Louise M. O'Brien

The Neurocognitive Effects of Sleep Disruption in Children and Adolescents

Sleep problems in children and adolescents are common, and sleep disruption is associated with a wide range of behavioral, cognitive, and mood impairments, including hyperactivity, reduced school grades, and depression. Insufficient or fragmented sleep may induce sleepiness, which is associated with problematic behavior, impaired learning, and/or negative mood. Furthermore, treatment of sleep disruption, by improving sleep hygiene or treating specific sleep disorders, is often associated with improvements in daytime performance, suggesting a common mechanism for the behavioral manifestations. This article reviews the daytime manifestations of sleep disruption.

Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study

OBJECTIVEnThis study aimed to prospectively examine the impact of chronic vs pregnancy-onset habitual snoring on gestational hypertension, preeclampsia, and gestational diabetes.nnnSTUDY DESIGNnThird-trimester pregnant women were recruited from a large, tertiary medical center from March 2007 through December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, preeclampsia, and gestational diabetes were obtained.nnnRESULTSnOf 1719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders, pregnancy-onset, but not chronic, snoring was independently associated with gestational hypertension (odds ratio, 2.36; 95% confidence interval, 1.48-3.77; P < .001) and preeclampsia (odds ratio, 1.59; 95% confidence interval, 1.06-2.37; P = .024) but not gestational diabetes.nnnCONCLUSIONnNew-onset snoring during pregnancy is a strong risk factor for gestational hypertension and preeclampsia. In view of the significant morbidity and health care costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility.

Association of maternal sleep practices with pre-eclampsia low birth weight and stillbirth among Ghanaian women.

To assess sleep practices, and investigate their relationship with maternal and fetal outcomes, among pregnant Ghanaian women.

Sleep-Disordered Breathing Affects Auditory Processing in 5–7 Year-Old Children: Evidence From Brain Recordings

Poor sleep in children is associated with lower neurocognitive functioning and increased maladaptive behaviors. The current study examined the impact of snoring (the most common manifestation of sleep-disordered breathing) on cognitive and brain functioning in a sample of 35 asymptomatic children ages 5–7 years identified in the community as having habitual snoring (SDB). All participants completed polysomnographic, neurocognitive (NEPSY), and psychophysiological (event-related potentials [ERPs] to speech sounds) assessments. The results indicated that sub-clinical levels of SDB may not necessarily lead to reduced performance on standardized behavioral measures of attention and memory. However, brain indices of speech perception and discrimination (N1/P2) are sensitive to individual differences in the quality of sleep. We postulate that addition of ERPs to the standard clinical measures of sleep problems could lead to early identification of children who may be more cognitively vulnerable because of chronic sleep disturbances.

The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for sleep‐disordered breathing

In the absence of formal polysomnography (PSG), many children with symptoms of sleep‐disordered breathing (SDB) go unrecognized and thus may be at risk for perioperative respiratory adverse events (PRAE).

Typical sleep positions in pregnant women

OBJECTIVEnMaternal supine posture in late pregnancy and labor is known to compromise maternal hemodynamics and subsequently affect the fetus. Recently, maternal supine sleep position during late pregnancy has been postulated to play a role in stillbirth. However, no objective data exist regarding how often pregnant women sleep supine. This study was therefore conducted to determine the proportion of pregnant women who spend time asleep in the supine position.nnnMETHODSnA secondary analysis of data from pregnant women who underwent home sleep studies.nnnRESULTSnOf 51 pregnant women, mean gestational age 28.3±6.9weeks, the vast majority of women (82.4%) spent some time sleeping in the supine position. The median proportion of overall time spent in the supine sleep position was 26.5% (90%CI 0.0-82.9%).nnnCONCLUSIONnOur data suggest that if supine position plays a role in stillbirth, most women may benefit from education regarding sleep position.nnnPRACTICE IMPLICATIONSnMost pregnant women spend time asleep on their back. Given the known data on supine posture and maternal cardiovascular compromise together with emerging data on supine sleep position and stillbirth, it may be pertinent for healthcare providers to provide pregnant women with information about sleep position particularly during late pregnancy.

A Preliminary Study of New Parents, Sleep Disruption, and Driving: A Population at Risk?

Background Drowsy driving is estimated to be a causal factor in 2–16xa0% of vehicular crashes. Several populations are reported to be at high risk for drowsy driving accidents, including shift workers, teenage drivers, medical residents, and pilots. Although new parents are known to have significant sleep disruption, no study has investigated vehicular accidents or near miss accidents in this population. Methods A preliminary cross-sectional, anonymous survey of parents who had given birth within the previous 12xa0months. Participants were asked about their sleep, including validated measures of sleep disruption, their driving patterns, and information about near miss traffic accidents and actual crashes. Results Overall, 72 participants were enrolled. A large proportion of participants had poor sleep including approximately 30xa0% with daytime sleepiness, 60xa0% with poor daytime function and two-thirds with poor sleep quality. The mean sleep duration was only 6.4xa0h. Although most participants drove <100 miles per week, 22.2xa0% reported at least one near miss accident and 5.6xa0% reported a crash. Sleep problems were more common in those with near miss accidents and actual crashes than in those without. Of note, poor sleep quality was associated with a sixfold increase in near miss accidents even after accounting for other factors. Conclusion Poor sleep is common in new parents and we provide preliminary evidence that sleep disruption in this population is associated with near miss motor vehicle accidents. Drowsy driving results in thousands of unnecessary serious injuries and fatalities each year; raising public awareness that new parents are a high-risk group is important.

The STBUR questionnaire for identifying children at risk for sleep‐disordered breathing and postoperative opioid‐related adverse events

Children with symptoms of sleep‐disordered breathing (SDB) appear to be at risk for perioperative respiratory events (PRAE). Furthermore, these children may be more sensitive to the respiratory‐depressant effects of opioids compared with children without SDB.

Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact.

OBJECTIVEnThe aim of this study was to assess the frequency and potential clinical impact of periodic leg movements during sleep (PLMS), with or without arousals, as recorded incidentally from children before and after adenotonsillectomy (AT).nnnMETHODSnChildren scheduled for AT for any clinical indications who participated in the Washtenaw County Adenotonsillectomy Cohort II were studied at enrollment and again 6 months thereafter. Assessments included laboratory-based polysomnography, a Multiple Sleep Latency Test (MSLT), parent-completed behavioral rating scales, neuropsychological testing, and psychiatric evaluation.nnnRESULTSnParticipants included 144 children (81 boys) aged 3-12 years. Children generally showed mild to moderate obstructive sleep apnea (median respiratory disturbance index 4.5 (Q1 = 2.0, Q3 = 9.5)) at baseline, and 15 subjects (10%) had at least five periodic leg movements per hour of sleep (PLMI ≥ 5). After surgery, 21 (15%) of n = 137 subjects who had follow-up studies showed PLMI ≥ 5 (p = 0.0067). Improvements were noted after surgery in the respiratory disturbance index; insomnia symptoms; sleepiness symptoms; mean sleep latencies; hyperactive behavior; memory, learning, attention, and executive functioning on NEPSY assessments; and frequency of attention-deficit/hyperactivity disorder (DSM-IV criteria). However, PLMI ≥ 5 failed to show associations with worse morbidity in these domains at baseline or follow-up. New appearance of PLMI ≥ 5 after surgery failed to predict worsening of these morbidities (all p > 0.05), with only one exception (NEPSY) where the magnitude of association was nonetheless negligible. Similar findings emerged for periodic leg movements with arousals (PLMAI ≥ 1).nnnCONCLUSIONnPLMS, with and without arousals, become more common after AT in children. However, results in this setting did not suggest substantial clinical impact.

Excessive Fetal Movements are a Sign of Fetal Compromise Which Merits Further Examination

Changes in fetal movement are associated with increased risk of stillbirth after 28u202fweeks of pregnancy. The majority of studies have focussed on maternal perception of reduced fetal movements, which is associated with stillbirth via placental dysfunction. Recent studies have also described an association between a single episode of excessive fetal movements and late stillbirth. We present a hypothesis that a sudden episode of excessive fetal activity indicates fetal compromise relating to underlying disturbance of the in utero environment, which if it persists can lead to fetal death. The origin of the excessive fetal movements is unknown; they may represent fetal seizures induced by asphyxia or infection, an attempt to release cord entanglement or a change in fetal behaviour (inducing signs of distress) in response to a noxious stimulus. It is also possible that an increase in maternal anxiety may lead to increased perception of fetal activity. Current evidence regarding excessive fetal movements is sparse; there is no clinical guidance regarding how reporting of this symptom might relate to a fetus at risk and which management might reduce the risk of subsequent stillbirth. This could be addressed by prospective observational studies of mothers presenting with excessive fetal movements which could both explore the underlying pathophysiology and determine which investigations could identify fetal compromise in this population. The presence of fetal seizures or umbilical cord entanglement could be evaluated at the time of presentation by cardiotocography and ultrasonography of the fetus and cord. Exposure to infection or noxious stimuli could be evaluated by maternal history and measurement of maternal blood for inflammatory markers or toxins. Maternal anxiety could be assessed by validated anxiety scores. Fetal outcome following excessive fetal movements can be recorded after birth. In addition, the presence of perinatal asphyxia can be assessed using Apgar scores, assessment of fetal acidaemia or measurement of stress-related factors in umbilical cord blood. The placenta and cord can be systematically examined for signs of hypoxia, infection or umbilical cord compression. Such studies would provide evidence regarding the underlying cause of excessive fetal movement and how this symptom might relate to in utero compromise and stillbirth. Ultimately, this approach will determine whether excessive fetal movements can be used alongside reduced fetal movements as a tool to reduce the perinatal mortality rate.