Sleep is essential for mental and physical well-being, yet it is often overlooked in children with medical conditions. To address this gap, we implemented screening for sleep disturbances to assess their prevalence in our clinics and identify potential intervention strategies. This cross-sectional study included children and adolescents aged 6-17 years with tics/Tourette syndrome, headaches, type 1 diabetes, and a healthy control group, who completed the validated Sleep Screening Questionnaire–Children and Adolescents (SSQ-CA).
In total, 157 children with medical conditions and 117 healthy children completed the Sleep Screening Questionnaire–Children and Adolescents. Overall, 81.5% of the children with medical conditions reported a sleep disturbance compared with 70.9% in the healthy group (P = .28). Those with medical conditions reported poorer sleep quality (P < .001) and more awakenings (P = .047), as well as more frequent use of mobile/computer (P = .001) and television (P = .002) before bedtime compared with healthy children.
We identified an alarmingly high prevalence of sleep disturbances in children with selected medical conditions, including more use of screens before bedtime, highlighting a significant yet frequently overlooked issue and possible target for intervention.
ThorsteinssonEB, Potrebny T, Arnarsson ÁM, Tynjälä J, Välimaa R, Eriksson C.Trends in sleeping difficulty among adolescents in five Nordic countries 2002-2014. Nordic Welfare Res. 2019;4:77–87.
2.
SchlieberMHanJ. The role of sleep in young children’s development: a review. J Genet Psychol. 2021;182:205–217.
3.
DahlRE. The impact of inadequate sleep on children’s daytime cognitive function. Semin Pediatr Neurol. 1996;3:44–50.
4.
KronholmE, Puusniekka R, Jokela J, et al.Trends in self-reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011. J Sleep Res. 2015;24:3–10.
5.
BeebeDW. Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin North Am. 2011;58:649.
6.
BaglioniC, Battagliese G, Feige B, et al.Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135:10–19.
7.
MillerMAKruisbrinkMWallaceJJiCCappuccioFP. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep. 2018;41:1–19.
8.
Ibarra-CoronadoEGPantaleón-MartínezAMVelazquéz-MoctezumaJ, et al.The bidirectional relationship between sleep and immunity against infections. J Immunol Res. 2015;2015:678164.
9.
AlDabalLBaHammamAS. Metabolic, endocrine, and immune consequences of sleep deprivation. Open Respir Med J. 2011;5:31.
10.
JennumP, Rejkjær-Knudsen M, Ibsen R, Kiær EK, von Buchwald C, Kjellberg J.Long-term health and socioeconomic outcome of obstructive sleep apnea in children and adolescents. Sleep Med. 2020;75:441–447.
11.
JennumPIbsenRKjellbergJ. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax. 2013;68:949–954.
12.
KaufmannCNSusukidaRDeppCA. Sleep apnea, psychopathology, and mental health care. Sleep Health. 2017;3:244.
13.
NewtonATCorkumPVBlundenSReidGJ. Influences on help-seeking decisions for behavioral child sleep problems: why parents do and do not seek help. Clin Child Psychol Psychiatry. 2021;26:207–221.
14.
LewandowskiASWardTMPalermoTM. Sleep problems in children and adolescents with common medical conditions. Pediatr Clin North Am. 2011;58:699.
15.
SinghNNSahotaP. Sleep-related headache and its management. Curr Treat Options Neurol. 2013;15:704–722.
16.
SivertsenBHysingMElgenIStormarkKMLundervoldAJ. Chronicity of sleep problems in children with chronic illness: a longitudinal population-based study. Child Adolesc Psychiatry Ment Health. 2009;3:22.
17.
BoergersJKoinis-MitchellD. Sleep and culture in children with medical conditions. J Pediatr Psychol. 2010;35:915–926.
18.
BlatyJLDelRossoLM. Tourette disorder and sleep. Biomed J. 2022;45:240.
19.
Ilter BahadurEÖzalkakSÖzdemirAAÇetinkayaSÖzmertEN. Sleep disorder and behavior problems in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2021;35:29–38.
20.
BruniO, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F, Guidetti V.Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia. 1997;17:492–498.
21.
Jiménez-JiménezFJAlonso-NavarroHGarcía-MartínEAgúndezJAG. Sleep disorders in Tourette syndrome. Sleep Med Rev. 2020;53:101335.
22.
CohrsS, Rasch T, Altmeyer S, et al.Decreased sleep quality and increased sleep related movements in patients with Tourette’s syndrome. J Neurol Neurosurg Psychiatry. 2001;70:192–197.
GuidettiVDosiCBruniO. The relationship between sleep and headache in children: implications for treatment. Cephalalgia. 2014;34:767–776.
25.
MonzonAMcDonoughRMeltzerLJPattonSR. Sleep and type 1 diabetes in children and adolescents: proposed theoretical model and clinical implications. Pediatr Diabetes. 2019;20:78–85.
26.
JiXWangYSaylorJ. Sleep and type 1 diabetes mellitus management among children, adolescents, and emerging young adults: a systematic review. J Pediatr Nurs. 2021;61:245–253.
27.
Van De WaterATMHolmesAHurleyDA. Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography—a systematic review. J Sleep Res. 2011;20:183–200.
28.
PaulsrudC, Thorsen SU, Helms P, et al.Validation of the newly developed Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) with objective sleep measures. Sleep Med. 2023;112:359–367.
29.
HarrisPA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
30.
ParuthiS, Brooks LJ, D’Ambrosio C, et al.Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med.2016;12:785–786.
31.
Sundhedsstyrelsen. Nationale Kliniske Anbefalinger for Behandling Med Melatonin Ved Søvnforstyrrelser Hos Børn Og Unge. 2022.
32.
CepedaMSStangPBlacketerCKentJMWittenbergGM. Clinical relevance of sleep duration: results from a cross-sectional analysis using NHANES. J Clin Sleep Med. 2016;12:813.
33.
MonzonADPattonSRKorenD. Childhood diabetes and sleep. Pediatr Pulmonol. 2022;57:1835–1850.
34.
HysingMSivertsenBMorten StormarkKElgenILundervoldAJ. Sleep in children with chronic illness, and the relation to emotional and behavioral problems-a population-based study. J Pediatr Psychol. 2009;34(6):665–670. doi:https://doi.org/10.1093/jpepsy/jsn095.
35.
ArshadD, Joyia UM, Fatima S, et al.The adverse impact of excessive smartphone screen-time on sleep quality among young adults: a prospective cohort. Sleep Sci. 2021;14:337.
36.
WongNABahmaniH. A review of the current state of research on artificial blue light safety as it applies to digital devices. Heliyon. 2022;8:e10282.
37.
CarterBReesPHaleLBhattacharjeeDParadkarMS. A meta-analysis of the effect of media devices on sleep outcomes. JAMA Pediatr. 2016;170:1202.
38.
HeJWTuZHXiaoLSuTTangYX. Effect of restricting bedtime mobile phone use on sleep, arousal, mood, and working memory: a randomized pilot trial. PLoS One. 2020;15(2):e0228756.
39.
HagenauerMHPerrymanJILeeTMCarskadonMA. Adolescent changes in the homeostatic and circadian regulation of sleep. Dev Neurosci. 2009;31:276.
40.
CrowleySJCainSWBurnsACAceboCCarskadonMA. Increased sensitivity of the circadian system to light in early/mid-puberty. J Clin Endocrinol Metab. 2015;100:4067.
41.
OwensJ, Au R, Carskadon M, et al.Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics. 2014;134:e921–e932.
42.
WheatonAGJonesSECooperACCroftJB. Short sleep duration among middle school and high school students - United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67:85–90.
43.
TarasHPotts-DatemaW. Sleep and student performance at school. J School Health. 2005;75:248–254.
44.
MatriccianiLAOldsTSBlundenSRigneyGWilliamsMT. Never enough sleep: a brief history of sleep recommendations for children. Pediatrics. 2012;129:548–556.
45.
TaylorRW, Haszard JJ, Jackson R, et al.Effect of sleep changes on health-related quality of life in healthy children: a secondary analysis of the DREAM crossover trial. JAMA Netw Open. 2023;6:E233005.
46.
Bin-HasanSKapurKRakeshKOwensJ. School start time change and motor vehicle crashes in adolescent drivers. J Clin Sleep Med. 2020;16:371.
47.
Fricke-OerkermannL, Plück J, Schredl M, et al.Prevalence and course of sleep problems in childhood. Sleep. 2007;30:1371.
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