Survey of sleep problems amongst Singapore children in a psychiatric setting

Abstract

Background

Sleep problems are common among children and range from transient ones to chronic problems like snoring, somnambulism and bedwetting. Sleep problems in turn impact on children’s health, learning, school performance, quality of life and are often closely related to mental health problems. Population based surveys have also revealed a strong association between sleep problems and behavioral and emotional symptoms in children. The objectives of our study were to estimate the prevalence of sleep problems in children and adolescents attending psychiatric services in Singapore and to identify the correlates of sleep problems in this population.

Methods

A total of 490 parents/guardians accompanying their children to the child guidance clinic consented to complete a questionnaire, which was used to collect both sociodemographic data and the frequency of sleep problems. These included sleep starts, confusional arousal, sleep talking, bruxism, sleep walking, sleep terrors, nightmares, sleep paralysis and nocturnal enuresis. Psychiatric diagnosis was determined from case record survey of the participating subjects.

Results

About 62.2% (95% CI 57.8%–66.6%) of the children suffered from at least one problem. Girls were significantly more likely to suffer from sleep problems when compared with boys (χ² = 8.5, P < 0.005). The significant predictors for sleep problems were gender, diagnosis of developmental disorders and a family history of sleep problems.

Conclusions

The study highlights the need for child and adolescent psychiatrists to enquire about sleep problems since sleep disturbances of children are frequent and may not be self-reported.

Appendix 1

Sleep Survey in Children and Adolescents

		Never occurred	Previously only	Still ongoing	Frequent (>2 times/month)	Infrequent (>2 times/month)
1.	Sleep starts	□	□	□	□	□
	Sudden brief body jerks, one or both legs, arms or head, in isolation or occasionally several in succession.
2.	Confusional arousal	□	□	□	□	□
	Episodes of marked confusion during and following arousal from sleep.
3.	Sleep talking	□	□	□	□	□
	Speech or sound uttered during sleep without awareness.
4.	Bruxism	□	□	□	□	□
	Repeated grinding, crunching of teeth during sleep.
5.	Sleep walking	□	□	□	□	□
	Episodes where the child arises from deep sleep and without awakening, walks.
6.	Sleep terrors	□	□	□	□	□
	Sudden sitting up during sleep and emitting a piercing scream; appears to be in acute terror.
7.	Nightmares (terrifying dreams)	□	□	□	□	□
	Dreams during sleep that become frightening to the sleeper and leads to awakening.
8.	Sleep paralysis	□	□	□	□	□
	Child is conscious but unable to perform voluntary movements either at sleep onset or upon awakening.
9.	Nocturnal enuresis	□	□	□	□	□
	Bed wetting
10.	Family history of any of the above.	Yes	No
	List if yes ——————————————————————————	□	□