Obstructive sleep apnea: a polysomnographic study of sleep apnea before and after tonsillectomy and adenoidectomy

We report about polysomnographic studies including EEG, EOG, EMG, ECG, measurement of oropharyngeal airflow, recording of chest wall movements and transcutaneous measurements of pO2 and pCO2 in a 4-year-old girl with severe obstructive sleep apnea. Her sleep profile was characterized by a disturbed cyclic pattern of sleep stages with onset of sleep at stage 4, shortening of REM-sleep periods and of sleep stages 1 and 2, and an increased quantity of sleep stage 4. The total time spent in apneic episodes was 11.3% of the total sleep period (only obstructive events). Apneic attacks were recorded mainly in REM and light NREM sleep states. Tonsillectomy and adenoidectomy resulted in marked improvement without further evidence of abnormal sleeping pattern or of sleep apneas.     

Evaluating sleep and sleep disorders in the pediatric primary care setting

Sleep is a vital physiologic function. Asking parents about their children's sleep should be part of every routine physical examination. Evaluating infants requires an understanding of changes in sleep associated with developmental stage. Problems with sleep associations may begin in late infancy and become a major issue for toddlers. Good sleep is crucial for success in learning for all children. Daytime behaviors in children may be symptoms of nighttime problems. Adolescents are often chronically sleep-deprived. Educating parents and their children about the importance of sleep is an important intervention that over time can help children lead happier, more productive lives.     

癫伴睡眠障碍患儿的睡眠结构特征及影响因素分析

目的了解癫伴睡眠障碍住院患儿的睡眠结构特征,探寻癫伴睡眠障碍的影响因素。方法选取2006年12月至2010年6月就诊的111例癫伴睡眠障碍患儿为病例组;同期89例癫不伴睡眠障碍患儿为对照组。采用多导生理参数睡眠监测仪对患儿睡眠情况进行监测,并使用自拟住院癫患儿睡眠生活质量问卷对患儿家长进行调查。采用Epidata3.0建立数据库,用SPSS13.0完成统计分析。结果两组患儿的性别和智力水平差异有统计学意义(P<0.01)。与对照组患儿相比,病例组患儿睡眠结构紊乱明显。经单因素分析显示,影响癫伴睡眠障碍的主要因素有:性别、智力水平、睡眠情况、家庭情况。多因素非条件Logistic回归分析显示,睡眠不安、多动或频繁觉醒、入睡困难、家庭睡眠环境不安静的癫患儿伴睡眠障碍的可能性大。女童、家长对患儿睡眠作息时间规律十分重视的癫患儿伴睡眠障碍的可能性小。结论癫伴睡眠障碍患儿睡眠结构改变明显,其睡眠障碍的发生受多种因素影响。对癫患儿睡眠情况应进行早期监测与指导,提高癫患儿的生活质量。     

Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution

Concerns about bedsharing as a risk for sudden infant death syndrome and other forms of sleep‐associated infant death have gained prominence as a public health issue. Cardboard “baby boxes” are increasingly promoted to prevent infant death through separate sleep, despite no proof of efficacy. However, baby boxes disrupt “breastsleeping” (breastfeeding with co‐sleeping) and may undermine breastfeeding. Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow's milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance. Moreover, the focus on bedsharing neglects more potent risks such as smoking, drugs, alcohol, formula feeding, and poverty. Distribution of baby boxes may divert resources and attention away from addressing these other risk factors and lead to a false sense of security wherein we overlook that sudden unexplained infant deaths also occur in solitary sleep environments. Recognizing breastsleeping as the evolutionary and cross‐cultural norm entails re‐evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co‐sleeping, investigating ways to safely minimize separation for formula‐fed infants, and mitigating the potential harms of mother–infant separation when breastsleeping is disrupted. Resources would be better spent addressing such questions rather than on a feel‐good solution such as the baby box.     

Parental depressive symptoms and children's sleep: the role of family conflict

Background: We used a multi‐method and multi‐informant design to identify developmental pathways through which parental depressive symptoms contribute to children’s sleep problems. Environmental factors including adult inter‐partner conflict and parent–child conflict were considered as process variables of this relation. Methods: An ethnically and socioeconomically diverse sample of children (n = 268) participated (M age = 9.44 years, SD = 8.61 months). Children wore actigraphs for 7 consecutive nights and also reported on their sleep problems. Results: Higher levels of maternal depressive symptoms were associated with children’s sleep/wake problems. Higher levels of paternal depressive symptoms were associated with shorter time in bed and fewer sleep minutes. Inter‐partner conflict and parent–child conflict were mechanisms of effects in the associations between maternal depressive symptoms and children’s actigraphy‐based and self‐reported sleep problems. Conclusions: Findings build on this scant literature and highlight the importance of identifying pathways of risk and familial and environmental influences on children’s sleep problems.     

Disturbed sleep: effects of sociocultural factors and illness

To assess the prevalence of sleep disturbance and associated risk factors, sleep patterns were analysed in 14,372 English and Scottish children. Approximately 4% of children aged 5 experienced disturbed sleep more than once a week, but this decreased to 1% from age 9. Less than 25% of the parents with an affected child consulted a doctor. Sleep disturbance was associated with persistent wheezing compared to non-wheezing children (odds ratio 4.42; 95% confidence interval (CI) 3.17 to 6.13), and more frequent in children of Indian subcontinent descent than in white children (odds ratio 2.20; 95% CI 1.34 to 3.60), and in children whose mother reached no more than primary education compared with those with higher education (odds ratio 2.41; 95% CI 1.51 to 3.84). Sociocultural factors associated with ethnicity and respiratory illness are important risk factors for sleeping disorders in childhood.     

上海市松江区学龄前儿童睡眠状况和睡眠问题的横断面调查

目的调查学龄前儿童的睡眠情况,分析不同特征学龄前儿童的常见睡眠问题。方法在普遍动员、自愿参与的原则下,以上海市松江区幼儿园作为问卷调查现场,以《儿童家族社会环境与睡眠健康问卷》作为调查工具,以年龄和性别分层分析。睡眠问题包括睡眠不足,就寝延迟,睡眠中发生每周＞2次的以下情况：害怕就寝、打鼾、白天嗜睡、磨牙、夜惊、梦魇、入睡困难和梦游。先对幼儿园保健老师集中统一培训,保健老师再对幼儿园班主任进行培训。问卷填写人为幼儿父或母或抚养人且近１年与幼儿一起生活。当场发放问卷、填写和回收。结果2018年5~6月22所幼儿园参与问卷调查,向儿童家长发放问卷8 624份,有效问卷8 586份,男孩4 595名(53.5%),女孩3 991名; 3~岁占17.8%、4~岁占34.1%、5~岁占32.0%、6~岁占16.1%。平均晚上就寝时间为21∶43,平均晨醒时间为7∶01,随年龄增长,白天、夜间和全天睡眠时间总量在减少,晚上就寝时间点延迟,平均晨醒时间点提前,差异有统计学意义（P＜0.01）。不同性别学龄前儿童白天、夜间、全天睡眠总量和就寝时间,差异均无统计学意义（P＞0.05）。睡眠不足的发生率为12.2%,就寝延迟的发生率为75.7%。随年龄增长,睡眠不足和就寝延迟的发生率逐渐增加,差异有统计意义(P＜0.05)。害怕就寝72.4%,打鼾62.5%,白天嗜睡51.2%,磨牙50.4%,夜惊49.2%,梦魇41.2%,入睡困难33.4%,梦游4.4%。打鼾和磨牙的发生率男童高于女童（P＜0.05）,夜惊、梦魇、入睡困难和梦游的发生率女童高于男童（P＜0.05）。结论上海市松江区学龄前儿童睡眠时间不足,就寝延迟,睡眠问题发生率高,应引起社会及家长的重视。     

上海市松江区学龄前儿童睡眠状况和睡眠问题的横断面调查

目的调查学龄前儿童的睡眠情况，分析不同特征学龄前儿童的常见睡眠问题。方法在普遍动员、自愿参与的原则下，以上海市松江区幼儿园作为问卷调查现场，以《儿童家族社会环境与睡眠健康问卷》作为调查工具，以年龄和性别分层分析。睡眠问题包括睡眠不足，就寝延迟，睡眠中发生每周＞2次的以下情况：害怕就寝、打鼾、白天嗜睡、磨牙、夜惊、梦魇、入睡困难和梦游。先对幼儿园保健老师集中统一培训，保健老师再对幼儿园班主任进行培训。问卷填写人为幼儿父或母或抚养人且近１年与幼儿一起生活。当场发放问卷、填写和回收。结果2018年5~6月22所幼儿园参与问卷调查，向儿童家长发放问卷8 624份，有效问卷8 586份，男孩4 595名(53.5%)，女孩3 991名； 3~岁占17.8%、4~岁占34.1%、5~岁占32.0%、6~岁占16.1%。平均晚上就寝时间为21∶43，平均晨醒时间为7∶01，随年龄增长，白天、夜间和全天睡眠时间总量在减少，晚上就寝时间点延迟，平均晨醒时间点提前，差异有统计学意义（P＜0.01）。不同性别学龄前儿童白天、夜间、全天睡眠总量和就寝时间，差异均无统计学意义（P＞0.05）。睡眠不足的发生率为12.2%，就寝延迟的发生率为75.7%。随年龄增长，睡眠不足和就寝延迟的发生率逐渐增加，差异有统计意义(P＜0.05)。害怕就寝72.4%，打鼾62.5%，白天嗜睡51.2%，磨牙50.4%，夜惊49.2%，梦魇41.2%，入睡困难33.4%，梦游4.4%。打鼾和磨牙的发生率男童高于女童（P＜0.05），夜惊、梦魇、入睡困难和梦游的发生率女童高于男童（P＜0.05）。结论上海市松江区学龄前儿童睡眠时间不足，就寝延迟，睡眠问题发生率高，应引起社会及家长的重视。     

Depth of sleep and sleep habits among enuretic and incontinent children

In order to evaluate differences in sleep factors between children with wetting problems and dry children, questionnaire data were obtained from 1,413 schoolchildren between the ages of 6 and 10 y. The analyses were performed using logistic regression, and adjusted odds ratios (ORs) were calculated to approximate the relative risk. Current enuresis was associated with a subjectively high arousal threshold, pavor nocturnus, nocturia and confusion when awoken from sleep (ORs 2.7, 2.4, 2.1 and 3.4, respectively), whereas children with current incontinence often experienced bedtime fears, onset insomnia or nocturia (ORs 2.4, 2.3 and 2.7, respectively). Children exhibiting urinary urgency were overrepresented among both children with current enuresis (OR 2.5) and those with current incontinence (OR 17.2). It is concluded that impaired arousal mechanisms and bladder instability are aetiological factors underlying nocturnal enuresis.