Sleep health in Indigenous Australian children: a systematic review.

OBJECTIVE/BACKGROUND: The health and wellbeing of Indigenous Australian children has long been an issue of concern. However, to date there is a lack of attention to sleep health (particularly education and appropriate health service availability) in Indigenous Australians. The present review aimed to evaluate the prevalence of sleep problems in Indigenous Australians children. METHOD: Up to August 2020, a systematic search using the keywords: "sleep problems"; "sleep disturbances"; "sleep quality"," "sleep disorder"; "sleep apnoea"; "obstructive sleep apnoea"; "OSA"; and "sleep-disordered breathing" AND "Indigenous Australians"; "Aboriginal"; "Torres Strait Islander"; was conducted on PubMed; Informit Indigenous Collection Scopus and CINAHL; "LIt.search tool" from the Lowitja Institute; Indigenous HealthInfoNet, Google Scholar (advanced), government agencies and relevant grey literature. RESULTS: The search found only 13 studies focusing on sleep issues in Indigenous Australian children (birth to 17 years) with a pool of up to 4664 participants with 11 community-based studies (using mostly parental or self-report) and two in clinical populations (sleep laboratory). Three studies were longitudinal, all others were cross-sectional. Insomnia symptoms varied from 15% to 34.7%. Indigenous children reported severe daytime sleepiness (20%), short sleep (10.9%) late sleepers (50%). Snoring was reported in 14.2% with children in the community while up to 51% were objectively diagnosed to have OSA in a clinical setting. CONCLUSION: The availability of only 13 studies investigating paediatric Indigenous sleep highlights the paucity of data in this area. Compared with non-indigenous people, Indigenous children are significantly more likely to experience short sleep duration and a high proportion reported symptoms of sleep disordered breathing. Working and conferring with Indigenous communities is an opportunity to engage in partnerships to improve sleep health and subsequently general health.

Interindividual and intraindividual variability in adolescent sleep patterns across an entire school term: A pilot study.

OBJECTIVES: This study aimed to investigate sleep patterns in adolescent males over a 12-week period (a 10-week school term and pre and post term holidays). DESIGN: Intensive longitudinal design, with sleep data collected daily via actigraphy for 81 consecutive days. SETTING: Five Secondary Schools in Adelaide, South Australia. PARTICIPANTS: Convenience sample of 47 adolescent males aged 14 to 17 years. MEASUREMENTS: Daily sleep duration, bedtimes, rise times, and sleep efficiency were collected via actigraphy with all (except sleep efficiency) also measured by sleep diary. Mood was measured weekly with Depression Anxiety Stress Scale-21 (DASS-21) and weekly wellbeing with the Satisfaction with Life Scale (SWLS). Age, body mass index, self-reported mood, life satisfaction, and chronotype preference assessed at baseline (pre-term holiday week) were included as covariates. RESULTS: Dynamic Structural Equation Modeling indicated significant but small fixed-effect and random-effect auto-regressions for all sleep variables. Collectively, these findings demonstrate day-to-day fluctuations in sleep patterns, the magnitude of which varied between individuals. Age, morningness, and mood predicted some of the temporal dynamics in sleep over time but other factors (BMI, life satisfaction) were not associated with sleep dynamics. CONCLUSIONS: Using intensive longitudinal data, this study demonstrated inter-individual and intra-individual variation in sleep patterns over 81 consecutive days. These findings provide important and novel insights into the nature of adolescent sleep and require further examination in future studies.

Developing a musculo-skeletal screening survey for Indigenous Australians living in rural communities.

INTRODUCTION: Indigenous Australians living in rural communities experience high levels of musculoskeletal conditions that significantly impair their daily activities. Aboriginal health workers (AHWs) have a close understanding of their communities' needs and play a central role in the assessment and management of these conditions. To assist in the musculoskeletal assessment process a screening survey was collaboratively developed, trialled and evaluated for use by AHWs. METHODS: A cross-sectional survey was developed following discussions with key community informants, and a literature review for relevant survey instruments. It was piloted before being administered by AHWs and the findings compared with those of a clinical assessment conducted by musculoskeletal health professionals. The participants included 189 members of an Australian rural Indigenous community. RESULTS: The screening survey achieved face and content validity. It provided high sensitivity (above 70%) and moderately high specificity (above 60%) for measuring musculoskeletal conditions in this community. It did not achieve high enough Kappa scores when measuring agreement between the screening tool and clinical assessment. A significant correlation was, however, obtained between the most prevalent musculoskeletal condition and between reported overall pain as assessed by AHWs and chiropractors. CONCLUSIONS: The screening survey has applicability in this community and has the potential to be adapted in similar settings. Incorporating a basic range of motion and palpation assessment to localise painful anatomical sites may help to further improve the sensitivity and specificity of this instrument.

Are sleep problems under-recognised in general practice?

AIMS: To evaluate the frequency of sleep problems in Australian children aged 4.5-16.5 years, and to determine whether the frequency of sleep problems on questionnaire predicts the reporting of sleep problems at consultation. METHODS: Parents of 361 children (aged 4.5-16.5 years) attending their general practitioner for "sick" visits were asked to assess their child's sleep over the previous six months using the Sleep Disturbance Scale for Children, from which six sleep "disorder" factors and a total sleep problem score were obtained. RESULTS: The percentage of children with a total sleep problem score indicative of clinical significance (T score >70 or >95th centile) was 24.6% (89/361). Despite this high frequency, parents only addressed sleep problems in 4.1% (13/317) of cases and reported that GPs discussed sleep problems in 7.9% (25/317) of cases. Of the 79 children who reported total sleep problem T scores in the clinical range, only 13.9% (11/79) discussed sleep with their general practitioner within the previous 12 months. Regression analyses revealed an age related decrease in problems with sleep-wake transition and sleep related obstructive breathing; sleep hyperhydrosis, initiating and maintaining sleep, and excessive daytime sleepiness did not significantly decrease with age. No significant gender differences were observed. CONCLUSIONS: Results suggest that chronic sleep problems in Australian children are significantly under-reported by parents during general practice consultations despite a relatively high frequency across all age groups. Given the impact on children and families, there is a need for increased awareness of children's sleep problems in the community and for these to be more actively addressed at consultation.

Reduced neurocognition in children who snore.

Obstructive sleep apnea syndrome (OSAS) has been associated with reduced neurocognitive performance in children, but the underlying etiology is unclear. The aim of this study was to evaluate the relationship between hypoxemia, respiratory arousals, and neurocognitive performance in snoring children referred for adenotonsillectomy. Thirteen snoring children who were referred for evaluation regarding the need for adenotonsillectomy to a children's hospital otolaryngology/respiratory department underwent detailed neurocognitive and polysomnographic (PSG) evaluation. PSGs were evaluated for respiratory abnormalities and compared with 13 nonsnoring control children of similar age who were studied in the same manner. The snoring children had an obstructive respiratory disturbance index within normal range (mean obstructive apnea/hypopnea index, 0.6/hr). Despite this, several domains of neurocognitive function were reduced in the snoring group. These included mean verbal IQ scores (snorers 92.6 vs. nonsnorers 110.2, P < 0.001), mean global IQ scores (snorers 96.7 vs. nonsnorers 110.2, P < 0.005), mean selective attention scores (snorers 46.4 vs. nonsnorers 11.8, P < 0.001), mean sustained attention scores (snorers 8.0 vs. nonsnorers 2.2, P = 0.001), and mean memory index (snorers 95.2 vs. nonsnorers 112.1, P = 0.001). There was a direct relationship between number of mild oxygen desaturations of > or = 3%, obstructive hypopneas with > or = 3% oxygen desaturations, and respiratory arousals and severity of neurocognitive deficits, with the greatest effect being on memory scores. The disruption of sleep in snoring children produced by relatively mild changes in oxygen saturation or by increases in respiratory arousals may have a greater effect on neurocognitive function than hitherto appreciated. A possible explanation for these neurocognitive deficits may be the combination of the chronicity of sleep disruption secondary to snoring which is occurring at a time of rapid neurological development in the first decade of life. Future studies need to confirm the reversal of these relatively mild neurocognitive decrements post adenotonsillectomy.

Aboriginal health in Aboriginal hands: development, delivery and evaluation of a training programme for Aboriginal health workers to promote the musculoskeletal health of Indigenous people living in a rural community.

CONTEXT: Indigenous Australians living in rural communities suffer from multiple musculoskeletal problems that significantly impair their activities of daily living. They commonly report physical disability and 'having learned to live with their pain'. A pilot, accredited musculoskeletal training program in the form of a sports massage course was designed and implemented in an attempt to address modifiable, commonly-presenting musculoskeletal conditions in this community. ISSUE: Sports massage was taught to 20 participant Aboriginal Health workers (AHWs) and community Elders at Durri Aboriginal Corporation, New South Wales, Australia. Sports massage was chosen as the vehicle for skills development because sport was widely valued in the community. The participants were taught a variety of theoretical and massage skills in the 2 week course using the informal 'round table' techniques developed by Booroongen Djugun College, NSW, Australia. The course was evaluated positively by participants. Because the course was developed according to community guidelines it had high cultural acceptability. LESSONS: Sports massage skills have been adapted for treatment of patients with chronic illness and stress within the community. Development of the course according to community needs was essential for acceptance, as was the active involvement of AHWs in all phases. For sustainability, such courses require appropriate funding.

Cognitive and behavioural performance in children with sleep-related obstructive breathing disorders.

Sleep-related obstructive breathing disorders (SROBD) are common in children. While the sequelae of cor pulmonae, and growth and developmental impairment have been well documented, neurocognitive deficits have been less well studied. There is emerging evidence that children with SROBD show reduced neurocognitive functioning especially in the inter-related areas of attentional capacity, memory and cognitive function. In addition, these children show increased problematic behaviour and reduced school performance. Early reports suggest that some of these deficits may be reversible with treatment. The genesis of the defects is unclear but may include hypoxaemia and subtle changes in sleep architecture. The natural history of SROBD and long-term effects on neurocognitive functioning and behaviour remain to be fully examined.

Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls.

Sleep disordered breathing in children is a common but largely underdiagnosed problem. It ranges in severity from primary snoring to obstructive sleep apnea syndrome (OSAS). Preliminary evidence suggests that children with severe OSAS show reduced neurocognitive performance, however, less is known about children who snore but do not have severe upper airway obstruction. Participants included 16 children referred to the Ear, Nose and Throat/Respiratory departments of a Children's Hospital for evaluation of snoring and 16 non-snoring controls aged 5-10 years. Overnight polysomnography (PSG) was carried out in 13 children who snored and 13 controls. The PSG confirmed the presence of primary snoring in seven and very mild OSAS (as evidenced by chest wall paradox) in eight children referred for snoring while controls showed a normal sleep pattern. To test for group differences in neurocognitive functioning and behavior, children underwent one day of testing during which measures of intelligence, memory, attention, social competency, and problematic behavior were collected. Compared to controls, children who snored showed significantly impaired attention and, although within the normal range, lower memory and intelligence scores. No significant group differences were observed for social competency and problematic behavior. These findings suggest that neurocognitive performance is reduced in children who snore but are otherwise healthy and who do not have severe OSAS. They further imply that the impact of mild sleep disordered breathing on daytime functioning may be more significant than previously realized with subsequent implications for successful academic and developmental progress.

The development of a new methodology to assess perceived needs among indigenous Australians.

The present study examined a new methodology to assess the perceived needs of Indigenous Australians in two urban communities. This methodology, utilizing graphics, allowed for the classification of general areas of need into four domains namely, health, education and employment, housing as well as social issues and community facilities. In addition participants were able to prioritize their identified needs both within the four domains as well as across domains. Overall, a number of similarities of perceived needs were noted between the communities. The results are discussed in terms of the lack of information on Indigenous Australian peoples' perceptions of their needs and the use of the new methodology to allow a wider examination of perceived needs.

The prevalence of drug use in urban aboriginal communities.

The use of both licit and illicit drugs has been identified as a major health issue for Australian Aborigines. However, data on the proportion of people who use such drugs is scant. This cross-sectional survey of a randomly selected sample of urban Aboriginal people provides information on the use of the drugs alcohol, tobacco, marijuana, cocaine, heroin as well as petrol sniffing. Overall, a significantly smaller proportion of Aboriginal people were found to be current alcohol drinkers compared to non-Aboriginal Australians. A larger proportion of these drinkers were, however, found to be drinking at levels that were hazardous to their health. A significantly greater proportion of people from the Aboriginal sample were also found to be smokers compared to their non-Aboriginal counterparts. An examination of the use of the illicit substances revealed that a greater proportion reported they had ever used marijuana, compared to the other substances. The findings are discussed in terms of their implications for the health of Aboriginal people.