Prevalence and predictors of significant sleep disturbances in children undergoing ambulatory tonsillectomy and adenoidectomy

Objective To evaluate children's sleep patterns before and afterambulatory surgery and to identify predictors of sleep decrementsfollowing surgery. Methods Participants were 55, 6- to 12-year-oldchildren undergoing tonsillectomy and adenoidectomy. Sleep wasassessed using actigraphy for 5 nights prior to and 5 nightsfollowing surgery. Parent state and trait anxiety, and childperioperative anxiety and temperament were assessed. Data onpostoperative pain and use of analgesics were collected. ResultsChildren had significantly less efficient sleep following surgerythan before surgery. Approximately one-third of children demonstratedclinically significant decrements in sleep efficiency. Discriminantfunction analysis indicated less sociable and more anxious childrenwere more likely to experience these sleep decrements, as werechildren who experienced greater pain in the postoperative period.Conclusion Children's sleep is an important consideration inrecovery from surgery and this article takes a first step towardidentifying predictors of the development of clinically significantsleep disruptions following surgery.     

Liability to anxiety and severe life events as predictors of new-onset sleep disturbances

STUDY OBJECTIVES: This study examined the effects of liability to anxiety and stressful life events on the onset of sleep disturbances. DESIGN: A 5-year longitudinal observational cohort study. PARTICIPANTS: A population sample of 16,627 men and women with undisturbed sleep and 2572 with disturbed sleep at baseline. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Liability to anxiety, as indicated by a general feeling of stressfulness (the Reeder stress inventory) and symptoms of sympathetic nervous system (SNS) hyperactivity, was assessed at baseline. The occurrence of post-baseline life events and sleep disturbances was measured at follow-up five years later. Both liability to anxiety and exposure to negative life events were strongly associated with sleep disturbances. Among the men liable to anxiety, the odds of sleep disturbances were 3.11 (95% CI 1.90-5.10) times higher for those who had experienced a severe life event within 6 months than for the others. For the men not liable to anxiety, the corresponding odds ratio was only 1.13 (95% CI 0.40-3.18). For the men and women liable to anxiety, the odds ratio for sleep disturbance 0-6 months after divorce was 2.05 (95% CI 1.38-3.05), with the corresponding odds ratio being 1.47 (95% CI 0.84-2.58) for the men and women not liable to anxiety. The effects of total or specific life events on sleep after 6 months were not dependent on liability to anxiety. CONCLUSION: This study provides prospective evidence that individuals liable to anxiety may be at particularly high risk of post-event sleep disturbances at least during the first months after the event.     

Suicidality and sleep disturbances

STUDY OBJECTIVES: A growing body of research indicates that sleep disturbances may be specifically linked to suicidal behaviors. It remains unclear, however, whether this link is largely explained by depressive symptoms. The present study investigated the relationship between suicidality, depression, and sleep complaints in a clinical outpatient setting. DESIGN AND SETTING: Upon admission, 176 outpatients completed measures on sleep disturbances, suicidal symptoms, and depression. Several sleep disturbances were evaluated with regard to suicidal ideation, including insomnia, nightmares, and sleep-related breathing symptoms. MEASUREMENTS AND RESULTS: Regression analyses revealed that insomnia and nightmare symptoms were associated with both depressive symptoms and suicidality. Sleep-related breathing symptoms were associated with depressive symptoms, but did not show an association with suicidal ideation. After controlling for depressive symptoms, only nightmares demonstrated an association with suicidal ideation. This relationship emerged as a nonsignificant trend (P = .06). Nightmares were particularly associated with suicidality among women compared with men. Posthoc analyses revealed that, after controlling for sex and depressive symptoms, nightmare symptoms were significantly associated with suicidality (P = .04). CONCLUSIONS: Although insomnia and nightmares were significantly associated with depressive and suicidal symptoms, after controlling for additional variables, such as depression and sex, only nightmares remained associated with suicidality. This association was slightly stronger among women compared with men.     

Perinatal complications as predictors of developmental disabilities

This study examined the differences between normals and developmentally disabled children in perinatal complications. Orthogonal contrasts showed significant group differences for factors relating to conditions of labor and delivery, and neonatal gestation and birth weight, with developmentally disabled children experiencing more complicated/high‐risk pregnancies, labor, and deliveries. A stepwise discriminant analysis indicated that on the basis of perinatal information alone, developmentally disabled children were differentiated from normals with clinical levels of accuracy. The results were discussed in terms of their implications for the identification of high‐risk children.     

Coping with sleep disturbances among young adults: a survey of first-year college students in Taiwan

Sleep problems are highly prevalent among young adults and affect different aspects of their quality of life. In this study, the authors aimed to investigate the young adults' coping strategies for these sleep disturbances and the effectiveness of the coping strategies upon sleep quality and daytime sleepiness. The subjects included 1,922 first-year college students, 44% of whom reported experiencing sleep problems, with insufficient sleep being the most common complaint (23.9%). Taking naps and adjusting sleep schedules were the coping strategies associated with better sleep quality. On the other hand, subjects who reported attempting a sleep-promoting activity, ignoring their sleep problems altogether, or trying unsuccessfully to find a way of coping with their sleep problems reported a poorer sleep quality. Although some coping strategies were associated with better sleep quality than others, the levels of daytime sleepiness were equally impaired in all coping groups to a degree that is equivalent to the sleepiness in patients with a moderate sleep-related breathing disorder.     

The trajectories of sleep disturbances in Rett syndrome

Rett syndrome is a rare neurodevelopmental disorder usually affecting females, and is associated with a mutation in the MECP2 gene. Sleep problems occur commonly and we investigated the trajectories and influences of age, mutation and treatments. Data were collected at six time points over 12 years from 320 families registered with the Australian Rett Syndrome Database. Regression analysis was used to investigate relationships between sleep disturbances, age, mutation type and use of treatment, and latent class growth analysis was performed to identify sleep problem phenotypes and model the effect of mutation type. The age range of subjects was 2.0–35.8 years. The study showed that sleep problems occurred in more than 80% of individuals and the prevalence decreased with age. Night laughing and night screaming occurred in 77 and 49%, respectively, when younger. Those with a large deletion had a higher prevalence of night laughing, which often occurred frequently. Treatment was associated with a 1.7% reduction in risk of further sleep problems. High and low baseline prevalence groups were identified. Approximately three‐quarters of girls and women with sleep disturbances were in the high baseline group and problems persisted into adulthood. Conversely, 57% with night laughing and 42% with night screaming in the high baseline group exhibited mild improvement over time. Mutation type was not found to be a significant predictor of group membership. In conclusion, the evolution of sleep problems differed between subgroups of girls and women with Rett syndrome, in part explained by age and genotype. Treatment was not associated with improvement in sleep problems.     

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.     

Respiratory and body movements as indicators of sleep stage and wakefulness in infants and young children

Conventional polysomnographic (PSG) sleep staging to sleep staging based on a static-charge-sensitive bed (SCSB) recording in infants and young children was compared. The study consisted of whole-night clinical sleep studies in 22 children at 24 weeks (SD 24, range 1–79 weeks) of age. Most of the children presented with respiratory disturbances during sleep. From the SCSB record, sleep stages were differentiated according to regularity of breathing, presence of body movements, and most important, presence of high-frequency components of breathing (SCSB spikes). With both methods, three sleep/wake stages were distinguished: rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep and wakefulness. The average inter-scorer reliability of the PSG sleep staging controlled in nine subjects was 88%. The average concordance between the two methods ranged from 82 to 85%, depending on the criteria used for scoring the SCSB. The mean sensitivity of the SCSB to detect NREM sleep ranged from 77 to 90% and the mean sensitivity to detect REM sleep ranged from 61 to 86%. The mean positive predictive value was 89–96% for NREM sleep and 54–67% for REM sleep. In conclusion, REM sleep is characterized by irregular breathing with superimposed fast respiratory movements. These changes are specific enough to allow distinction between episodes of NREM sleep, REM sleep and wakefulness with the non-invasive SCSB method in infants and young children. Incomplete concordance between PSG and SCSB score was most frequently observed during sleep stage transition periods, where the behavioural state and electrophysiological criteria disagreed. When combined with the PSG, the SCSB provides complementary information about the behavioural state of child.     

Association of hostility with sleep duration and sleep disturbances in an employee population

Background: Sleep disturbances are common among the general population, and hostile persons have been proposed to be at greater risk of several serious health problems and diseases. Purpose: This study examined the relationships between hostility, sleep disturbances, and sleep duration in a large non-clinical sample of 5,433 employees working in 12 Finnish hospitals. Method: Data were collected by questionnaire surveys in 1998 and 2000. Results: Higher hostility was cross-sectionally associated with increased sleep disturbances but not with sleep duration after adjustment for gender, age, marital status, education, shift work, smoking, alcohol consumption, physical activity, body mass index, psychiatric morbidity, and somatic disease. A stratified analysis distinguishing individuals with stable hostility across the two measurements and those with transient hostility (>0.5 SD difference between measurements) replicated the association with increased sleep disturbance in both groups, but among those with transient hostility, there additionally was a cross-sectional association between higher hostility and shorter sleep duration. Conclusion: Our evidence suggests that hostility is an independent risk factor for sleep disturbances and that transient hostility may also predispose shorter sleep duration. However, the effect sizes for all these associations were small, suggesting limited clinical significance for our findings.     

Assessment and treatment of sleep disturbances in older adults

Sleep disturbances are common in older adults. These disturbances are often secondary to medical illness and/or medication use or are due to specific problems such as sleep disordered breathing, periodic limb movements in sleep and circadian rhythm disturbances. The prevalence of sleep disordered breathing and periodic limb movement in sleep increases with age. The circadian rhythm tends to advance with age, causing older people to awaken early in the morning. Insomnia is often caused by pain associated with medical illness. Insomnia can also be caused by stimulating medications. In institutionalized elderly, sleep becomes even more disturbed and fragmented than in community-dwelling older adults. Accurate assessment and diagnosis is crucial since effective treatment strategies are available for these sleep disturbances. The effect, prevalence and treatment of each of these conditions is reviewed.     

Dyadic disturbances in cocaine-abusing mothers and their infants

A recently developed instrument for the quantification of mother-infant interaction, the Parent-Child Early Relationship Assessment (PCERA), was used to observe drug-abusing mothers and their infants. Compared to the standardization sample used in the development of the PCERA, these drug-abusing mothers (N = 5) showed a tendency toward rigidity and overcontrol in their parenting, a lack of enjoyment and pleasure in relating to their infants, and limited emotional involvement and responsivity in their interaction. An analysis of the dyadic behaviors showed an overall reduction in reciprocity, mutual enjoyment, and regulation of interaction between mother and infant.     

EEG predictors of dreaming outside of REM sleep

The stream of human consciousness persists during sleep, albeit in altered form. Disconnected from external input, the mind and brain remain active, at times creating the bizarre sequences of thought and imagery that comprise “dreaming.” Yet despite substantial effort toward understanding this unique state of consciousness, no reliable neurophysiological indicator of dreaming has been discovered. Here, we identified electroencephalographic (EEG) correlates of dreaming using a within‐subjects design to characterize the EEG preceding awakenings from sleep onset, REM (rapid eye movement) sleep, and N2 (NREM Stage 2) sleep from which participants were asked to report their mental experience. During the transition into sleep, compared to periods during which participants reported thinking, emergence of dream imagery was associated with increased absolute power below 7 Hz. During later N2, dreaming conversely occurred during periods of decreased relative power below 1 Hz, accompanied by an increase in relative power above 4 Hz. No EEG predictors of dreaming were identified during REM. These observations suggest an inverted‐U relationship between dreaming and the prevalence of low‐frequency EEG rhythms, such that dreaming first emerges in concert with EEG slowing during the sleep‐wake transition, but then disappears as high‐amplitude slow oscillations come to dominate the recording during later N2 sleep.     

Self-report sleep habits as predictors of subjective sleepiness

Although sleepiness is pervasive in our society, there is little agreement on how to measure sleepiness or on how well sleepiness is actually related to sleep habits. To better assess how subjective sleepiness is related to sleep, the authors used self-report measures of sleep quantity, sleep quality, and napping to predict 4 different sleepiness-related measures in a group of healthy young and middle-aged-to-older adults. A forward regression analysis indicated that sleep quality was better than sleep quantity as a predictor of participants' sleepiness. The sleep measures, furthermore, predicted sleepiness better in the older adults than in the younger adults. Finally, the 4 sleepiness measures differed in how well they were related to sleep. The findings in the study suggest that sleepiness is a complex phenomenon rather than a simple reflection of sleep quantity.     

Cardiac changes during sleep in sleep-deprived infants

OBJECTIVE: To evaluate the influence of a brief period of sleep deprivation on cardiac autonomic controls during sleep in healthy infants. DESIGN: Twelve healthy infants with a median age of 8 weeks (range, 7 to 18 weeks) were recorded polygraphically during a morning and an afternoon nap in a sleep laboratory. They were sleep deprived for approximately 2 hours, either in the morning or in the afternoon, before being allowed to fall asleep. Six infants were sleep deprived before the morning nap, and 6 before the afternoon nap. During both naps, their sleep, breathing, and heart-rate characteristics were continuously recorded. Spectral analysis of heart rate was evaluated as a function of sleep stages. Two major peaks were recognizable: a low-frequency component related to sympathetic and parasympathetic activities and a high-frequency component reflecting parasympathetic tonus. The ratio of low-frequency to high-frequency powers was calculated as an index of sympathovagal interaction. RESULTS: When sleep deprived, the infants had an increase in basal heart rate during non-rapid eye movement sleep (P=.021). With sleep deprivation, the ratio of low-frequency to high-frequency powers increased in non-rapid eye movement sleep (P=.005). These findings were consistent with an increase in sympathetic tone. CONCLUSION: Infants exposed to short-term sleep deprivation manifest changes in cardiac autonomic controls during sleep. These findings could be relevant to mechanisms associated with the sudden infant death syndrome.     

Effect of derivatives of gamma-aminobutyric acid on sleep disturbances in neuroses

Electropolygraphic investigations revealed a tendency in patients with sleep disturbances associated with various forms of neuroses for the total duration of sleep to increase under the influence of derivatives of -aminobutyric acid (GABA), on account of an increase in the principal stages of sleep (second stage, sleep, and fast sleep) and a statistically significant decrease in the number of spontaneous awakenings, in the total duration of wakefulness at night, and in the activation index of movements. Analysis of some of the electrographic indices within the stages of sleep revealed a tendency for the number of sleep spindles to increase in the second stage, an increase in the index in the third and fourth stages of sleep, and an increase in the mean numerical indices of rapid eye movements in the absence of significant changes in their specific occurrence per unit time. GABA derivatives in the doses used cause on the whole similar changes in the structure of sleep in its various disturbances, with sodium hydroxybutyrate having a relatively stronger action.Department of Pathology of the Autonomic Nervous System, I. M. Sechenov First Moscow Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. V. Zakusov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 85, No. 2, pp. 174–177, February, 1978.