A questionnaire based survey was performed to determine the prevalence of sleep related disorders in Indian school-going children residing in Delhi. The questionnaire used for the purposes of this study was based on the Pediatric Sleep Questionnaire, University of Michigan, USA. A total number of 4000 questionnaires were distributed of which 2774 were received back. A total number of 2475 questionnaires were finally selected for analysis as they satisfied all criteria for acceptance. A sub-group of patients who were suspected as having sleep disordered breathing on the basis of the questionnaire were subjected to polysomnography.
The overall prevalence of snoring was found to be 12.7% (Males=12.8%, Females=12.6%). The overall prevalence of sleep disordered breathing (SDB) was 4.8%. Approximately 24.3% of the children (26.3% males and 22.9% females) were seen to suffer from excessive daytime sleepiness. Sleep deprivation(32.2%) was found to correlate positively with age (p<0.001). The overall prevalence of bedtime resistance was found to be 25.8%. About 41% (Males=41.1%, Female=40.9%) of the children experienced nightmare once in a while. Amongst all subjects, 5.8% suffered from night terrors. About 12% of the entire population (13.3% males and 10.4% females) were seen to suffer from bruxism. Approximately 7.7 % of the overall population was observed to suffer from bedwetting. Insomnia was found in 17.3% of our subjects. On the whole, approximately 47.5% of the children were observed to suffer from some form of sleep disorder.
This study is an attempt to highlight the sleep problems in general and those related to sleep-disordered breathing in particular amongst school-going children in an urban setting in North India. An attempt has been made to compare and contrast the western and Asian scenario of sleep disorders in school children with that in India. It also highlights the fact that no effort was made on the part of parents to seek medical help in the significantly large number of children in whom sleep disorders were present, indicating a total lack of awareness amongst the general population about the larger implications of sleep disorders in children.
Ron Chervin et. al. Pediatric Sleep Questionnaire, University of Michigan (email@example.com)
Owens J. Classification and epidemiology of childhood sleep disorders. Sleep Med Clin 2007, (2):353-361.
Owens JA, Spirito A, McGuiun M. The children's Sleep Habits Questionnare (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 2000; 23(8):1043-1051.
Bruni O, Ottaviano S, Guidetti V et al. The Sleep Disturbance Scale for Children (SDSC): Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res 1996;5(4):251- 261.
Liu X, Liu L, Owens JA et al. Sleep patterns and sleep problems among school children in the United States and China. Pediatrics 2005;115(1 Suppl):241-9.
Blader JC, Koplewicz HS, Abikoff H et al. Sleep problems of elementary school children: a community survey. Arch Pediatr Adolesc Med 1997;151(5):473-480.
Owens JA, Spirito A, Mc Guinn M, et al. Sleep habits and sleep disturbance in elementary school-aged children J Dev Behv Pediatr 2000;21(1):27-36.
Pagel JF, Forister BS, Kwiatkow Ki C. Adolescent Sleep disturbance and school performance: the confounding variable of socioeconomics. J Clin Sleep Med 2007;3(1):19- 23.
Kahn A, Van de Merckt C, Rebuffat E, et al. Sleep problems in healthy preadolescents. Pediatrics 1989;84(3):542-546.
Vignau J, Bailly D, Buhamel A, et al. Eipidemiologic study of sleep quality and troubles in French secondary school adolescents. J Adolesc Health 1997;21(5):343-350.
Levy D, Gray-Donald K, Leech J, et al. Sleep patterns and problems in adolescents. J Adolesc Health Care 1986;7(6):386-389.
Gibson ES, Powler AC, Thabane L et al. Sleepiness is serious in adolescence: two surveys of 3235 Canadian students. BMC Public Health 2006;6:116-124.
Bharti B, Malhi P, Kashyap S. Patterns and problems of sleep in school-going children. Indian Pediatr 2006;43:35- 38.
Liu X, Ma Y, Wang Y, et al. An epidemiologic survey of the prevalence of Sleep disorders among children 2 to 12 years old in Beijing, China. Pediatrics 2005;115(2):266-268.
Stein MA, Mendelsohn J, Obermeyer WH et al. Sleep and behavior problems in school aged children. Pediatrics 2001;107:60-64.
Archibald K, Pituch K, Panahi P et al. Symptoms of sleep disturbances among children at two general pediatric clinics. J Pediatr 2002;140:97-102.
Laberge L, Tremblay R, Vitaro F et al. Development of parasomnias from childhood to early adolescence. Pediatrics 2000; 106:67-74.
Simmonds JF, Parraga H. Prevalence of Sleep Disorders and Sleep behaviors in Children and adolescents. J Am Acad Child Psychiatry 1982;21:383-388.
Hackett R, Hackett L, Bhakta P et al. Enuresis and encopresis in a south Indian population of children. Child Care Health Dev 2001;27:35-46.
Byrd R, Weitzman M, Lanphear N, et al. Bedwetting in US Children: Epidemiology and related behavior problems. Pediatrics 1996;98:414-419.
Reimao R, Lefevre A. prevalence of sleep talking in childhood. Brain Dev 1980;2:353-357.
Sadeh A, Raviv A. Gruber R. Sleep patterns and sleep disruptions in school-age children. Dev Psychol 2000;36:291-301.
Kaur G, Kalra M. Prevalence of sleep disorders among urban Indian seven-year old children. Sleep 2004; Suppl A:102.
Lozoff B, Wolff AW, Davis NS. Cosleeping in urban families with young children in the United States. Pediatrics 1984;74:171-182.
Ali NJ, Pirson DJ, Stradling JR. Snoring, sleep disturbance and behavior in 4-5 year olds. Arch Dis Child 1993;68:360- 366.
Gisalson T, Benediktdottir B. Snoring, apneic episodes and nocturnal hypoxemia among children 6 months to 6 years old, Chest 1995;107:063-966.
Heistand D.M. Sleep in the child: Normal, walking, talking, wetting and wailing. ACCP Sleep Board Review Course 2006. 223-229.
Heistand D.M. ACCP Pediatric Sleep I: Normal sleep and non-respiratory sleep complaints: infancy through adolescence. Sleep Board Review Course 2006.8-12.
Uliel S, Tauman R, Green Field M et al. Chest 2004;125:872-878
Jaffat T, Scott S, Hendriks JH et al. Sleep disorders in children. In ABC of Sleep Disorders Ed Shapiro C. BMJ Publishing Group 1993;41-44
Brietzke SE, Katz ES, Roberson DW. Can history and physical examination reliably diagnose pediataric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol head Neck Surg 2004;131:827-832.
Teculescu DB, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children. Pediatr Pulmonol 1992;13:239-244.
Castronovo V, Zucconi M, Nosetti L, Ossola E, Moscatelli D, Calori G, Nespoli L, Ferini-Strambi L. Habitual snoring among children aged 3 to 6 years: an epidemiologic study with objective measurement of snoring and oxygen saturation. Sleep 1998;21:S51.
Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. Chest 1995;107:963-966.
Quan SF, Enright PL, Kaemingk KL, Rosen GM, Morgan WJ, Fregosi RF. Prevalence of obstructive sleep apnea I children: preliminary report of the Tucson Children Assessment of Sleep Apnea Study (TuCASA). Sleep 2000;23:A195.
Quan SF, Pernisco N, Morgan WJ. Prevalence of sleep disturbances and snoring in children ages 3-14 years. Sleep 1999;22:S185.
Gottlieb DJ, Vezina RM, Chase C, Lesko SM, Heeren TC, WeeseMayer DE, Auerbach SAA, Corwin MJ. Sleepdisordered breathing in 5-year-old children: correlates and association with problem behaviors. Am J Respir Crit Care med 2001;163:A299.
Rosen CL, Russo LJ, Arnold JL, DiFiore JM, Surovec SA, RedlineS. Prevalence of key clinical features of sleepdisordered breathing in a community-based sample of 8- 10 year old US children. Sleep 2000;23:A194.
Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Am J Respir Crit Care Med 1999;159:1527-1532
American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996;153:866-878
Spanier-Mingoletti SR, Weese-Mayer DE, Silvestri JM. Hypopnea in pediatric polysomnography: ill-defined and underused. Am J Respir Crit Care Med 1998;157:A123.
Tang JP, Rosen CL, Larkin EK, DiFiore JM, Arnold JL, Surovec SA, Youngblut JM, Redline S. Identification of sleepdisordered breathing in children: variation with event definition. Sleep 2002;25:72-79.