especially benefit from better sleep.     

Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study

BackgroundPrior studies report less favorable sleep characteristics among non-Whites as compared with non-Hispanic Whites. However, few population-based studies have used objective measures of sleep duration, especially in more than two racial/ethnic groups. We tested whether objectively estimated sleep duration and self-reported sleep quality varied by race and whether differences were at least partially explained by the variability in clinical, psychological, and behavioral covariates.MethodsAdults aged 35–64 years who self-identified as White, Black, Asian, or Hispanic were randomly sampled from Chicago, IL, and the surrounding suburbs. Our analytic sample included adults who had an apnea–hypopnea index <15 after one night of screening and who completed seven nights of wrist actigraphy for determination of sleep duration, sleep percentage, minutes of wake after sleep onset, and sleep fragmentation (n = 495). Daytime sleepiness was estimated using the Epworth Sleepiness Scale (ESS), and sleep quality was estimated from the Pittsburgh Sleep Quality Index (PSQI).ResultsFollowing statistical adjustment for age, gender, education, work schedule (ie, day vs. night shift), smoking status, depressive symptoms, body mass index (BMI), hypertension, and diabetes, sleep duration (minutes) was significantly (all p < 0.01) shorter in Black (mean = 399.5), Hispanic (mean = 411.7), and Asian (mean = 409.6) participants than in White participants (mean = 447.4). All remaining sleep characteristics were significantly less favorable among Black participants as compared with White participants. Asian participants also reported significantly more daytime sleepiness than did White participants.ConclusionsDifferences in sleep characteristics by race/ethnicity are apparent in a sample of adults with a low probability of sleep apnea and following adjustment for known confounders.     

Comparison of longitudinal diary and actigraphy-assessed sleep in pregnant women

Study objectivesVarious methods are employed to assess sleep in pregnant women, including self-report, sleep diary, and actigraphy. Unfortunately, the data are often contradictory, and interpretations are often inconsistent. The current aims are to compare subjective and objective sleep data in pregnant women collected longitudinally in early pregnancy.MethodsIn this secondary analysis of 104 pregnant women, sleep was collected via diary and actigraphy for 14 days during three separate occasions (10–12 weeks; 14–16 weeks; and 18–20 weeks). Sleep variables included wake after sleep onset (WASO), sleep efficiency (SE), bedtime/lights out, sleep onset latency (SL), and total sleep duration (TST). Repeated measures ANOVAs compared each sleep variable across Time and by Method of data collection, while controlling for parity and daytime naps.ResultsSignificant differences were noted for only the method of data collection for sleep component studied for WASO, F (1, 98) = 147.20, p < 0.001; SE, F (1, 98) = 129.41, p < 0.001); bedtime/lights out, F (1, 103) = 5.33, p < 0.05); and sleep duration, F (1, 104) = 182.75, p < 0.001). Significant variation was not seen in any variable across time-period. Conclusions: There are substantial discrepancies between diary- and actigraphy-assessed sleep measures in pregnant women which is in alignment with previous literature. These data highlight that these methodologies assess different constructs. We contend that these data may be useful as a reference to compare high-risk women or those with sleep disorders. Using a multi-modal approach to identify sleep disturbance in pregnancy is likely a more clinically useful option.     

Racial disparities in sleep health between Black and White young adults: The role of neighborhood safety in childhood

ObjectivesBlack adults in the United States have shorter sleep durations and poorer sleep efficiency relative to White adults, yet reasons for these disparities are not well explicated. The objective of this study was to examine neighborhood safety in childhood as a mediator of subsequent racial disparities in sleep.MethodsData were from Black and White young adults attending a large, predominantly White university in the Southeastern United States (N = 263; 52% Black, 53% female; Mean age = 19.21 years, SD = 1.01). Sleep parameters were assessed from eight nights of wrist actigraphy (time in bed, sleep duration, and efficiency) and an established self-report measure of daytime sleepiness. Residential histories from birth through age 18 were documented, and retrospective self-reports of neighborhood safety in childhood were assessed.ResultsBlack participants had less time in bed (p < 0.001), shorter sleep duration (p < 0.001), poorer sleep efficiency (p < 0.001), and more daytime sleepiness (p = 0.009) than White participants. Neighborhood safety mediated race differences in time in bed (p = 0.028), sleep duration (p = 0.033), and daytime sleepiness (p = 0.048), but not sleep efficiency. Findings were substantively unchanged after adjustment for family socioeconomic status, BMI, and substance use.ConclusionsFindings support the hypothesis that neighborhood safety in childhood may partially account for race differences in subsequent sleep duration and daytime sleepiness. Addressing racial inequities in childhood neighborhood safety may be an important step toward reducing racial disparities in sleep health.     

Subjective sleep disturbances in children with partial epilepsy and their effects on quality of life

PurposeThe purposes of this study were to explore the prevalence of sleep disturbances in a large cohort of school-aged children with partial epilepsy, to compare the findings with those in children without epilepsy of the same age and gender, and to evaluate the relationship between sleep disturbances and health-related quality of life (HRQoL).MethodsOne hundred thirty children with partial epilepsy aged 4 to 10 years, who were treated in the outpatient setting of a Dutch epilepsy clinic, and 161 age- and sex-matched controls participated in this study. In addition to providing information about their child's demography and health, parents of both groups of children completed three questionnaires to measure their child's sleep [Sleep Disturbance Scale for Children (SDSC), Medical Outcomes Study-Sleep Scale (MOSS-S), and Groningen Sleep Quality Scale (GSQS)] and one questionnaire to measure quality of life (Kidscreen-27). Parents of children with epilepsy also completed the Hague Scales to measure the severity of epilepsy. The prevalence of sleep disturbances and scores on HRQoL in children with and without epilepsy were compared. Additionally, the HRQoL scores were compared between children with and without sleep disturbances in children both with and without epilepsy.ResultsThe answers for all three questionnaires suggested worse sleep in children with epilepsy than in children of the same age and gender without epilepsy. Pathological scores (T-value > 70) for total SDSC were seen twelve times more frequently in children with epilepsy (36.92% vs. 3.01%, p < 0.001). Children with epilepsy also scored significantly lower for all dimensions of HRQoL. Between subgroups of children with and without disturbed sleep, insignificant differences in quality of life were found, with the lowest scores in children with sleep disturbances in both groups.ConclusionThis study confirms the high prevalence of disturbed sleep, as well as its effect on quality of life, in a large group of children with partial epilepsy. The abnormalities are both more prevalent and more severe than in children without epilepsy.     

Sleep/wake behaviour of competitive adolescent athletes in New Zealand: insight into the impact of early morning training

ObjectiveSleep plays a crucial role in the health, wellbeing, and development of adolescent athletes' sporting and academic lives. This study aimed to monitor the sleep/wake behaviour of adolescent athletes who have frequent early morning training sessions.Methods13 swimmers (mean age 14.8 ± 1.4; 46% male) and 19 rowers (mean age 16.5 ± 1.1; all male) wore actigraphs and completed sleep diaries over a 2-week training period. Diaries included the Hooper Index and a question regarding device use before bed. Participants also completed chronotype questionnaires. Nights of the week were categorised as taking place before “morning training”, “mornings off”, “weekend mornings off”, and “weekend morning training”. Actigraphy and sleep diary variables were compared for different nights of the week.ResultsAll athletes were classified as “morning type”. Average sleep duration across the study was 7h55 (±1h33). Median sleep duration was significantly shorter on nights before weekday morning training (6h44) compared to weekday mornings off (8h45). This was due to an earlier wake time (04:51) while bedtime remained constant (∼22:15). Athletes went to bed later, woke later and slept for longer on nights before weekend mornings off compared to weekday nights.ConclusionsEarly morning training advanced the wake times of the athletes while bedtime remained constant. This shortened sleep below age recommended durations on the nights before early morning training during the week. These findings suggest that weekly average sleep duration does not accurately reflect athletes' nightly sleep given the large variability across a training week.     

Sleep parameters assessed by actigraphy in Fabry's disease patients: a proof-of-concept

BackgroundIn a previous study developed by our group, we identified a phase inversion in 6-sulfatoxymelatonin – melatonin metabolite in urine – daily profile in Fabry's disease patients. Since melatonin is an endogenous marker, it could also be accompanied by behavioral changes in sleep-wake cycle, which impairs the overall patient's life quality.ObjectiveIn this study, we evaluated sleep-wake cycle in Fabry disease patients. We hypothesized that patients would have increased daytime naps, given our previous results for urinary 6-sulfatoxymelatonin.Patients/methodsThis was a cross-sectional and case–control study, performed between October 2016 and May 2017. Volunteers recorded activity and rest rhythm by actigraphy and answered Pittsburgh Sleep Quality Index (PSQI). From actigraphy data, we calculated sleep parameters: sleep latency, wake after sleep onset, sleep (WASO) efficiency, awakenings index (PSQI), and the amount and duration of daytime naps. We included 16 Fabry disease patients with biochemical and molecular diagnosis and 10 control individuals matched by age and gender.ResultsWe did not observe significant differences for any of the parameters analyzed (p > 0.05). However, evaluating the magnitude of the effect, we found that patients dozed, on average, about 42 min longer (d = 0.9 - large effect size) than control group.ConclusionsThis is a preliminary study, a proof-of-concept, and our results indicate that changes in melatonin secretion phase may have behavioral consequences in sleep-wake cycle, with longer duration of daytime naps.     

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

Study objectivesTo examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.MethodsThe current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015–2016 on 736 children aged 3–6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.ResultsAn hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.ConclusionsIncreased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.     

Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder

ObjectiveTo compare objective and subjective measures of sleep in children with attention-deficit/hyperactivity disorder (ADHD) and healthy control subjects.MethodsIncluded were 107 unmedicated children with ADHD and 46 healthy control subjects, all aged 6–14. Sleep–wake patterns were monitored with actigraphy for at least five consecutive days. Subjects and parents completed daily electronic diaries assessing sleep and daytime behavior.ResultsActigraphy data from 80 ADHD patients and 45 control subjects showed that, compared to the healthy control group, the ADHD group experienced shorter actual sleep time (defined as time in minutes [from sleep onset to final morning awakening] of all epochs scored as sleep [i.e., excluding total duration of all epochs scored as “wake”]) (489.39 vs. 460.30 min, p = .001), significantly fewer sleep interruptions (44.45 vs. 35.33, p < .001), but more total interrupted sleep time (44.49 vs. 56.70 min, p = .002). Child diaries indicated children with ADHD had significantly more daytime sleepiness and difficulty getting up and less refreshing sleep. Parent diaries indicated children with ADHD had significantly more behavioral difficulties than the control group.ConclusionsResults suggest children with ADHD have reduced sleep quantity and more disturbed sleep on actigraphic measures, reduced sleep quality on the self report, and more problematic behaviors on the parent report. Clinical interventions for children with ADHD who present with sleep problems should include screening for etiologic and exacerbating factors, institution of behavioral-management strategies, and consideration of pharmacologic treatment targeted toward evening ADHD symptoms.     

Sensory profile in infants and toddlers with behavioral insomnia and/or feeding disorders

BackgroundSleep and feeding difficulties are two common disorders in early childhood. It has been shown that feeding difficulties are more common among children with sleep disorders and vice versa. Since a child's characteristics play a substantial role in these two conditions, we aimed to investigate the sensory profile of infants and toddlers with behavioral insomnia (BI) or feeding disorders (FDs) in comparison with healthy age-matched controls.MethodsChildren aged 7–36 months with BI or FD were recruited from the sleep and feeding disorders clinics. Healthy controls were recruited from well-baby clinics. Parents completed a questionnaire which included demographics and socioeconomic status, as well as a sensory profile evaluation using the Infant/Toddler Sensory Profile (ITSP).ResultsTwenty-five children with BI, 28 with FDs and 32 controls were recruited. Oral processing scores were significantly lower in both BI and FD groups vs the controls (p = 0.015 and 0.001, respectively). Auditory processing scores were lower in the FD group vs the controls (p = 0.028). The scores of three out of the four ITSP sensory quadrants (Low Registration, Sensory Sensitivity, and Sensation Avoiding) were significantly lower in the FD group vs the controls (p = 0.027, 0.025, and 0.001, respectively), and in one quadrant (Sensation Avoiding) in the BI group vs the controls (p = 0.037).ConclusionsThere were considerable differences in sensory processing, as reported by parents between children with BI and those with FDs compared to healthy controls, most often in the direction of the ‘hypersensitive’ profile. These differences may underlie the development and partially explain the coexistence of the two disorders. Sensory profile may be a target of intervention as part of the management of sleep and feeding disorders in early childhood.