J.D. Kennedy

Eczema and sleep and its relationship to daytime functioning in children

Chronic childhood eczema has significant morbidity characterised by physical discomfort, emotional distress, reduced child and family quality-of-life and, of particular note, disturbed sleep characterised by frequent and prolonged arousals. Sleep disturbance affects up to 60% of children with eczema, increasing to 83% during exacerbation. Even when in clinical remission, children with eczema demonstrate more sleep disturbance than healthy children. Notably, disturbed sleep in otherwise healthy children is associated with behavioural and neurocognitive deficits. Preliminary evidence suggests that disturbed sleep in children with eczema is also associated with behavioural deficits while the impact on neuropsychological functioning remains unexplored. In conclusion, a disease which affects up to 20% of children in some countries and may produce long-term behavioural and neurocognitive deficits merits further evaluation using standardised tests of sleep, behaviour and neurocognition.

Snoring and cognitive development in infancy.

OBJECTIVE This study aimed to assess the influence of snoring and sleep duration on developmental outcomes in 6 month old infants. METHODS As part of a longitudinal study of snoring in infancy, we identified 16 children (13 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 months of age and 88 healthy infant controls who were reported never to snore in the absence of a cold (36 males). Infants were assessed at 6 months of age with the Bayley Scales of Infant and Toddler Development Edition III, and parents completed demographic, sleep, and developmental surveys. RESULTS Cognitive development was reduced in infants who snored frequently (mean=95.3; SD=4.3) from the first month of life compared to control infants (mean=100.6; SD=3.9) (F [1, 99]=23.8, p<.01; η(p)(2)=.21). CONCLUSION Snoring during the first 6 months of life was associated with lower cognitive development scores. It is unknown whether these infants will continue to snore through childhood and, if so, whether the associated neurocognitive deficits will become worse with time.

Prevalence of snoring and associated factors in infancy

INTRODUCTION In children aged 3-12 years snoring is associated with significant neurocognitive and behavioural deficits; however, there are few studies that have considered both the prevalence of snoring in infants and associated factors that may influence the development of snoring. The goal of the present study was to examine sleep, snoring and associated factors in a community sample of 0-3 month olds. METHODS Previously validated infant sleep and parent sleep questionnaires were completed by parents of 457 term infants aged 1-13.9 weeks old (mean age=4.6 weeks; SD=2.7; 45% males) during a home-based nurse visit. RESULTS Approximately 9% of infants were reported to snore habitually (snoring ≥ 3 nights/week). Habitual snoring was significantly associated with exclusive formula feeding (OR: 28.87; p<.01), maternal concern about childs breathing during sleep (OR: 3.91; p=.01) and restless sleep ≥ 3 nights/week (OR: 17.76; p<.001). CONCLUSION These results show that snoring is as common in infants as it is in older children. Given the known relationships between Sleep Disordered Breathing (SDB) and neurocognitive development, the effect of SDB developing early in childhood may have important consequences on future developmental outcomes.

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

BACKGROUND Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown. AIMS This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction. STUDY DESIGN AND PARTICIPANTS Mothers of infants aged 12 months old (N=111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device. RESULTS Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction. CONCLUSIONS Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.

Psychometric properties of an omnibus sleep problems questionnaire for school-aged children.

OBJECTIVE There is a paucity of sleep questionnaires that have been psychometrically validated for use in school-aged children. Due to the limitation regarding the psychometric properties and the great variety in question design, there remains a need for a robust omnibus questionnaire that assesses sleep problems in community populations. This study aimed to develop such a questionnaire for school-aged children by assessing the construct validity and reliability of a questionnaire based on a combination of childrens sleep domains from two frequently used and validated questionnaires (Habits Questionnaire and Sleep Disorders Scale for Children) and author devised questions. PATIENTS/METHODS Parents of 1904 children aged 5-10 years (mean 7.7 ± 1.7 years) from 32 elementary schools in Adelaide, South Australia, completed the questionnaire. RESULTS Principal axis factoring revealed six unique sub-scales--Sleep Routine, Bedtime Anxiety, Morning Tiredness, Night Arousals, Sleep Disordered Breathing, and Restless Sleep--containing a total of 26 items. Internal consistency for sub-scales were moderate to strong (range α = 0.6-0.8) and test-retest reliability was adequate (>0.4). T-score cut-offs were devised for age and sex. CONCLUSION The new questionnaire provides a robust set of sleep problem sub-scales which can be used for assessment of sleep concerns in a community sample as well as provide for optimal analysis of associations with other measures of childhood daytime functioning such as neurocognition and behaviour.

Parental-reported snoring from the first month of life and cognitive development at 12 months of age.

OBJECTIVE The aim of the present study was to evaluate the effect of persistent snoring in the first year of life on developmental outcomes. METHODS As part of a longitudinal study of snoring and sleep in infancy, we identified 13 children (10 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 and 12 months of age and 78 controls (31 males) who were reported by parents to never snore in the absence of a cold. Infants were assessed with the Bayley Scales of Infant and Toddler Development Edition III and parents completed demographic and sleep questionnaires. RESULTS Infants reported to snore frequently from the first month of life and who continued to snore frequently until 12 months of age had significantly lower cognitive development scores (mean=94.2; SD=3.9) compared to controls (mean=100.6; SD=3.7) (F (1, 96)=40 6, p<0.001; η(p)(2)=0.32). CONCLUSION Persistent frequent snoring from the first month of life was associated with lower cognitive development scores at 12 months of age. It is possible that this deficit will become worse with age.

Parent versus teacher report of daytime behavior in snoring children

PurposeProblematic behavior is widely reported in children with sleep-disordered breathing (SDB). Daytime behavior is an important component in the evaluation of clinical history in SDB; however, there is a reliance on parental report alone, and it is unclear whether reports by teachers will aid diagnosis.MethodsWe assessed sleep and behavior reported by both parents and teachers in 19 children with SDB and 27 non-snoring controls. All children were screened for prior diagnoses of other medical and/or behavior and learning disorders and underwent polysomnography and both parental and teacher assessment of behavior.ResultsBoth parents and teachers report greater problematic behavior in SDB children, predominantly of an internalizing nature. Despite this consistency and moderate correlation between informants, the agreement between parent and teacher reports of individual child behavior was poor when assessed using Bland–Altman plots.ConclusionsClinicians should be mindful that the behavioral history of a child being evaluated for SDB may vary depending on whether parent or teacher report is being discussed as this may influence clinical decision making.

Thermoregulation, scratch, itch and sleep deficits in children with eczema

Successful sleep onset and maintenance is associated with a reduction in core temperature, facilitated by heat loss at the distal periphery. Problems with initiating and maintaining sleep in children with eczema may relate to impaired thermoregulatory mechanisms, which also contribute to itching and scratching. Our hypothesis was that nocturnal distal skin temperature in eczematous children would be lower than controls, and would also be related to poor sleep quality. We compared overnight polysomnography and distal (finger) and proximal (clavicle) skin temperature in 18 children with eczema and 15 controls (6-16 years). Children with eczema had longer periods of nocturnal wakefulness (mean [SD] = 88.8 [25.8] vs. 44.3 [35.6] min) and lower distal temperatures (34.1 [0.6] °C vs. 34.7 [0.4] °C) than controls, whereas proximal temperature and the distal-proximal gradient were not significantly different. In children with eczema, a higher distal temperature was associated with indicators of poor sleep quality, whereas lower distal temperature was related to more scratching events during sleep. In conclusion, our findings indicate complex interrelationships among eczema, thermoregulation and sleep, and further, that deficits in thermoregulatory mechanisms may contribute to sleep disturbances in children with eczema.