Sleep disturbances in Malaysian children with cerebral palsy

Abstract

DIMSMETHOD The study was a case-control study of 109 children with CP (61 males, 48 females; mean age 9y, SD 3y 11mo, range 4-18y) and their healthy siblings (56 males, 53 females; mean age 10y, SD 3y 9mo, range 4-18y). The Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. In children with CP, multiple regression analysis was be used to determine factors related to higher Total SDSC sleep scores.RESULTS Ninety-seven children (89%) had spastic CP, 10 (9%) had dyskinetic CP, and two (2%) had mixed CP. Based on the Gross Motor Function Classification System (GMFSC), 34 patients (31%) were at GMFSC level I or II, 10 patients (9%) at level III, and 65 patients (60%) at level IV or V. Children with CP scored significantly higher than their siblings on Total SDSC and four SDSC subscale scores -difficulty in initiating and maintaining sleep, sleep breathing disorders, sleep-wake transition disorders, and sleep hyperhidrosis. Caregiver sleep duration of less than 7 hours (p=0.02) and caregiver sleep latency of more than 30 minutes (p=0.03) were significantly associated with higher Total SDSC scores. Co-sleeping was not a significant factor.INTERPRETATION Sleep disturbances are more common in children with CP than in their siblings. Attention should be given to caregiver sleep when evaluating sleep disturbances in children with CP as this factor was shown to be associated with higher Total SDSC scores.There is a growing body of evidence that children with cerebral palsy (CP) are at increased risk of sleep disturbances. [1][2][3] Owing to the heterogeneity of the condition (nature of the underlying brain injury, spectrum and evolution of the clinical picture over time, and multiple comorbid conditions), the types of sleep disturbances and their risk factors in these children may be varied. For those with total body involvement and spasticity, muscle spasm and the need for repositioning in the night can result in a disrupted sleep. 4,5 Epilepsy, which is a common comorbidity, has been shown to be strongly correlated with sleep disorders.

Co‐sleeping in school‐aged children with a motor disability: a comparative population‐based study

“…Even though the comparison is limited by the study not focusing on a single diagnosis, our rates of regular co‐sleeping in the children with motor disability are similar to those reported in previous studies on CP and Duchenne muscular dystrophy . In their study, Atmawidjaja et al reported a rate of co‐sleeping of about twice the rate we found in children with motor disabilities. Besides the different demographic and medical characteristics of their study population, the difference found in terms of co‐sleeping rate and type may be related to the cultural and social aspects involved in how families handle sleep arrangements.…”

“…Even though the comparison is limited by the study not focusing on a single diagnosis, our rates of regular cosleeping in the children with motor disability are similar to those reported in previous studies on CP and Duchenne muscular dystrophy. 7,9 In their study, Atmawidjaja et al 8 reported a rate of co-sleeping of about twice the rate we GMFCS, Gross Motor Function Classification System. found in children with motor disabilities.…”

“…In their study on sleep disorders in children with CP, Newman et al found that 22.9% of the children co‐slept at least weekly, and this was positively associated with sleep disorders. In a different sociocultural setting, Atmawidjaja et al found a 76% rate of co‐sleeping in children with CP, and there was no significant association with sleep disorders. For children with severe psychomotor impairments of various origins Tietze et al reported a 24% rate of frequent, at least three times a week, co‐sleeping.…”

Children with cerebral palsy: why are they awake at night? A pilot study

“…Evidence suggests that children with CP more commonly experience sleep disturbance than their typically developing peers (Atmawidjaja, Wong, Yang, & Ong, ; Wayte et al., ). However, the majority of studies investigating sleep problems in children with CP have focused on pathophysiological reasons why they are awake, including obstructive sleep apnea, sleep disordered breathing, insomnia, delayed sleep onset, issues maintaining sleep, and nocturnal epilepsy (Atmawidjaja et al., ; Sandella et al., ; Wright, Tancredi, Yundt, & Larin, ). There is a paucity of research that focuses on sleep disturbance related to care and comfort needs for children with CP.…”

Sleep: the other life of children with cerebral palsy

“…Atmawidjaja et al. 's study makes a significant contribution to the literature on sleep in CP, by exploring sleep quality in an ethnically and culturally distinct population of Malaysian children, compared with previous research performed in Western countries …”