SUMMARY The outcome of 19 consecutive children referred with sleep disorders and managed by behavioural methods is described. An 84 % success rate is reported, which was maintained at 6 months' follow up. Successful outcome was associated with absence of marital discord and attendance of both parents at treatment sessions.A sleep problem is one of the most common disorders reported by parents of preschool children. Difficulty may be experienced settling a child to sleep or in frequent night waking, or both. This may seriously disrupt family life leading to fatigue, irritability, limitations on the parents' activities, and marital strain. Bax has drawn attention to the association of sleep problems with child abuse and maternal depression.'Most epidemiological studies have investigated the prevalence of night waking rather than settling problems. One study reported night waking in 23 % of infants at 1 year, 24% at 18 months, and 14% at age 3 years.2 Other studies report similar data.3-5 Richman et al.6 found that 13 % of 3 year olds were having difficulty settling to sleep and 14% were waking at night. The longitudinal studiesl 4 5 substantiate the clinical impression that in many children night waking persists through the preschool years.
BackgroundSleep deprivation and fatigue from long-shift work impacts doctors' personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK deanery.MethodsA trainee cohort numbering 38 (21 core, 17 higher surgical trainees, 29 men and 9 women, median age 31 (25–44 years)) completed a sleep diary over 30 days using the Sleep Time (Azumio) smartphone application and triangulated with on-call rosters to identify shift patterns. The primary outcome measure was sleep quality related to rostered clinical duties.ResultsConsecutive 1152 individual sleep episodes were recorded. The median time asleep (hours:min) was 6:29 (5:27–7:19); the median sleep efficiency was 86% (80%–93%); the median light sleep (hours:min) was 2:50 (1:50–3:49); and the median rapid eye movement (REM) sleep (hours:min) was 3:20 (2:37–4:07). Significant adverse sleep profiles were observed in trainees undertaking emergency on-call duty when compared with elective (non-on-call) duty; the median time asleep (hours:min) 5:49 vs 6:43 (p<0.001); the median sleep efficiency was 85% vs 87% (p<0.001); the median light sleep (hours:min) was 2:16 vs 2:58 (p<0.001); and REM sleep (hours:min) was 2:57 vs 3:27 (p<0.001). Recovery of sleep duration, efficiency and quality necessitated five full days of time.ConclusionSurgical emergency on-call duty adversely influences sleep quality. Proper consideration of fail-safe rota design, prioritising sleep hygiene, recovery and well-being, allied to robust patient safety and quality of care should be made a priority.
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