Risk factors and consequences of early childhood dyssomnias: New perspectives
Sleep Research Centre, Sacré-Coeur Hospital, Montreal, Quebec, Canada H4 J 1C5. Sleep Medicine Reviews
(Impact Factor: 8.51).
02/2009; 13(5):355-61. DOI: 10.1016/j.smrv.2008.12.001
Dyssomnias are largely under-diagnosed in infants and toddlers. This literature review proposes an integrative model based on empirical data on determinants and consequences of sleep disturbances occurring in early life. This model proposes that parental behaviors that impede the child's autonomy toward sleep periods are primary grounds for the development of dyssomnias, e.g., parental presence until the child falls asleep, and putting an already sleeping child to bed. The model also indicates the serious potential consequences of a modest but chronic loss of sleep in childhood. At least three developmental domains could be directly affected: behavioral/social competence, cognitive performance, and physical condition. Thus, children with short nocturnal sleep duration before age 3.5 years show increased risk of high hyperactivity-impulsivity scores and low cognitive performance at 6 years compared to children who sleep 11 h per night, after controlling for potentially confounding variables. Moreover, persistent short sleep duration in early infancy increased the risk of suffering of obesity at 6 years of age, after controlling for potentially confounding variables. Finally, the importance of allowing the child to sleep at least 10 h per night in early childhood is stressed, as the National Sleep Foundation Poll suggests, for optimal child development.
Available from: Dieter Riemann
- "A theoretical model of infant sleep regulation integrating multiple environmental systems was developed in 1993  and revised in 2009 (for an overview, see Ref. ). This integrative model emphasizes the role of postnatal environmental stressors in developing infant insomnia . "
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ABSTRACT: Insomnia is very common in the adult population and it includes a wide spectrum of sequelae, that is, neuroendocrine and cardiovascular alterations as well as psychiatric and neurodegenerative disorders. According to the conceptualization of insomnia in the context of the 3-P model, the importance of predisposing, precipitating, and perpetuating factors has been stressed. Predisposing factors are present before insomnia is manifested and they are hypothesized to interact with precipitating factors, such as environmental stressful events, contributing to the onset of insomnia. Understanding the early-life origins of insomnia may be particularly useful in order to prevent and treat this costly phenomenon. Based on recent evidence, prenatal-early-life stress exposure results in a series of responses that involve the stress system in the child and could persist into adulthood. This may encompass an activation of the hypothalamic-pituitary-adrenal axis accompanied by long-lasting modifications in stress reactivity. Furthermore, early-life stress exposure might play an important role in predisposing to a vulnerability to hyperarousal reactions to negative life events in the adult contributing to the development of chronic insomnia. Epigenetic mechanisms may also be involved in the development of maladaptive stress responses in the newborn, ultimately predisposing to develop a variety of (psycho-) pathological states in adult life.
Copyright © 2014 Elsevier B.V. All rights reserved.
Sleep Medicine 01/2015; 16(4). DOI:10.1016/j.sleep.2014.10.013 · 3.15 Impact Factor
Available from: Jessica Chen
- "Mothers serve a primary role entraining young infants' immature rhythm to a 24-hour period through both direct caregiving interaction and management of the physical home environment   including control of light exposure . While parenting behavior is a strong determinant of infant rest–activity pattern, within the mother–infant dyad the influence is bidirectional in that infant activity pattern (i.e., waking, crying) disrupts parent sleep . Activity pattern, operationalized as state-dependent movement, is a critical representation of physiological synchrony within the mother-infant dyad and is the most relevant circadian rhythm predicting later interactive synchrony and infant regulation  . "
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ABSTRACT: Background: Mutual circadian rhythm is an early and essential component in the development of maternal-infant physiological synchrony. Aims: The aim of this to examine the longitudinal pattern of maternal-infant circadian rhythm and rhythm synchrony as measured by rhythm parameters. Study design: In-home dyadic actigraphy monitoring at infant age 4, 8, and 12 weeks. Subjects: Forty-three healthy mother-infant pairs. Outcome measures: Circadian parameters derived from cosinor and non-parametric analysis including mesor, magnitude, acrophase, L5 and M10 midpoints (midpoint of lowest 5 and highest 10 h of activity), amplitude, interdaily stability (IS), and intradaily variability (IV). Results: Mothers experienced early disruption of circadian rhythm, with re-establishment of rhythm over time. Significant time effects were noted in increasing maternal magnitude, amplitude, and IS and decreasing IV (p < .001). Infants demonstrated a developmental trajectory of circadian pattern with significant time effects for increasing mesor, magnitude, amplitude, L5, IS, and IV (p < .001). By 12 weeks, infant phase advancement was evidenced by mean acrophase and M10 midpoint occurring 60 and 43 min (respectively) earlier than at 4 weeks. While maternal acrophase remained consistent over time, infants became increasingly phase advanced relative to mother and mean infant acrophase at 12 weeks occurred 60 min before mother. Mother-infant synchrony was evidenced in increasing correspondence of acrophase at 12 weeks (r = 0.704), L5 (r = 0.453) and M10 (r = 0.479) midpoints. Conclusions: Development of mother-infant synchrony reflects shared elements of circadian rhythm.
Early Human Development 12/2014; 90(12). DOI:10.1016/j.earlhumdev.2014.09.005 · 1.79 Impact Factor
Available from: Charlene Soobiah
- "Figure 2 depicts a proposed model of sleep disturbances in children and adolescents with chronic illness, such as JIA. This model was originally developed to illustrate sleep problems in healthy children [41-44] and was subsequently adapted for children with chronic illnesses. The model depicts theoretical relationships among physiological, disease-related, psychological (cognitive/affective/behavioural) and socio-cultural factors (including social determinants of health) that may contribute to the development and maintenance of sleep problems among children with chronic illnesses. "
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Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (or JIA). However, little is known about the frequency and severity of sleep disturbance(s) and the factors that are associated with sleep problems in children with JIA. The mechanism(s) of the relationships characterizing the development or exacerbation of sleep problems in children with JIA are still unknown, however studies have reported an association. The purpose of this study was to synthesize existing research related to sleep problems in children with JIA.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. An experienced librarian conducted searches in MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to January 2012, to identify potentially relevant citations. Two members independently selected, rated methodological quality using the QUIPS tool, and extracted data from included studies.
Ten studies were included and findings varied across studies; studies were mostly cross-sectional, or case-controlled designs, with only one cohort study available. Four studies found that children and adolescents diagnosed with JIA had significantly more sleep disturbances when compared to healthy controls. Pain was most often associated with sleep disturbances. The heterogeneous findings highlight the complex relationships between JIA and sleep, and low methodological quality of studies in the field.
This review supports an association between poor sleep and increased symptoms related to JIA, specifically the experience of pain. However, results need to be interpreted cautiously given the inconsistent findings regarding factors associated with sleep problems in JIA, the limited evidence available, and its low quality. Furthermore it is not yet determined if the poor sleep patterns predate the symptoms reported with JIA. More research is vital to understanding the factors that predict or perpetuate poor sleep in children and adolescents diagnosed with JIA.
Pediatric Rheumatology 06/2014; 12(1):19. DOI:10.1186/1546-0096-12-19 · 1.61 Impact Factor
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