Parasomnias and sleep disordered breathing in Caucasian and Hispanic children - the Tucson children's assessment of sleep apnea study

James L Goodwin, Kris L Kaemingk, Ralph F Fregosi, Gerald M Rosen, Wayne J Morgan, Terry Smith, Stuart F Quan, James L Goodwin, Kris L Kaemingk, Ralph F Fregosi, Gerald M Rosen, Wayne J Morgan, Terry Smith, Stuart F Quan

Abstract

Background: Recent studies in children have demonstrated that frequent occurrence of parasomnias is related to increased sleep disruption, mental disorders, physical harm, sleep disordered breathing, and parental duress. Although there have been several cross-sectional and clinical studies of parasomnias in children, there have been no large, population-based studies using full polysomnography to examine the association between parasomnias and sleep disordered breathing. The Tucson Children's Assessment of Sleep Apnea study is a community-based cohort study designed to investigate the prevalence and correlates of objectively measured sleep disordered breathing (SDB) in pre-adolescent children six to 11 years of age. This paper characterizes the relationships between parasomnias and SDB with its associated symptoms in these children.

Methods: Parents completed questionnaires pertaining to their child's sleep habits. Children had various physiological measurements completed and then were connected to the Compumedics PS-2 sleep recording system for full, unattended polysomnography in the home. A total of 480 unattended home polysomnograms were completed on a sample that was 50% female, 42.3% Hispanic, and 52.9% between the ages of six and eight years.

Results: Children with a Respiratory Disturbance Index of one or greater were more likely to have sleep walking (7.0% versus 2.5%, p < 0.02), sleep talking (18.3% versus 9.0%, p < 0.006), and enuresis (11.3% versus 6.3%, p < 0.08) than children with an Respiratory Disturbance Index of less than one. A higher prevalence of other sleep disturbances as well as learning problems was observed in children with parasomnia. Those with parasomnias associated with arousal were observed to have increased number of stage shifts. Small alterations in sleep architecture were found in those with enuresis.

Conclusions: In this population-based cohort study, pre-adolescent school-aged children with SDB experienced more parasomnias than those without SDB. Parasomnias were associated with a higher prevalence of other sleep disturbances and learning problems. Clinical evaluation of children with parasomnias should include consideration of SDB.

Figures

Figure 1
Figure 1
Associations between sleep disordered breathing and parasomnias. Sleep disordered breathing (SDB) was defined as an RDI of more than one per hour of total sleep time. See text for complete definition.
Figure 2
Figure 2
Associations between parasomnias, and symptoms of sleep disordered breathing, and learning problems. SW, sleepwalking; ST, sleep talking; TR, sleep terrors; EN, enuresis; SN, snoring; EDS, excessive daytime sleepiness; INSOM, insomnia; LP, learning problems; WITAP, witnessed apnea. See text for complete definitions.

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