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Insomnia Symptoms Linked With Medical
Complaints in Young School-Aged Children
A study in the December 15th issue of the Journal of Clinical Sleep Medicine
indicates that significant associations exist between parent-reported insomnia
symptoms and medical complaints of gastrointestinal distress (regurgitation)
and headaches in young school-aged children
Results of the study show that parent-reported insomnia was 3.3 times more
likely in children with gastrointestinal regurgitation and 2.3 times more likely
in children with headaches. Nineteen percent of children met the criteria for
insomnia, which was defined as often having trouble falling asleep and/or
waking up often in the night. Gastrointestinal problems were reported in 7.5
percent of children with insomnia and two percent of children who did not have
sleep disturbances. Headaches were reported in 24.4 percent of children
with insomnia and 13.2 percent of children without disturbed sleep.
The research team from the department of Psychiatry at Penn State College of
Medicine in Hershey, Pa., reported that children who have insomnia symptoms
should be screened by their physician for underlying medical conditions, stating
"The first and most important step in children with medical complaints and sleep
disturbances would be an evaluation for underlying medical disorders and
providing treatment. If the associated sleep disturbances do not improve despite
improvement in medical complaints the disturbances should be further assessed
and treated."
Data from 700 children between the ages of 5 and 12 years were collected from the
Penn State Children's Cohort for this cross-sectional study. All children underwent a
medical and psychiatric history, physical examination, overnight polysomnography
and neuropsychological testing. Comprehensive sleep and development questionnaires
were completed by a parent. To assess gastrointestinal regurgitation the parent was
asked, "Does food or liquid come back up into your child's mouth or does your child
complain of tasting food or liquid back up in his mouth?"
Children with sleep disturbances had significantly more parent-reported complaints
of gastrointestinal symptoms (heartburn, pain,colic and regurgitation), headaches
and bedwetting. After controlling for demographic variables; apnea-hypopnea index;
learning, psychiatric and behavioral disorders; and socioeconomic and minority
status, gastrointestinal regurgitation and headaches most significantly remained
associated with insomnia symptoms.
The authors suggest that future studies should explore the possible underlying
patho-physiological causes of the relationship between insomnia symptoms and
medical complaints in children. These studies should explore whether treatment
of sleep complaints improves the associated medical complaints and vice versa.
The AASM (American Academy Of Sleep Medicine) published "Practice
parameters for behavioral treatment of bedtime problems and night wakings
in infants and young children" in the journal SLEEP in 2006. About 94 percent
of the studies that were reviewed reported that behavioral interventions as a
whole produced clinically significant improvements in bedtime resistance and
night waking.
In 2003 an AASM task force of sleep experts examined the use of medications
to treat insomnia in children. A consensus meeting summary was published in
2005 in the Journal of Clinical Sleep Medicine. The task force emphasized
that behavioral treatment approaches to bedtime struggles and night waking
in children have a well-documented empirical basis and are the mainstay of|
treatment, and that pharmacologic approaches should be largely considered
adjuncts in the treatment of pediatric insomnia.
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