Sleep characteristics of youth with functional abdominal pain and a healthy comparison group

OBJECTIVE: To describe sleep problems among youth with and without functional abdominal pain (FAP). METHODS: Participants were 8-15 years of age diagnosed with FAP (n = 67) or healthy pain-free comparisons (n = 80). Parents and participants completed instruments assessing sleep, psychiatric status, and FAP symptoms. Parent and child reports of sleep problems were compared across groups and the association of FAP to behavioral sleep problems was assessed controlling for psychopathology. RESULTS: Children with FAP were reported to have more symptoms of behavioral sleep disorders (BSD), as well as increased nightmares and daytime tiredness than the comparison group. There were no group differences in total sleep time. Logistic regression analysis indicated that FAP was associated with a significantly increased risk of BSD symptoms [Odds ratio (OR): 4.17] after controlling for psychopathology. CONCLUSION: Sleep problems in youth with FAP warrant clinical attention and future research should continue to explore sleep problems that co-occur with and independent of psychopathology.     

Sleep disturbances in allergic diseases

Sleep is fundamental for physical and mental health as well as daytime performance and represents a crucial aspect in the personal representations of well-being. Sleep disturbances in patients with chronic disorders constitute a factor that contributes to exacerbate symptoms, complicate management, and affect mood and quality of life (QoL). Allergic diseases are a global health problem of increasing prevalence that affects up to 15% of the population in Western countries. Sleep problems associated with allergic diseases may play a role in worsening the burden of illness, contributing to impairment of the QoL. The aim of this review was to describe the most common causes leading to sleep disturbance in allergic patients and their consequences on the QoL. The possible negative effects of treatment on sleep parameters has been also considered.     

Sleep disruptions in parents of children and adolescents with chronic illnesses: prevalence, causes, and consequences

OBJECTIVE: Provide a comprehensive review of the existing literature on the prevalence, causes, and consequences of sleep disruptions in parents of youth with chronic illnesses. METHODS: A comprehensive literature search of PsychInfo, MEDLINE, and CINAHL for articles related to sleep in parents of youth with chronic illnesses yielded 59 potential articles, with 19 meeting inclusion criteria. RESULTS: Parents of children with eczema were the most commonly studied group. The prevalence of sleep disruptions was 15-86%. Potential causes of parent sleep disruptions included nighttime caregiving, monitoring of the child's illness, and stress related to the child's illness. Consequences included poor sleep quality, depression, and anxiety. CONCLUSIONS: Parents of youth with chronic illnesses experience sleep disruptions, providing a potential mechanism to explain elevated rates of negative daytime functioning found in previous studies. To provide interventions and support for these parents, additional research is needed to address the limitations of the existing literature.     

Sleep problems in children with autism

Autism is a developmental disability characterized by severe deficits in social interaction and communication, and the presence of repetitive-ritualistic behaviors. Sleep problems are frequently reported by parents of children with autism with prevalence estimates of 44-83% for sleep disorders in this population. To better understand sleep in autism, we surveyed sleep problems in 210 children with autism using a Likert-based questionnaire for parent report. The most frequently reported sleep problems included difficulty in falling asleep, restless sleep, not falling asleep in own bed, and frequent wakenings. Least frequently reported sleep problems were sleep walking, morning headaches, crying during sleep, apnea, and nightmares. When surveys were divided into mental retardation (MR)/not MR categories, no significant differences were identified in frequencies of reported sleep problems except for waking at night which occurred much more frequently in the MR group. There was also no difference in sleep problems related to age of the child other than nocturnal enuresis. An association was noted between certain medical problems and sleep problems. Vision problems, upper respiratory problems, and runny nose were associated with decreased nighttime sleep. Vision problems, poor appetite, and poor growth were associated with increased nighttime waking. Poor appetite and poor growth were associated with decreased willingness to fall asleep. This study confirms a high prevalence of sleep problems reported by parents of children with autism and points to the need for more systematic research as an initial step in developing treatment strategies.     

Sleep disturbances in Rett syndrome: Impact and management including use of sleep hygiene practices

Sleep disturbances are debilitating for individuals with Rett syndrome (RTT) and their families yet the evidence base for management is poor. We investigated management strategies and their relationships with sleep problems. Data were provided by 364/461 (79%) families with a child with RTT and registered with the International RTT Phenotype Database. Logistic regression models were used to investigate relationships between impacts of sleep problems on the child and family with age group, mutation type, medication type, and sleep hygiene score. Linear regression models were used to estimate the association of disorders of initiating and maintaining sleep (DIMS) with age group, mutation type, medication type, and sleep hygiene. Among those who ever had difficulty falling asleep or night waking, use of any medication was associated with higher odds of moderate/major impact sleep problems (relative to minor/no impact) for the affected child and the family, as well as higher DIMS scores, when compared with the no treatment/nonmedication group accounting for the effects of age, mutation type, and sleep hygiene score. Better use of sleep hygiene practices was associated with lower odds of moderate/major impact on the family (odds ratio 0.60, 95% confidence intervals [CIs] 0.37, 0.98) and lower DIMS scores (geometric mean ratio 0.86, 95%CI 0.80, 0.92) compared with poorer use after adjusting for covariates. Attention to sleep hygiene remains an important management strategy for sleep problems in RTT. Further prospective research is required to investigate efficacy of pharmaceutical treatments.     

Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain

OBJECTIVE: To investigate the value of pain catastrophizing in explaining pain, disability, and somatic complaints, beyond negative affectivity (NA). METHOD: Two cross-sectional studies, one in a sample of school children (n = 193) and a second in a clinical sample of children with recurrent or chronic pain (n = 43), were conducted. In both studies, measures of pain catastrophizing and NA were examined for their ability to explain pain, disability, and somatic complaints. RESULTS: In both studies, pain catastrophizing significantly accounted for the variance of pain, disability, and somatic complaints, beyond the effects of age, sex, and NA. Furthermore, pain catastrophizing significantly mediated the relationship between NA and somatic complaints in both studies and between NA and functional disability in study 1. CONCLUSIONS: Results suggest the importance of assessing for pain catastrophizing in children. Pain catastrophizing is further discussed in terms of communicating distress to significant others.     

Chronic pain and its impact on quality of life in adolescents and their families

OBJECTIVE: To study chronic pain not caused by somatic disease in adolescents and the effect of pain on the quality of life of the adolescents and their families. METHODS: One hundred twenty-eight youngsters (12-18 years) who had reported chronic pain kept a 3-week diary of their pain and completed a questionnaire on quality of life. Their mothers completed a questionnaire on the impact of their youngster's pain on the family. RESULTS: The most prevalent pains were limb pain, headache, abdominal, and back pain. The pain increased during the day, with the highest frequency around dinner time and the highest intensity around bedtime. Girls reported more intense and more frequent pain than boys. The higher the intensity and frequency of the pain, the lower the self-reported quality of life of the female or male adolescent, especially regarding psychological functioning (e.g. feeling less at ease), physical status (a greater incidence of other somatic complaints), and functional status (more impediments to leisure and daily activities). Chronic pain also had a negative impact on family life. The mothers reported restrictions, particularly in social life, and problems dealing with the stress of the adolescent's pain. CONCLUSIONS: Chronic pain, not caused by somatic disease, was present to a higher degree in girls; the pain increased during the day and had a negative impact on quality of life of the adolescents and the family. There is a need for future research aimed at identifying risk factors for chronic pain and pain-associated quality of life in children and adolescents.     

Sleep Quality and Presleep Arousal in Chronic Pain

This study was designed (1) to characterize the extent and nature of sleep complaints of chronic pain patients and (2) to examine the factors that predict sleep quality. A heterogeneous sample of 51 outpatients with benign, chronic pain was recruited from newspaper and pain clinic advertisements. Patients completed a variety of self-report instruments including the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index, the Pre-Sleep Arousal Scale, and the Beck Depression Inventory. Sleep complaints were reported by 88% of the sample. Presleep cognitive arousal, rather than pain severity, was found to be the primary predictor of sleep quality.     

Sleep and pain interference in individuals with chronic pain in mid‐ to late‐life: The influence of negative and positive affect

Poor sleep and chronic pain are known to be interrelated, but the influence of negative and positive affect on this relationship is not fully understood. The present study sought to examine whether negative and positive affect mediate the relationship between sleep and pain interference. Secondary data analysis from Midlife in the United States (MIDUS‐III) was used to examine 948 individuals with chronic pain (mean age = 64.73 years). Sleep disturbance was conceptualized as the sum of self‐reported difficulty with sleep‐onset latency, wake after sleep onset, early morning awakening and daytime sleepiness, and total sleep time was assessed via self‐reported sleep duration. Pain interference was operationalized as the sum of pain‐related interference with general activity, relationships and enjoyment of life. Finally, items from the Positive and Negative Affect Schedule were used to measure affect. Mediation analyses revealed that sleep disturbance indirectly predicted pain interference via both negative affect (β = 0.15, confidence interval: 0.10, 0.21) and positive affect (β = 0.18, confidence interval: 0.12, 0.25). Similarly, negative (β = ?0.003, confidence interval: ?0.01, ?0.001) and positive affect (β = ?0.003, confidence interval: ?0.01, ?0.001) also mediated the effect between total sleep time and pain interference. This study highlights the unique role of negative and positive affect on pain interference for individuals with chronic pain in mid‐ to late‐life. Additionally, findings suggest that holistic treatment approaches, which assess both sleep and affect in the context of chronic pain, may be beneficial.     

Sleep electroencephalogram in children with a parental history of alcohol abuse/dependence

We examined the sleep electroencephalogram (EEG) in 9- and 10-year-old children with (PH+) and without (PH−) a parental history of alcohol abuse/dependence to determine whether sleep disturbances associated with alcohol precede the onset of alcohol use. Participants slept on a fixed sleep schedule that ensured at least a 10-h time in bed for 1 week before an adaptation and baseline night. Data were collected in a four-bed sleep research laboratory. Thirty healthy boys and girls aged 9 or 10 years were classified as either PH+ or PH− based on DSM-IV criteria applied to structured parental interviews. All-night polysomnography was performed, sleep data were scored visually in 30-s epochs, and EEG power spectra were calculated for each epoch. All-night EEG spectra were calculated for rapid eye movement (REM) and non-REM (NREM) sleep, and cycle-by-cycle spectra were calculated for NREM sleep. The two groups did not differ on any sleep stage variable. All-night analyses revealed normalized power in the delta band and spindle range were lower in PH+ children. Within NREM sleep cycles PH+ children exhibited less normalized power in the delta band and spindle range compared with PH− children. This effect occurred in the first four cycles and was most pronounced in the first sleep cycle of the night. We found no signs of sleep disruption in sleep stages for PH+ children. Sleep EEG spectral differences, however, suggest that certain circuits responsible for 'protecting' sleep may be impaired in PH+ children, which may lead to disrupted sleep later in life.     

Sleep problems and internet addiction among children and adolescents: a longitudinal study

Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four‐wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014. The sleep problems of the student participants were measured by parental reports on the Sleep Habit Questionnaire, which catalogues early insomnia, middle insomnia, disturbed circadian rhythm, periodic leg movements, sleep terrors, sleepwalking, sleep talking, nightmares, bruxism, snoring and sleep apnoea. The severity of internet addiction was measured by students’ self‐reports on the Chen Internet Addiction Scale. Based on the results of time‐lag models, dyssomnias (odds ratio = 1.31), especially early and middle insomnias (odds ratio = 1.74 and 2.24), sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm (odds ratio = 2.40), regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence.     

Determining Sleep Quality in Children with Sleep Disordered Breathing: EEG Spectral Analysis Compared with Conventional Polysomnography

Study Objectives:

To identify the extent of sleep disruption in children with various severities of sleep disordered breathing (SDB) using both conventional visually scored assessment of sleep stages and arousal indices together with EEG power spectral analysis.

Design:

Sleep stages and power spectral analysis of the sleep EEG in children with varying severities of SDB with matched control subjects with no history of snoring were compared across the whole night, across sequential hours from sleep onset, and across sleep stages.

Measurements:

Overnight polysomnography was performed on 90 children (49M/41F) aged 7-12 y with SDB and 30 age-matched healthy controls (13M/17F). Sleep stages were visually scored and the EEG spectra were analyzed in 5-s epochs.

Results:

Conventional visual scoring indicated that, although sleep duration was reduced in severely affected children, sleep quality during the essential stages of SWS and REM was preserved, as evidenced by the lack of any significant decrease in their duration in SDB severity groups. This finding was supported by the lack of substantial differences in EEG spectral power between the groups over the whole night, within specific hours, and in individual sleep stages.

Conclusions:

Both conventional scoring and EEG spectral analysis indicated only minor disruptions to sleep quality in children with SDB when assessed across the night, in any specific hour of the night, or in any specific sleep stage. These results suggest that reduced daytime functioning previously reported in children with SDB may not be due to sleep disruption. We speculate that in children, in contrast to adults, a stronger sleep drive may preserve sleep quality even in severe SDB.

Citation:

Yang JSC; Nicholas CL; Nixon GM; Davey MJ; Anderson V; Walker AM; Trinder JA; Horne RSC. Determining sleep quality in children with sleep disordered breathing: EEG spectral analysis compared with conventional polysomnography. SLEEP 2010;33(9):1165-1172.     

Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder

Study Objectives:

We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity.

Design:

Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold.

Setting:

Orofacial pain clinic and inpatient sleep research facility

Participants:

Fifty-three patients meeting research diagnostic criteria for myofascial TMD.

Interventions:

N/A

Measurements and Results:

We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05).

Conclusions:

High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.

Citation:

Smith MT; Wickwire EM; Grace EG; Edwards RR; Buenaver LF; Peterson S; Klick B; Haythornthwaite JA. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. SLEEP 2009;32(6):779–790.     

Sleep disturbances and childhood sexual abuse

OBJECTIVE: This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)]. METHOD: Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories. RESULTS: Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD. CONCLUSIONS: Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.     

Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders

Objective To compare anxiety symptoms and disorders inchildren and adolescents with recurrent abdominal pain (RAP),anxiety disorders, and healthy control children. Methods Twenty-onechildren with RAP (nine males, mean age = 11.05) were comparedto 21 children with anxiety disorders (11 males, mean age =12.29), and 21 children without pain or anxiety (nine males,mean age = 11.57) using diagnostic interviews and continuousmeasures of anxiety and other internalizing symptoms. Results Sixty-sevenpercent of children with RAP met criteria for an anxiety disorder.Children with RAP were higher than well children but not significantlydifferent from children with anxiety on total internalizingand anxiety symptoms. Conclusions RAP and anxietyare closely related. Further understanding between these disordersis essential to understanding the development and progressionof RAP, and to inform the prevention and treatment of the disorder.     

Catastrophizing and symptoms of sleep disturbances in children

Catastrophizing about sleeplessness is a cognitive process associated with sleep disturbance in adults. This study aimed to (1) examine whether children catastrophize about the consequences of not sleeping; (2) define the topics that children catastrophize about; (3) assess whether there is a link between catastrophizing and sleep disturbance in children; and (4) examine whether an association between catastrophizing and sleep in children is mediated by anxiety and depression symptoms. Children completed the sleep self-report and a catastrophizing interview. Testing took place in two inner-city schools in London, UK and participants comprised 123 children aged between 8 and 10 years (49% male). Thirty-four (28%) participants reported concerns in response to the catastrophizing questionnaire. The main topics being catastrophized were concerns about sleep, physiological issues and one's own emotions. Catastrophes predicted sleep disturbance after controlling for age and sex ( β  = 0.35, P  < 0.001) but not when controlling additionally for anxiety and depression symptoms ( β  = 0.15, P  = 0.106). Symptoms of anxiety (Sobel test = 3.30, P  < 0.001) and depression (Sobel test = 2.90, P  = 0.004) mediated the influence of catastrophizing on sleep. A proportion of children catastrophized about the consequences of sleeplessness and this was associated with sleep disturbance, an association which was mediated through anxiety and depression symptoms.     

Sleep disturbances following mild traumatic brain injury in childhood

OBJECTIVE: To examine objective and subjective reports of sleep disturbance in school-aged children who had sustained mild traumatic brain injury (TBI) at least 6 months prior to the study. METHODS: Eighteen children aged 7-12 years with a history of mild TBI (GCS 13-15. LOC < 15 min) were compared to 30 children with orthopedic injuries using actigraphy and parental and self-report sleep questionnaires. RESULTS: Parents reported greater sleep disturbance in the mild TBI group. No significant differences were found in parental ratings of daytime sleepiness, child-reported sleep difficulties, or objective (actigraph) sleep measures. CONCLUSIONS: The finding of greater parental reports of sleep disturbance following mild TBI 6 months after injury requires greater exploration and future research with a larger sample followed from the point of injury would seem appropriate.     

孤独症谱系障碍儿童的睡眠行为

目的:探讨学前期和学龄期孤独症谱系障碍(autism spectrum disorders,ASD)儿童的睡眠行为的特点和差异。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的ASD儿童84名和年龄性别匹配的正常儿童91名,使用儿童睡眠习惯问卷(CSHQ)和一周睡眠日记,由儿童主要照顾者记录儿童的睡眠情况。依据CSHQ总分大于41分为睡眠不良,以具体条目中睡眠行为发生频率超过2晚/周的标准界定睡眠行为问题,分3～5岁和6～12岁两个年龄段比较ASD与对照组儿童在睡眠行为和习惯上的差异。结果:3～5岁ASD组儿童CSHQ的睡眠潜伏期[(2.1±0.8)vs.(1.6±0.7)]、睡眠持续情况[(5.4±1.7)vs.(4.8±1.3)]得分高于对照组,入睡困难(77.6%vs.49.0%)、睡眠量不足(63.3%vs.42.9%)、夜醒哭闹(34.7%vs.12.2%)及日间疲乏(36.7%vs.10.2%)的比例较对照组高(均P0.05)。6～12岁ASD儿童平时睡眠总时长短于对照组[(8.68±0.76)h vs.(9.33±1.00)h],CSHQ的入睡抵触[(10.1±2.8)vs.(8.6±2.5)]、睡眠潜伏期[(1.7±0.7)vs.(1.4±0.6)]与睡眠焦虑[(5.4±2.0)vs.(4.5±1.9)]得分高于对照组,入睡困难(54.3%vs.31.0%)、睡眠量不足(60.0%vs.35.7%)、与父母同睡(65.7%vs.38.1%)、入睡需陪伴(68.6%vs.35.7%)的比例较对照组高(均P0.05)。结论:ASD儿童普遍存在睡眠总量少、入睡困难等问题,学龄前期以夜醒后哭闹和白天疲倦较为突出,而学龄期则以睡眠焦虑较为明显。     

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.This research was partially supported by a Department of Veterans Affairs Merit Review grant awarded to Robert D. Kerns.