Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study

This study compared parent-reported sleep characteristics in 2- to 5-year-old children with autism spectrum disorders (ASD) to children with other developmental delays (DD) and typical development (TD). We included 529 children (303 ASD [167 males], 63 DD [46 males], and 163 TD [134 males]) enrolled in the CHARGE study, an ongoing population-based case-control study. The mean age of participants was 3.6 years (standard deviation, 0.8 years). ASD diagnosis was confirmed with Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedules (ADOS). Cognitive and adaptive functioning was assessed using Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS), respectively. Demographic, medical and sleep history information were ascertained from California birth records, telephone interview, medical assessments at clinic visit, and parent-administered questionnaires. Fifty-three percent of children with ASD had at least one frequent sleep problem, followed by 46% of children with DD, and 32% of the TD group (P < 0.0001). Exploratory factor analyses of sleep history data yielded two factors: sleep onset problems and night waking. Children with ASD had marginally higher sleep onset factor scores and significantly higher night waking factor scores compared with the TD group. Factor scores for children with DD were intermediate between the ASD and TD groups. Cognitive or adaptive development did not predict severity of sleep problems in the ASD group.     

Everyday pain responses in children with and without developmental delays

OBJECTIVE: To examine whether children with developmental delays respond to painful events differently than nondelayed children. METHODS: Sixty families participated. Children between the ages of 2 and 6 years were observed at daycare centers while engaged in usual daily activities, such as free play. Spontaneous painful incidents and the child's responses were recorded using an observational measure (Dalhousie Everyday Pain Scale) designed to capture pain behavior. RESULTS: Children with developmental delays (n = 24) displayed a less intense distress response to an equivocal pain event than nondelayed children (n = 36). Children with developmental delays were more likely to display no reaction following a pain event, whereas children without delays cried more often. Further, children with developmental delays engaged in fewer help-seeking behaviors and were less likely to display a social response following a pain event than nondelayed children. CONCLUSIONS: Children with developmental delays appear to react in a different manner to pain events than nondelayed children do; we discuss a possible socio-communicative deficit.     

Sleep quality and risk of cancer: findings from the English longitudinal study of aging

Study ObjectiveTo prospectively examine the association between sleep quality and incident cancer risk in the elderly.MethodsA total of 10,036 participants aged ≥50 years free of cancer at baseline from the English Longitudinal Study of Ageing at wave 4 (2008) were included, and followed up until 2016. The primary endpoint was new onset physician-diagnosed cancer. Sleep quality was assessed by four questions regarding the frequency of sleep problems and overall subjective feeling of sleep quality in the last month, with higher score denoting poorer sleep quality. The multivariable Cox regression model was used to calculate hazard ratio (HR) with 95% confidence interval (CI) for incident cancer risk according to sleep quality.ResultsAt 8-year follow-up, a total of 745 (7.4%) participants developed cancer. Compared with good sleep quality at baseline, HR (95% CI) for incident cancer risk was 1.328 (1.061, 1.662) for intermediate quality, 1.586 (1.149, 2.189) for poor quality. Similarly, compared with maintaining good sleep quality in the first 4 years, HR (95% CI) for incident cancer risk was 1.615 (1.208, 2.160) for maintaining intermediate quality and 1.608 (1.043, 2.480) for maintaining poor quality. The exclusion of participants with family history of cancer or abnormal sleep duration yielded consistent results.ConclusionsPoor sleep quality is positively associated with the long-term risk of developing cancer in an elderly cohort. Both medical staffs and the general public should pay more attention to improving sleep hygiene.     

Developmental screening in South Africa: comparing the national developmental checklist to a standardized tool

BackgroundWorldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental ‘screening’ tool is integrated as part of ''The Road to Health Booklet (RTHB).MethodThe study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS:DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa.ResultsSensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants.     

Long-term neuropsychological outcome of high risk infants with intracranial hemorrhage.

Evaluated long-term neuropsychological outcome of 20 high risk infants with intracranial hemorrhage (ICH) during the neonatal period who appeared free of significant impairment through 30 months of age. This group was compared with a matched sample of 20 high risk infants without intracranial hemorrhage and a group of 70 children with no history of perinatal or chronic health problems. A comprehensive neuropsychological evaluation at age 5 revealed that the two high risk groups tended to perform at a lower level than the control group across most measures. However, the ICH group performed at a significantly lower level than the control group on measures of perceptual-motor skills and intermodal memory abilities while the high risk group without ICH did not. The implications of differences in level and pattern of performance are discussed along with the implications of the current findings for long-term functioning of high risk infants with ICH.     

Sleep organization in the first year of life: developmental trends in the quiet sleep-paradoxical sleep cycle

The night sleep of 48 healthy drug-free infants, aged 1-54 weeks, was recorded and analysed in order to show how cycles contribute to sleep episode organization and how the balance among different sleep states (i.e. quiet sleep, paradoxical sleep and ambiguous sleep) within cycles changes as a function of age. A greater proportion of time spent in cycles (TCT) on total sleep time (TST), as a result of the lengthening of sleep cycles, was found in older infants, whereas sleep out of cycles decreases with age. The internal structure of the sleep cycles also changes with age, because of the increase in the proportion of quiet sleep (QS), the appearance of slow wave sleep (SWS) from the 21st week onwards, and the decrease in ambiguous sleep. The proportion of paradoxical sleep (PS), however, remains stable throughout the first year of age. The improvement of sleep organization across the first year of life is paralleled by an internal restructuring of the cycle, involving mainly changes in QS. We may speculate that both changes, one involving the lengthening of cycle and the other involving the increase in QS component, contribute to the improvement of biological and psychological sleep functions during development.     

A sleep disturbance in high risk for SIDS infants

A developmentally immature sleep pattern has been identified in infants with a recent history of an unexplained life-threatening episode of sleep apnoea who are considered at risk for SIDS. In these infants there is a persistence of Sleep Onset REM Periods (SOREMPS) after prolonged wakefulness when compared to controls matched for age, sex, birthweight and race. This sleep characteristic has not been previously reported.     

Methodological issues in outcome studies of at-risk infants

OBJECTIVE: To identify methodologic problems found in follow-up studies of infants at biologic and environmental risk and provide solutions and recommendations. METHODS: This article is a literature review. RESULTS: Problems fall into four groupings: (1) conceptualization/design issues, 2) subject population concerns, 3) procedural issues, and 4) measurement/outcome concerns. CONCLUSIONS: Main-effect models are not useful; confounding and mediating variables must be identified. In addition, the following are needed: alternative analytic techniques, more precise subject selection and characterization of risk factors, geographically defined samples, broadened scope of outcome measures, and use of epidemiologic techniques.     

The effects of maternal risk factors during pregnancy on the onset of sleep difficulties in infants at 3 months old

Sleep problems in young children are among the most common concerns reported to paediatricians. Sleep is thought to have important regulatory functions, and sleep difficulties in early childhood are linked to several psychosocial and physiological problems. Moreover, several prenatal factors have been found to influence infants’ sleep. Among them, most of the studies have been focused on maternal prenatal depression and/or anxiety as potential risk factors for sleep problems in childhood, whereas other relevant psychological factors during pregnancy have not received as much attention. Therefore, we aimed to examine the effect of several psychiatric maternal risk factors during pregnancy (i.e. symptoms of anxiety, depression, insomnia, alcohol use, seasonality, attention deficit and hyperactivity disorder and/or stressful life events) on the onset of some sleep problems related to sleep quality and sleep practices in 3‐month‐old infants. We examined 1,221 cases from a population‐based birth cohort, with subjective measures during pregnancy in mothers, and at 3 months after birth in the infants. The findings showed that all the maternal risk factors during pregnancy, except for symptoms of alcoholism and sleepiness, were related to sleep difficulties in infants. Interestingly, attention deficit and hyperactivity disorder symptomatology in mothers during pregnancy was the only variable that predicted more than two sleeping difficulties (i.e. long sleep‐onset latency, co‐sleeping with parents and irregular sleeping routines) at 3 months old. Our results highlight the relevance of maternal risk factors during pregnancy, and not only prenatal depression and/or anxiety, as variables to be considered when examining sleep difficulties in infants.     

Risk factors for atopic dermatitis in infants at high risk of allergy: the PIAMA study

BACKGROUND: It has been suggested that the period immediately after birth is a sensitive period for the development of atopic disease. OBJECTIVE: We investigated whether birth characteristics and environmental factors are associated with the development of atopic dermatitis in the first year of life. METHODS: Seventy-six children with and 228 without atopic dermatitis, all children of mothers with respiratory allergy or asthma (PIAMA birth cohort study) were included in the study. Atopic dermatitis was defined as a positive history of an itchy skin condition with at least two of the following characteristics: visible dermatitis, history of outer arms/leg involvement, or general dry skin. Multiple logistic regression analysis was performed to study the independent effects of various risk factors. RESULTS: A birth weight >/=4000 g compared to 3000-4000 g was a significant risk factor for atopic dermatitis (odds ratio (OR)=2.4; 95% CI: 1.1-5.1) as was day care attendance (OR=2.9; 95% CI: 1.5-5.9). Exclusive breastfeeding in the first 3 months was negatively associated with atopic dermatitis (OR=0.6; 95% CI: 0.3-1.2), especially with visible dermatitis (OR=0.4; 95% CI: 0.2-1.0). Gender, gestational age, the presence of siblings or pets, and parental smoking were not significantly associated with atopic dermatitis. CONCLUSION: This study shows that a high birth weight and day care attendance increase the risk of atopic dermatitis in the first year of life, while exclusive breastfeeding is a protective factor when dermatitis is found on inspection.     

Factors Affecting Development of Children at Risk

The study aimed to determine the variables that characterizenormal and abnormal or questionable performance of Filipinochildren (n = 911) with histories of perinatal risk events (e.g.birth weight less than 2,500 grams, age of gestation less than37 weeks, instrumental delivery) on the Metro-Manila DevelopmentalScreening Test (MMDST), a restandardized Philippine versionof the Denver Developmental Screening Test. Children's agesranged between 2 weeks and 6 A years (53% male, 47% female).In addition to MMDST performance, data on 34 structural-situationalvariables were used in discriminant analysis. Thirteen variableswith significant discriminant function coefficients formed fiveclusters: a child-situational variable cluster, health variablecluster, mother variable cluster, socioeconomic variable cluster,and an age variable cluster.     

Sleep and sleep ecology in the first 3 years: a web-based study

This study was designed to provide data on sleep patterns during the first 3 years, based on a large US–Canada Internet sample, to assess the prevalence of parental interventions and related factors of infant sleep ecology and to evaluate the links between sleep ecology and sleep. Five thousand six parents completed a web-based online questionnaire about their children, aged from birth to 36 months. The questionnaire included items pertaining to sleep patterns, sleep environment, sleep-related parental interventions, sleep position, and demographic information. The results reflected clear sleep-related developmental changes including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night, which was manifested in a decrease in night wakings and nocturnal wakefulness. Sleep ecology and parental behaviors significantly explained a portion of the variance in the child's sleep patterns. Parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep, especially in comparison to more active interactions that were associated with shorter and more fragmented sleep. These findings provide parents and professionals reference data for assessing sleep in young children. Furthermore, the results provide information on specific ecological factors that are associated with increased risk for sleep problems.     

Revision of a Parent-Completed Developmental Screening Tool: Ages and Stages Questionnaires

Examined the Ages and Stages Questionnaires (ASQ), a seriesof 11 developmental questionnaires designed to be completedby parents and caregivers of young children from 4 to 48 monthsof age. The ASQ were recently revised and additional psychometricdata were gathered. Analyses on over 7,000 questionnaires indicatedhigh test-retest reliability, interobserver reliability, andinternal consistency Concurrent validity using standardizedmeasures yielded an overall agreement of 85%, with a range of76–91%. Specificity was high 'across questionnaire intervalswhile sensitivity was lower and varied across intervals. Useof parent-completed screening tools such as the ASQ is attractivein terms of costeffectiveness, parental involvement, and flexibiliryin administration procedures.     

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.     

Behavior characteristics and security in sleep-disturbed infants treated with extinction.

Measured and compared the behavior characteristics and security scores of 35 infants (6-24 months) treated with extinction for sleep disturbance with those of 13 untreated and 15 normal sleep controls. There was no evidence of detrimental effects on the treated infants whose security, emotionality/tension, and likeability scores improved. The findings are congruent with those from a previous study with preschoolers and have important implications for the prevention of later behavior problems in sleep-disturbed children.     

Sleep condition and cognitive decline in Japanese community‐dwelling older people: Data from a 4‐year longitudinal study

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community‐dwelling older adults with intact cognition at baseline, using 4‐year longitudinal data. A total of 3,151 community‐dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age‐ and education‐specific mean. Cognitive decline was defined in one or more cognitive tests at follow‐up. Self‐reported sleep duration (short, ≤6.0 hr; medium, 6.1–8.9 hr; long, ≥9.0 hr) and EDS at first‐wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second‐wave examination. The incidence of cognitive decline differed significantly among the sleep‐duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05–2.13) and EDS (1.43; 1.01–2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12–2.52; EDS, 1.55, 1.05–2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults.     

Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women

Previous longitudinal studies have demonstrated that poor sleep may precede depression and anxiety. The current study examined the association between self-reported sleeping difficulties and new onset depression and anxiety in young women. A nationally representative sample of 9,683 young women from the Australian Longitudinal Study of Women’s Health was analyzed. Women were surveyed in 2000 (aged 22 to 25 years), 2003, 2006, and 2009. Generalized estimating equations were used to examine the association between sleeping difficulties in 2000 and new-onset depression (excluding postnatal depression) and anxiety at each subsequent survey. Significant increased risk of new onset depression (odds ratio (OR)?=?2.6 in 2003; OR?=?4.4 in 2006; OR?=?4.4 in 2009) and anxiety (OR?=?2.4 in 2006; OR?=?2.9 in 2009) was found at each follow-up survey in women who reported sleeping difficulties “often” in 2000. Further research is needed to uncover the mechanisms underlying the link between sleep problems and mental health.     

Reduced sleep quality in healthy girls at risk for depression

Depression is characterized by sleep difficulties, but the extent to which subjective and objective sleep disturbances precede depression are unclear. This study was designed to examine perceptions of sleep quality in addition to actigraphy‐ and diary‐measured sleep variables in healthy girls at low and high familial risk for major depressive disorder. Forty‐four healthy daughters and their mothers completed a week of daily sleep diary and actigraphy; 24 girls had mothers with no history of psychopathology (low risk, mean age 14.92 years), and 20 girls had mothers with recurrent depression during the daughter’s lifetime (high risk, mean age 14.12 years). All daughters had no current or past psychopathology. High‐risk girls reported significantly poorer subjective sleep quality than did low‐risk girls (P = 0.001). The two groups of participants did not differ in actigraphy‐ or diary‐measured sleep duration, onset latency or snooze duration. Healthy girls at high familial risk for depression report poorer sleep quality than do girls at low risk for depression, despite the absence of group differences in objective sleep disturbances as measured by actigraphy or daily diary. This pattern of findings may reflect a broader cognitive or physiological phenotype of risk for depression.