Comparison of sleep quality between outpatient and hospitalized children with respiratory tract dysfunction.

OBJECTIVES: The main objective of the study to compare the effect of hospitalized and outpatient settings on quality of sleep in children with respiratory tract dysfunction. METHODOLOGY: A descriptive correlational study was carried out at Dhi-Qar Health Directorate pediatric hospitals. The period of the study was from the November 19, 2023 to March 10, 2024. Purposive sample (non-probability) of 250 children (male and female). A total of (125) children were chosen from the children whose admitted to the hospitals, and a total of (125) children were chosen from the outpatient settings. The study instrument consisted of three parts: the sociodemographic sheet, clinical diagnosis sheet, and sleep quality scale. The questionnaire was modified according to experts' recommendation to use it for children with respiratory tract dysfunction. The questionnaire was evaluated by a panel of 15 experts from diverse medical and nursing professions. Both descriptive and inferential statistics were used to analyze the data. RESULTS: The study findings that effect outpatient settings have more effect from hospitalized settings on quality of sleep in children with respiratory tract dysfunction (M ± SD = 1.322 ± 0.1522). CONCLUSION: A study showed that the quality of sleep in children with respiratory tract dysfunction was generally average, whether in hospitalized or outpatient settings, outpatient settings had greater difficulties falling asleep and waking than children in hospitalized.

Validity and reliability of the Swedish version of the Children's Sleep Habits Questionnaire (CSHQ-SWE).

BACKGROUND: To translate and culturally adapt the Children's Sleep Habits Questionnaire (CSHQ) to a Swedish version, CSHQ-SWE, and to assess its validity and reliability for use with children with attention deficit hyperactivity disorder (ADHD). METHODS: A total of 84 children with ADHD (51 boys and 33 girls; 6-12 years) and parents (7 men and 77 women; 28-51 years) were included in the study. CSHQ was translated and culturally adapted to Swedish, and assessed for concurrent validity with sleep actigraphy (analyzed by Kendall's Tau) and for reliability by internal consistency (analyzed by McDonald's Omega H). Face and content validity was evaluated by parents (n = 4) and healthcare professionals (n = 6) qualitatively (comprehensiveness, relevance, and comprehensibility assessed by interviews and analyzed by thematic analysis) and quantitatively (analyzed by content validity ratio and content validity index for 33 items and four non-scored inquiries). RESULTS: Parent-reported sleep problems (CSHQ-SWE total score) were moderately correlated with less "Sleep Efficiency" (Tau = -0.305; p < 0.001) measured by sleep actigraphy. Parent-reported problems with "Sleep Onset Delay" was moderately correlated with measured time for "Sleep Onset Latency" (Tau = 0.433; p < 0.001). Parent-reported problems with "Night Wakings" were weakly correlated with measured time for "Wake After Sleep Onset" (Tau = 0.282; p < 0.001). Parents estimation of "Total daily sleep duration" was moderately correlated with measured "Total Sleep Time" (Tau = 0.386; p < 0.001). Five of the seven subscales reached an acceptable level for internal consistency (McDonald's Omega H > 0.700). Comprehensiveness, relevance, and comprehensibility of CSHQ-SWE were satisfactory overall. Content validity ratio was 0.80 to 1.00 for six items, 0.00 to 0.60 for 22 items, and < 0.00 for nine items. Content validity index was 0.22. CONCLUSIONS: CSHQ-SWE demonstrated acceptable concurrent validity with objectively measured sleep and internal consistency, whereas the overall results of face and content validity assessment varied. The instrument needs to be further evaluated regarding construct validity, responsiveness, test-retest reliability, and its generalization to other populations.

The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial.

BACKGROUND: Adequate sleep and exercise are important components of the human lifestyle. Paying attention to these two factors is very important to improve the condition of children with type 1 diabetes. Therefore, this study aimed to investigate the effect of exercise on sleep habits in children with type 1 diabetes. MATERIAL & METHODS: 62 children with type 1 diabetes participated in this clinical trial. They will be divided into the intervention group (31) and the control group (31). Sleep habits were measured using the Children's Sleep Habits Questionnaire (CSHQ). All children's parents completed the CSHQ. The intervention for the experimental group consisted of 8 weeks of regular exercise program. The exercise program was prepared as an educational video and provided to parents. Paired sample t-test and ANCOVA test were used with SPSS 23. RESULTS: 62 children with an average age of 9.32 ± 2.02 were studied. Fifty-four and eight% of the children were girls and the rest were boys. The analysis of the variance test showed a significant difference (F = 144.72, P ≤ 0.01) between the average score of the sleep habits of the control group (62.45 ± 5.12) and the experimental group (47.06 ± 4.39). CONCLUSION: Sleep habits in the experimental group improved after 8 weeks of exercise training using educational videos. Exercise as a non-pharmacological treatment is an effective way to manage diabetes and improve sleep quality in diabetic children.

Sleep Habits, Academic Performance and Health Behaviors of Adolescents in Southern Greece.

Adolescents often experience insufficient sleep and have unhealthy sleep habits. Our aim was to investigate the sleep patterns of secondary education students in Heraklion, Crete, Greece and their association with school performance and health habits. We conducted a community-based cross-sectional study with 831 students aged 13-19 years who completed an online self-reported questionnaire related to sleep and health habits. The data are mostly numerical or categorical, and an analysis was performed using t-tests, chi-square tests and multiple logistic regression. During weekdays, the students slept for an average of 7 ± 1.1 h, which is significantly lower than the 7.8 ± 1.5 h average on weekends (p < 0.001). Nearly 79% reported difficulty waking up and having insufficient sleep time, while 73.8% felt sleepy at school at least once a week. Having sufficient sleep time ≥ 8 h) was positively correlated with better academic performance (OR: 1.48, CI: 1.06-2.07, p = 0.022) and frequent physical exercise (never/rarely: 13.5%, sometimes: 21.2%, often: 65.3%; p = 0.002). Conversely, there was a negative correlation between adequate sleep and both smoking (OR: 0.29, CI: 0.13-0.63) and alcohol consumption (OR: 0.51, CI: 0.36-0.71, p = 0.001). In conclusion, this study shows that students in Heraklion, Crete frequently experience sleep deprivation, which is associated with compromised academic performance, reduced physical activity and an increased likelihood of engaging in unhealthy behaviors like smoking and alcohol consumption.

Evaluation of Sleep Habits and Their Relationship With Quality of Life in Children With Epilepsy.

BACKGROUND: The aim of this study was to investigate sleep habits, quality of life (QoL), and the relationship between them in children with epilepsy. METHODS: In this cross-sectional study, children aged two to 18 years being followed up for epilepsy were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and the Pediatric Quality of Life Inventory (PedsQL). Pearson or Spearman correlation analysis was performed to examine the relationship between normally distributed and non-normally distributed variables, respectively. Linear regression analysis was used to examine independent variables associated with PedsQL total scale score. Level of significance was accepted as P < 0.05. RESULTS: The study included 112 children with a mean age of 10.5 ± 4.4 years (51.8% female). The frequency of poor sleep habits was 96.4%. There was a good level of agreement between children's and parents' PedsQL total, physical health, and psychosocial health scores (P < 0.001). Correlation analysis between QoL and sleep parameters revealed negative correlations between total sleep score and self-assessed PedsQL total scale, physical health, and psychosocial health scores (P < 0.05) and parent-assessed PedsQL total scale and psychosocial health scores (P < 0.05). The results of linear regression analysis indicated that the factors most significantly associated with lower QoL were high CSHQ total sleep score and exclusively daytime seizures (P < 0.001). CONCLUSIONS: It was found that children with epilepsy had poor sleep habits and low QoL and that poor sleep habits have a negative impact on QoL.

Impact of COVID-19 outbreak on subjective sleep during lockdown: relation with resilience characteristics.

The SARS-CoV-2 pandemic had a considerable impact on both the physical and mental health of people. Resilience is a psychological characteristic reflecting the ability to overcome or adapt to difficulties such as adversity, trauma, or extremely stressful situations. People with high resilience have been shown to exhibit lower levels of anxiety, stress and depression when faced with a stressful event. Sleep is particularly sensitive to anxiety and stress. The aim of this study was to investigate the impact of COVID-19 pandemic on sleep quantity, quality, and habits, while considering resilience as a factor. A total of 1260 individuals were recruited through an online survey. The variables that were assessed were socio-demographic, sleep habits and sleep disorders history, the Athens Insomnia Scale (AIS), the 25-item version of the Connor-Davidson Resilience Scale (CD-RISC), and any work/financial consequences during the first COVID-19 lockdown. The results showed that sleep habits during the lockdown changed for many of the participants. Their sleep schedule moving towards earlier or later for 9% and 67% of them, respectively; 38% of the participants were found to suffer from insomnia, based on the AIS score. A higher score on the CD-RISC was associated with better sleep. In conclusion, our study confirmed previous studies identifying quantitative and qualitative changes in sleep during the COVID-19 lockdown. It also expanded on the previous findings by identifying the correlation between sleep and resilience during the stressful period of the COVID-19 lockdown.

Late effects of caffeine use on sleep of infants born prematurely / Efeitos tardios do uso de cafeína no sono de crianças nascidas prematuras

ABSTRACT Objective: This study aimed to evaluate whether the therapeutic use of caffeine for premature newborns is associated with changes in sleep habits and the presence of obstructive sleep apnea in childhood. Methods: This is a cross-sectional single-center study in which the caretakers of 87 children aged 5-10 years, born full-term or preterm, treated or not with caffeine in the neonatal period, answered questionnaires to screen for obstructive sleep apnea (Pediatric Obstructive Sleep Apnea Screening Tool [PosaST]) and to characterize the sleep habits (Children's Sleep Habits Questionnaire [CSHQ]) of their children. ANOVA and linear regression tests were performed to verify possible differences between the groups. Results: Children born prematurely who were treated with caffeine woke up significantly later on weekdays than those born at term (09h±00h58 and 07h43±1h15, respectively, p=0.022) and had longer total daily sleep time also compared to those born at term (10h24±1h08 and 09h29±1h08, respectively, p<0.001). There was no significant difference between the three groups in overall PosaST and CSHQ scores. Conclusions: Caffeine use in the neonatal period did not impair sleep habits later in life and did not lead to increased obstructive sleep apnea scores in prematurely born children compared to those born at term.

RESUMO Objetivo: Avaliar se o uso terapêutico de cafeína para recém-nascidos prematuros se associa a alterações nos hábitos de sono e à presença de apneia obstrutiva do sono na infância. Métodos: Este é um estudo unicêntrico transversal no qual os responsáveis por 87 crianças com idades entre cinco e dez anos, nascidas a termo ou pré-termo e tratadas ou não com cafeína no período neonatal responderam a questionários para triagem de apneia obstrutiva do sono (Pediatric Obstructive Sleep Apnea Screening Tool - PosaST) e para a caracterização dos hábitos de sono (Children's Sleep Habits Questionnaire - CSHQ) de seus filhos. Foram realizados testes de variância (ANOVA) e de regressão linear para verificar possíveis diferenças entre os grupos. Resultados: As crianças nascidas prematuras que foram tratadas com cafeína acordaram significativamente mais tarde nos dias de semana do que as nascidas a termo (09h±00h58 e 07h43±1h15, respectivamente, p=0,022) e tiveram maior tempo total de sono diário também comparadas às nascidas a termo (10h24±1h08 e 09h29±1h08, respectivamente, p<0,001). Não houve diferença significativa entre os três grupos na pontuação geral dos questionários PosaST e CSHQ. Conclusões: O uso de cafeína no período neonatal não prejudicou tardiamente os hábitos de sono e não levou ao aumento dos escores de apneia obstrutiva do sono de crianças nascidas prematuras quando comparadas com crianças nascidas a termo.

Internet Addiction, Sleep Habits and Family Communication: The Perspectives of a Sample of Adolescents.

BACKGROUND: With the increase in communication technologies, the internet has become an indispensable tool in the life of the individual. Several studies report on the advantages of this resource; however, there is still a group of individuals who use the internet excessively. The aim of this study was to explore the relationships between internet addiction, daytime sleepiness, and family communication in adolescents. METHODS: A total of 340 adolescents aged between 12 and 17 years participated in this study. All completed the sociodemographic questionnaire, the internet addiction test, the pediatric daytime sleepiness scale, and the family communication scale. RESULTS: The results indicate that 64.1% of the adolescents had mild to moderate addiction to the internet. The main results suggest that internet addiction in adolescents is negatively associated with family communication and positively associated with excessive daytime sleepiness. It was also observed that gender had a significant effect on daytime sleepiness, with female participants having more excessive daytime sleepiness. Regarding age, the results indicate higher values of internet addiction among younger adolescents. CONCLUSIONS: In view of the above, it is considered important to develop preventive actions with a view to healthy family communication, with the adoption of sleep hygiene habits and the promotion of healthy use of the internet.

The relationship between sleep, perfectionistic strivings, perfectionistic concerns, and academic and sports performance in young athletes.

Perfectionism is associated with sleep as well as with academic and sports performance. Given the importance of sleep for performance and the sleep changes that occur during adolescence, the present study aimed to explore the relationship between sleep, two dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns), with academic and sports performance in young athletes. The occurrence of perfectionistic strivings was identified as a tendency to set high personal standards for oneself, while the occurrence of perfectionistic concerns was identified as a tendency to feel pressure to be perfect and have concerns about imperfections. A total of 32 athletes aged 13 to 16 years old participated in this study. Perfectionism, sleep, and course grades were measured at the end of the school year. Sleep was measured by actigraphy, and sports performance improvement was obtained by comparing individual performance at the beginning and the end of the school year. The moderating effect of both dimensions of perfectionism on the relationships between sleep and academic and sports performance improvement was measured. First, results showed no significant relationship between sleep and academic/sports performance. Further analyses revealed that perfectionistic strivings moderated the relationship between certain aspects of sleep with academic and sports performance improvement. Delayed and suboptimal sleep habits were associated with lower academic and sports performance improvement when low levels of perfectionistic strivings were present. Results with perfectionistic concerns showed that this dimension did not moderate the relationship between sleep and academic and sports performance improvement. This study supports the notion that high levels of perfectionistic strivings in young athletes may mitigate the adverse effects of poor sleep habits in young athletes.

Possible effects of N-acetylcysteine in autism spectrum disorders: major clinical aspects, eating behaviors, and sleeping habits.

BACKGROUND: N-acetylcysteine (NAC) is a promising agent for reducing irritability and hyperactivity and enhancing social responsiveness in children with autism spectrum disorders (ASD). This study aims to examine the effects of NAC on cardinal symptoms, eating, and sleeping habits in preschool children with autism. METHODS: The medical records of ASD patients were investigated retrospectively. 37 children with ASD who regularly received oral NAC in two divided doses per day (400-600 mg/day) for 8 weeks were included as the study group. The control group consisted of 21 children with ASD who were recommended NAC but never used it. The initial and second assessment scores after 8 weeks of regular use of the NAC group and control group on the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Children Eating Behavior Questionnaire (CEBQ), and the Sleep Habits Questionnaire (CSHQ) were compared. RESULTS: Our findings suggested that oral NAC alleviated the intensity of cardinal autistic symptoms in areas of social withdrawal, interpersonal relationships, body use, listening response, and verbal communication. Corresponding problem behaviors such as irritability, stereotypic behavior, and hyperactivity were reduced. It was determined that there was no difference between the two groups in terms of eating behaviors and sleeping habits. CONCLUSIONS: According to the results, NAC alleviated the severity of cardinal symptoms and reduced problem behaviors in autism. Additional trials with more systematic planning, controlling for confounding effects, and long-term follow-up should be provided in future studies.

Sobrepeso y obesidad en infancias de Bariloche, Argentina: más allá de la alimentación y la actividad física / Childhood overweight and obesity in Bariloche, Argentina: Beyond eating habits and physical activity

La incidencia de sobrepeso y obesidad es alarmante en el mundo. En Argentina son escasos los estudios multifactoriales a pesar de los altos índices de sobrepeso y obesidad en la población infantil (SOI). En este estudio evaluamos la prevalencia de SOI y sus factores de riesgo asociados desde una perspectiva multicausal: analizamos hábitos de sueño, uso de pantallas, estrés crónico en niños y sus cuidadores, problemas de relación social, alimentación y actividad física. De los 397 niños de primer y séptimo grado que completaron los cuestionarios, el 41 % presentó SOI. Los niños con obesidad mostraron realizar menos actividad física, tener un menor consumo de alimentos protectores, más riesgos de trastornos del sueño, mayores niveles de estrés crónico (tanto en los niños como en sus cuidadores) y mayor índice de rechazo entre pares. En la mayoría de los niños se encontró un uso generalizado de pantallas antes de acostarse. El presente estudio evidencia la diversidad de factores asociados a esta problemática y destaca la conveniencia de utilizar un enfoque multidimensional para abordar la obesidad en la infancia. Asimismo, los resultados de este trabajo sugieren la necesidad de considerar los hábitos de vida como estrategia preventiva y terapéutica para el tratamiento de esta enfermedad desde etapas tempranas.

The incidence of overweight and obesity is alarming worldwide. In Argentina, multifactorial studies are scarce despite the high rates of childhood overweight and obesity (OW/OB). In this study we assessed the prevalence of childhood OW/OB and the associated risk factors from a multicausal perspective: we analyzed sleep habits, screen use, chronic stress in children and their caregivers, social relationship problems, eating habits, and physical activity. Of the 397 first and seventh graders who completed the questionnaires, 41% had childhood OW/OB. In children with obesity, a lower level of physical activity, a lower consumption of protective foods, a higher risk for sleep disorders, higher levels of chronic stress (in both children and their caregivers), and higher rates of peer rejection were observed. Widespread use of screens before bedtime was noted in most children. This study evidences the diversity of factors associated with childhood OW/OB and highlights the convenience of a multidimensional approach to address it. In addition, the results of this study suggest the need to consider lifestyle habits as a preventive and therapeutic strategy for the management of OW/OB from early stages.

Changes in sleep quality of children with epilepsy and anxiety of their caregivers after COVID-19 infection: a case-series report.

Objective: To study the changes in epileptic seizures and sleep quality in children with epilepsy (CWE) and the changes in anxiety of their caregivers after infection with COVID-19. Methods: Outpatients and inpatients of CWEs were selected as subjects and a questionnaire survey was used to carry out this case-series study. The demographic information of the CWEs and their caregivers, information about epilepsy, and information about the vaccination, infection, and treatment of COVID-19 were collected. The changes in sleep quality of CWEs and the changes in anxiety of their caregivers were assessed by the Child Sleep Habits Questionnaire (CSHQ) and Caregiver Anxiety Scale (CAS). Risk factors affecting sleep habits in CWEs and caregiver anxiety were further analyzed by one-way analysis of variance. Results: A total of 312 children were included in the study. Among them, 134 patients (42.9%) were female. The average age of the children was 9.30 ± 3.88 years, and the duration of epilepsy was 4.59 ± 3.36 years. A total of 221 of the 312 children were infected with COVID-19, and all the infected children developed fever, which lasted for 1.71 ± 1.13 days. 10 children were satisfied with controlled seizures for more than 1 year and relapsed after COVID-19 infection (4.2%), 4 cases (3.6%) with increased seizures, and 8 children with reduced seizures (7.7%), 17 children (7.7%) had no change in seizures, and 182 children (82.3%) remained seizure-free after the COVID-19 infection. The average sleep time of the CWEs was 9.25 ± 1.04 h and the average total score of the CSHQ was 37.25 ± 5.19, among which 44 cases (14.1%) had more than 41 points. As the result of the CAS, 16 of them (5.13%) scored above 50 and the average total score was 31.49 ± 8.09. The control of seizures, age of onset, types of anti-seizure medicines (ASMs), and seizure duration were risk factors affecting sleep quality. Accordingly, the score of CAS was significantly lower when there was more than one caregiver who cared for the CWE. Conclusions: COVID-19 infection did not cause an increase in seizures in CWEs, nor did it worsen their sleep quality of them or aggravate the anxiety of their caregivers.

Quality of life and its relation with sleep habits of children with epilepsy from Eastern India.

BACKGROUND: Epilepsy is one of the most common chronic disorders of the central nervous system. The quality of life of children with epilepsy is influenced by various factors including their sleep. To assess the quality of life and sleep habits among children with epilepsy and to determine the association of QOL and sleep habits, with sociodemographic and clinical variables. MATERIALS AND METHODS: A cross-sectional study was carried out among 50 epileptic children aged 4-18 years, recruited using a convenient sampling technique from the IPDs and OPDs of the Paediatrics department of a tertiary care hospital in Eastern India. The data were collected using QOLCE-16 and CSHQ from parents of children with epilepsy. The collected data were analyzed using descriptive and inferential statistics such as ANOVA and Pearson correlation test. RESULTS: The overall mean score of QOL was 50.78 ± 17.98, with the cognitive domain having the highest mean score of 65.50 ± 27.79 and the social domain having the lowest mean score of 29.87 ± 22.81. The overall mean sleep score was found to be 56.98 ± 8.13. Daytime sleepiness, parasomnias, and bedtime resistance were found to be frequent sleep problems in children with epilepsy. There was a significant negative correlation between QOL and sleep disturbances in children with epilepsy (r = -0.65, P ≤ 0.001). CONCLUSION: The QOL of children with epilepsy should be improved to reduce the effect of sleep problems. Epilepsy children should be treated appropriately with due focus on medication compliance as it was found to be one of the determinants in improving their QOL.

Portrait of sleep in preschoolers involved with Child Protective Services and from the community.

OBJECTIVES: The objectives of this exploratory study were: 1) to draw a portrait of sleep, using actigraphic sleep measures, sleep diaries and a validated sleep questionnaire in preschoolers (3- to 5-year-olds) involved with Child Protective Services (CPS) and to compare it with preschoolers from the community, not involved with CPS and 2) to verify whether the sleep differences between the two groups persisted after adjusting for covariates (sociodemographic and child characteristics). METHODS: A total of 92 preschoolers aged from 3 to 5 years (49,5 ± 7,0 months) participated in the study (n = 22 preschoolers involved with CPS and n = 70 preschoolers from the community). Actigraphic sleep parameters were recorded using the child's non-dominant wrist over 72 h during weekdays and sleep diaries were filled out by parents (for nighttime) and childcare specialists (for daytime). Parents filled out the Child Sleep Habits Questionnaires (CSHQ) to measure their perception of their child's sleep. Chi-square tests, ANOVAs, and linear regressions were used to analyze the data and adjust for covariates (sociodemographic and child characteristics). RESULTS: Preschoolers involved with CPS took longer to fall asleep and signaled significantly fewer nighttime awakenings to their parents compared to the group of preschoolers from the community. These significant effects were still present after adjusting for covariates (sociodemographic and child characteristics). CONCLUSIONS: Understanding the underpinnings of these sleep differences by exploring their possible links with daytime cortisol production, sleep ecology and parent-child attachment are interesting avenues for future research.

Correlations between Sleep Features and Iron Status in Children with Neurodevelopmental Disorders: A Cross-Sectional Study.

A high prevalence of sleep disturbances has been reported in children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID). The etiology of sleep disorders in these children is heterogeneous and, recently, iron deficiency has received increasing attention. This study aims to investigate sleep features in children with NDDs and to explore a possible correlation between serum iron status biomarkers and qualitative features of sleep. We included 4- to 12-year-old children with a diagnosis of ASD, ADHD, or ID and assessed their sleep features through the children's sleep habits questionnaire (CSHQ). Venous blood samples were collected to investigate ferritin, transferrin, and iron levels. The mean CSHQ total score exceeds the cut-off in all groups of children. In the ASD group, the Parasomnias subscale negatively correlated with serum ferritin levels (Rho = 0.354; p = 0.029). Our findings may suggest the existence of an association between iron status, sleep quality, and neurodevelopmental processes. In clinical practice, sleep assessment should be included in the routine assessment for patients with NDDs. Furthermore, a routine assessment of iron status biomarkers should be recommended for children with NDDs who have sleep disturbances.

The Influence of Emotional Regulation and Cognitive Flexibility on Sleep Habits in Spanish Children and Adolescents through the Lens of Parents.

BACKGROUND: Previous research studies have suggested the importance of studying the relationship between emotional regulation and sleep habits. Some investigations have especially focused on how emotional regulation could impact sleep habits in children and adolescents. Therefore, these researchers have stated there exists a two-way direction in this relationship. OBJECTIVE: This study aimed to analyze the influence of emotional regulation on sleep habits in Spanish children and adolescents and the mediating role of anxiety in this relationship. METHOD: Participants were 953 Spanish parents who completed the assessment protocol according to their children and adolescents' information. RESULTS: The results revealed moderate-strong correlations between emotional regulation problems and sleep habit disturbances (r = 0.375, p < 0.001), trait (r = 0.488, p < 0.001) anxiety, and state (r = 0.589, p < 0.001) anxiety. Additionally, emotional regulation showed a direct impact on sleep habits (ß = 0.011, p = 0.005). Trait and state anxiety demonstrated a significant mediating role in the relationship between emotional regulation and sleep habits. CONCLUSIONS: Emotional regulation may have an impact on sleep habits during childhood and adolescence, suggesting the importance of early intervention focused on the emotions management and the prevention of sleep habit disturbances.

Patterns and Predictors of Multimorbidity in the Azar Cohort.

BACKGROUND: The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. METHODS: We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. RESULTS: The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. CONCLUSION: The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

Serdexmethylphenidate/dexmethylphenidate effects on sleep in children with attention-deficit/hyperactivity disorder.

Introduction: Sleep-related problems are common in children with attention-deficit/hyperactivity disorder (ADHD). Sleep disorders are also side effects of all stimulant ADHD medications. Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) is a once-daily treatment approved for patients age 6 years and older with ADHD. In this analysis, sleep behavior was assessed during SDX/d-MPH treatment in children with ADHD. Methods: In a 12-month, dose-optimized, open-label safety study in 6- to 12-year-old participants (NCT03460652), a secondary endpoint was assessment of sleep behavior based on the Children's Sleep Habits Questionnaire (CSHQ) consisting of 8 sleep domains (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness). This post hoc analysis examined the individual sleep domains in the 12-month safety study. Results: Of 282 participants enrolled, 238 were included in the sleep analysis. At baseline, mean (SD) CSHQ total sleep disturbance score was 53.4 (5.9). After 1 month of treatment, the mean (SD) CSHQ total score significantly decreased to 50.5 (5.4); least-squares mean change from baseline was -2.9 (95% CI: -3.5 to -2.4; p < 0.0001) and remained decreased up to 12 months. Mean sleep-score improvements from baseline to 12 months were statistically significant (p < 0.0001) for 5 of 8 sleep domains, including bedtime resistance, sleep anxiety, night wakings, parasomnias, and daytime sleepiness. Parasomnias and daytime sleepiness sleep domains showed the greatest mean improvement from baseline to 12 months. Sleep onset delay and sleep duration scores increased from baseline to 12 months. No statistically significant worsening occurred from baseline in sleep duration and sleep-disordered breathing domains; however, worsening of sleep onset delay was statistically significant. Conclusion: In this analysis of children taking SDX/d-MPH for ADHD, sleep problems did not worsen based on the mean CSHQ total sleep disturbance score. Statistically significant improvements in most CSHQ sleep domains were observed after 1 month and lasted for up to 12 months of treatment.

Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study.

Obstructive sleep apnoea syndrome (OSAS) has become vastly conceded in the last decade as a possible reason for significant morbidity in childhood. This study aims to evaluate the prevalence of OSAS among school children and to assess the interrelationship between OSAS and daytime sleepiness. Methods and materials: This cross-sectional study was conducted with 1029 children and adolescents aged 6-15 years attending elementary and secondary schools in Damascus, Syria. The questions involved 19 sleep problems items using the children sleep habits questionnaire, and 4 sleep disorder items (loud snoring, having snorts or gasps, breathing pauses, daytime sleepiness). Total sleep time (TST) was determined by sleep habits. Severe possible OSAS (p-OSAS) was addressed as having all OSA symptoms "frequently", and mild p-OSAS was defined as having any of the symptoms "sometimes". Severe and mild daytime sleepiness were rated as being very sleepy during the day "frequently", and "sometimes", respectively. Logistic regression was applied to predict risk factors of severe and mild daytime sleepiness. Results: The prevalence of p-OSAS was 22.2%, of them 15.8% were mild, and 6.3% were severe. p-OSAS was more recognized in males 15.2% children (P<0.05). Most p-OSAS children sleep less than 6 h of TST; however; the mean TST was significantly lower at the secondary school level (P≤0.001). Predicted risk factors for severe and mild daytime sleepiness were students' grade level (P<0.05), severe and mild p-OSAS (P≤0.001), and TST less than 6 h (P≤0.001). Conclusions: A significant number of children have p-OSAS, affecting daytime sleepiness in school age. Physicians should consider loud snoring, and breathing pauses as marked symptoms of severe daytime sleepiness. Moreover, raising parents awareness about OSAS and daytime sleepiness is essential to ensure early access to primary care.

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample. Methods: This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ). Results: Children with autism had significantly more sleep problems than non-autistic children [t (226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t (165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t (165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ. Conclusion: In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.