Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study

Abstract

ObjectiveTo explore whether children born extremely preterm (EPT) with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.DesignProspective, nationwide, questionnaire-based study. At 11 years of age, parents reported on four current sleep problems: difficulty falling asleep or frequent awakenings, snoring, daytime sleepiness and not recommended sleep duration (<9 hours). Behavioural problems were assessed by parents and teachers with the Strengths and Difficulties Questionnaire (SDQ). Parents assessed respiratory symptoms with the International Study of Asthma and Allergies in Childhood questionnaire and described use of asthma medication.SettingNorway.PatientsEPT children.Main outcome measuresSpecified sleep problems, behavioural problems and respiratory health.ResultsData were obtained from 216 of 372 (58 %) of eligible children. All four specified sleep problems were associated with significantly higher parent-reported SDQ total-score (OR 1.1 for all), and except for not recommended sleep duration, also with higher teacher-reported SDQ total-score (OR 1.1 for all). Daytime sleepiness was strongly associated with wheezing last 12 months (OR 3.4), disturbed sleep due to wheezing (OR 3.9), wheeze during or after exercise (OR 2.9), use of inhaled corticosteroids or oral leukotriene modifiers (OR 3.4) and use of bronchodilators (OR 3.9). Snoring was associated with wheezing during or after exercise (OR 2.8) and current asthma (OR 4.2).ConclusionEPT children with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.

Association of sleep disorders with asthma: a meta-analysis

“…We identified 216 potentially eligible articles by reviewing titles and abstracts. Ultimately, 23 studies6–17 19–21 29–36 met the eligibility criteria and were included in the meta-analysis.…”

“…Table 1 summarises the authors, regions and population characteristics (eg, age and sex) of each study. Five cohort studies6 7 21 29 32 and 18 cross-sectional studies8–17 19 20 30 31 33–36 were included in the meta-analysis. Sleep disorders were assessed using questionnaires, face-to-face interviews or medical records.…”

“…Two prospective cohort studies have found that chronic insomnia symptoms significantly increased the risk of asthma 6 7. However, other studies have indicated that asthma is not associated with poor sleep quality 8–12. Moreover, several large-scale cross-sectional studies8 10 13–20 have investigated the association between insufficient sleep and asthma, with widely divergent results.…”

Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms

“…Whilst the causal mechanisms implicating snoring in behavioural problems are unknown, parent-reported snoring two or more times a week was a stronger predictor of hyperactivity, inattention, psychosomatic, internalising and externalising problems than polysomnography-assessed and sleep-expert-scored apnea-hypopnea index severity in a community sample of children aged 6-10 years [21]. The only study in children born extremely preterm/ELBW showed that, at age 11, those children who snored had significantly greater emotional and conduct problems and there were trends towards higher hyperactivity/inattention and peer problems than extremely preterm/ELBW children who did not snore [22].…”

“…Regarding the association between sleep disturbance and behaviour, only one study has investigated this relationship in extremely preterm children [22]. Greater difficulties falling asleep or waking frequently were associated with greater emotional, conduct, hyperactivity/inattention and peer problems at age 11 years [22].…”