Flavia Giannotti

Circadian preference, sleep and daytime behaviour in adolescence.

The aim of this study was to determine the relationship between circadian preferences, regularity of sleep patterns, sleep problems, daytime sleepiness and daytime behaviour. As a part of an epidemiological survey on sleep in a representative sample of Italian high‐school students, a total of 6631 adolescents, aged 14.1–18.6 years, completed the School Sleep Habits Survey, a comprehensive questionnaire including items regarding sleep, sleepiness, substance use, anxiety and depressed mood, use of sleeping pills, school attendance and a morningness/eveningness scale. The sample consisted of 742 evening‐types (315 males and 427 females; mean age 17.1 years) and 1005 morning‐types (451 males and 554 females; mean age 16.8 years). No significant sex differences were found for morningness/eveningness score. Eveningness was associated with later bedtime and wake‐up time, especially on weekends, shorter time in bed during the week, longer weekend time in bed, irregular sleep–wake schedule, subjective poor sleep. Moreover, evening types used to nap more frequently during school days, complained of daytime sleepiness, referred more attention problems, poor school achievement, more injuries and were more emotionally upset than the other chronotype. They referred also greater caffeine‐containing beverages and substances to promote sleep consumption. Our results suggest that circadian preference might be related not only to sleep pattern, but also to other adolescent behaviours.

The Sleep Disturbance Scale for Children (SDSC) Construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence

SUMMARY To attempt a categorization of sleep disorders in children, we developed a 27 item Likert‐type rating scale (Sleep Disturbance Scale for Children: SDSC) and assessed the psychometric properties was developed. The scale was distributed to the mothers of 1304 children (1157 controls, mean age 9.8y; 147 sleep disorder subjects, mean age 9.2y, composed of four clinical groups: Insomnia 39 subjects, Hypersomnia 12 subjects, Respiratory disturbances during sleep 25 subjects and Parasomnias 71 subjects). The internal consistency was high in controls (0.79) and remained at a satisfactory level in sleep disorder subjects (0.71); the test/retest reliability was adequate for the total (r = 0.71) and single item scores. The factor analysis (variance explained 44.21%) yielded six factors which represented the most common areas of sleep disorders in childhood and adolescence. Enuresis was the only item with a factor loading lower than 0.40 and with a low inter‐item correlation and was therefore eliminated, resulting in a final scale of 26 items. The re‐evaluation of the sample, using the factor scores, supported the validity and the discriminating capacity of the scales between controls and the four clinical groups. The correlation between factor scores corroborated the hypothesis that childhood sleep disturbances are not independent entities nor do they cluster into different groupings related to each other. The SDSC appears to be a useful tool in evaluating the sleep disturbances of school‐age children in clinical and non‐clinical populations.

The Relationship Between Reported Sleep Quality and Sleep Hygiene in Italian and American Adolescents

Objective. The purpose of the study was to examine the relationship between self-reported sleep quality and sleep hygiene in Italian and American adolescents and to assess whether sleep-hygiene practices mediate the relationship between culture and sleep quality. Methods. Two nonprobability samples were collected from public schools in Rome, Italy, and Hattiesburg, Mississippi. Students completed the following self-report measures: Adolescent Sleep-Wake Scale, Adolescent Sleep Hygiene Scale, Pubertal Developmental Scale, and Morningness/Eveningness Scale. Results. The final sample included 776 Italian and 572 American adolescents 12 to 17 years old. Italian adolescents reported much better sleep hygiene and substantially better sleep quality than American adolescents. A moderate-to-strong linear relationship was found between sleep hygiene and sleep quality in both samples. Separate hierarchical multiple regression analyses were performed on both samples. Demographic and individual characteristics explained a significant proportion of the variance in sleep quality (Italians: 18%; Americans: 25%), and the addition of sleep-hygiene domains explained significantly more variance in sleep quality (Italians: 17%; Americans: 16%). A final hierarchical multiple regression analysis with both samples combined showed that culture (Italy versus United States) only explained 0.8% of the variance in sleep quality after controlling for sleep hygiene and all other variables. Conclusions. Cross-cultural differences in sleep quality, for the most part, were due to differences in sleep-hygiene practices. Sleep hygiene is an important predictor of sleep quality in Italian and American adolescents, thus supporting the implementation and evaluation of educational programs on good sleep-hygiene practices.

Sleep in children with autistic spectrum disorder.

Children and adolescents with autistic spectrum disorders (ASD) suffer from sleep problems, particularly insomnia, at a higher rate than typically developing children, ranging from 40% to 80%. Sleep problems in ASD might occur as a result of complex interactions between biological, psychological, social/environmental, and family factors, including child rearing practices that are not conducive to good sleep. Interestingly, children with a history of developmental regression have a more disturbed sleep pattern than children without regression. Even though regulation of sleep in children with ASD is still poorly understood, circadian abnormalities in autism might be the result of genetic abnormalities related to melatonin synthesis and melatonins role in modulating synaptic transmission. Recently a bifurcation of the sleep/wake cycle with increased sensitivity to external noise and short sleep duration causing irregular sleep onset and wake up times has been suggested. Identifying and treating sleep disorders may result not only in improved sleep, but also impact favorably on daytime behavior and family functioning. Several studies have also demonstrated effectiveness of behavioral interventions for sleep onset and maintenance problems in these populations. When behavioral interventions are not effective or lead only to a partial response, pharmacological treatment options should be considered. Studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run. The clinician assessing a child with an ASD should screen carefully for sleep disorders and make referrals as indicated.

Sleep Problems and Daytime Behavior in Childhood Idiopathic Epilepsy

Summary: Purpose: To evaluate the presence of sleep problems and their association with behavioral and adjustment problems in children with idiopathic epilepsy.

An Investigation of Sleep Characteristics, EEG Abnormalities and Epilepsy in Developmentally Regressed and Non-regressed Children with Autism

This study investigated sleep of children with autism and developmental regression and the possible relationship with epilepsy and epileptiform abnormalities. Participants were 104 children with autism (70 non-regressed, 34 regressed) and 162 typically developing children (TD). Results suggested that the regressed group had higher incidence of circadian rhythm disorders than non-regressed children. The regressed group showed higher Children’s Sleep Habits Questionnaire Bedtime Resistance, Sleep Onset Delay, Sleep Duration and Night-Wakings scores. Epilepsy and frequent epileptiform EEG abnormalities were more frequent in regressed children. Past sleep disorders and a history of developmental regression were significantly associated with sleep disorders. This study is an initial step in better understanding sleep problems in regressed children with autism, further studies are necessary to better investigate these aspects.

Controlled‐release melatonin, singly and combined with cognitive behavioural therapy, for persistent insomnia in children with autism spectrum disorders: a randomized placebo‐controlled trial

Although melatonin and cognitive–behavioural therapy have shown efficacy in treating sleep disorders in children with autism spectrum disorders, little is known about their relative or combined efficacy. One hundred and sixty children with autism spectrum disorders, aged 4–10 years, suffering from sleep onset insomnia and impaired sleep maintenance, were assigned randomly to either (1) combination of controlled‐release melatonin and cognitive–behavioural therapy; (2) controlled‐release melatonin; (3) four sessions of cognitive–behavioural therapy; or (4) placebo drug treatment condition for 12 weeks in a 1 : 1 : 1 : 1 ratio. Children were studied at baseline and after 12 weeks of treatment. Treatment response was assessed with 1‐week actigraphic monitoring, sleep diary and sleep questionnaire. Main outcome measures, derived actigraphically, were sleep latency, total sleep time, wake after sleep onset and number of awakenings. The active treatment groups all resulted in improvements across all outcome measures, with moderate‐to‐large effect sizes from baseline to a 12‐week assessment. Melatonin treatment was mainly effective in reducing insomnia symptoms, while cognitive–behavioural therapy had a light positive impact mainly on sleep latency, suggesting that some behavioural aspects might play a role in determining initial insomnia. The combination treatment group showed a trend to outperform other active treatment groups, with fewer dropouts and a greater proportion of treatment responders achieving clinically significant changes (63.38% normative sleep efficiency criterion of >85% and 84.62%, sleep onset latency <30 min). This study demonstrates that adding behavioural intervention to melatonin treatment seems to result in a better treatment response, at least in the short term.

Cosleeping and sleep behavior in Italian school-aged children.

The prevalence and predictors of cosleeping were investigated in 901 healthy school-aged children. Parent reports on the Children’s Sleep Habits Questionnaire and Child Behavior Checklist were used to assess children’s sleep and behavioral problems. Regular, long-lasting cosleeping was present in 5% of our sample. Cosleepers rated higher on the Children’s Sleep Habits Questionnaire total score and Bedtime Resistance, Sleep Anxiety, Nightwakings, and Parasomnias subscales than solitary sleepers. No significant behavioral problems were found in cosleepers. Regression results showed that low socioeconomic status, one parent who is a shiftworker, one-parent families, one parent who coslept as a child, prolonged breastfeeding, and previous and current sleep problems significantly predicted cosleeping. The high incidence of parents reporting having coslept as a child also suggested a lifestyle choice. Thus, cosleeping seems to reflect a parent’s way to cope with sleep problems, and the long persistence of this practice may be related to the lifestyle of families.

Sleep Patterns in Autism Spectrum Disorders

Like children with other developmental disabilities, children with autism spectrum disorders suffer from sleep problems at a greater rate than typically developing children. It is increasingly recognized that addressing these sleep problems may improve daytime functioning and decrease family stress. The sleep problems experienced by children with autism spectrum disorders are presented in this article.

Adolescent Sleep Patterns: Sleep Patterns and Daytime Function in Adolescence: An Epidemiological Survey of an Italian High School Student Sample

The developmental changes occurring during adolescence include psychological as well as organic factors and their nature and rapidity are striking. Modifications in sleeping patterns with chronologic age have been well documented and have been related to greater social pressures, as well as normal ontogenetic trends. Several studies have suggested that adolescents, despite an increasing physiological need for sleep, tend to sleep less with age (Simonds & Parrega, 1982; Carskadon, 1990a; Andrade, Benedito-Silva, Domenice, Amhold, & Menna-Barreto, 1993). The sleep-wake cycle tends to become delayed, and many adolescents may experience sleep phase delay syndrome with insufficient sleep (Carskadon, Vieira, & Acebo, 1993). The consequences of chronic insufficient sleep are numerous: daytime sleepiness, mood and behavioral problems, negative effects on daytime functions such as poor school achievement, greater risk of severe accidents, and increased vulnerability to psychoactive substance abuse. Furthermore, in adolescent years expanding social opportunities, including academic demands, changing parent-child relationship, and changing life habits, may also affect the development of adolescent sleep patterns. Despite the fact that very few epidemiological studies comparing sleep habits in different countries have been conducted, it has been hypothesized that ethnic and sociocultural factors may influence sleep patterns and habits, too (Strauch & Meier, 1988). Although the importance of healthy sleeping habits in this age group has been pointed out in other countries, this topic has not received adequate interest in Italy.