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Youth With Functional Abdominal Pain Disorders Have More Sleep Disturbances. A School‐Based Study

Wiley
Neurogastroenterology & Motility
Authors:
Neha R. Santucci
Neha R. Santucci
Neha R. Santucci
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Carlos Velasco at University of Valle
Carlos Velasco
Daniela Alejandra Velasco-Suarez at University of Valle
Daniela Alejandra Velasco-Suarez
Christopher Duncan King at Cincinnati Children's Hospital Medical Center
Christopher Duncan King
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Abstract and Figures

Background There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk for chronic pain, while chronic pain can interfere with sleep. Hence, we assessed the subjective sleep characteristics of youth with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal symptoms. Methods We included youth ages 10–18 years without a sleep or organic GI disorder diagnosis from a large private school. Participants completed demographics, sleep history, and validated questionnaires: sleep quality (ASWS‐SF), insomnia (PISI), daytime sleepiness (ESS), sleep disturbance (PROMIS SD), sleep‐related impairment (PROMIS SRI), and Rome 4 diagnostic questionnaire. Cases (FAPDs) completed abdominal pain index (API), nausea severity (NSS), anxiety, depression (PROMIS), and functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and gender. Results Of 120 youth (60 cases and 60 controls), the mean age was 13.5 ± 1.9 years and 50% were females. Youth with FAPDs had higher insomnia, sleep disturbance, sleep‐related impairment, daytime sleepiness, sleep hygiene, gasping, and nightmares than healthy youth (p < 0.05). Higher insomnia severity was associated with worse abdominal pain (r = 0.41, p < 0.01), higher daytime sleepiness with a family history of disorders of gut‐brain interaction (DGBIs, OR = 14.7, p = 0.002), and higher sleep‐related impairment (OR = 5.6, p = 0.02) and depression (OR = 6.1, p = 0.01) with black race. Conclusion Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdominal pain. Future studies could focus on determining mechanisms by which sleep disturbances affect abdominal pain and vice versa.
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Neurogastroenterology & Motility, 2025; 37:e14992
https://doi.org/10.1111/nmo.14992
Neurogastroenterology & Motility
ORIGINAL ARTICLE
Youth With Functional Abdominal Pain Disorders Have
More Sleep Disturbances. A School- Based Study
NehaR.Santucci1, 2 | CarlosAlbertoVelasco- Benitez3 | DanielaAlejandraVelasco- Suarez4 | ChristopherKing5 |
KellyByars2,5,6 | ThomasDye2,7, 8 | JesseLi1 | MiguelSaps9
1Pediatric Gastroenterolog y, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA | 2Department of Pediatrics, University of
Cincinnati College of Medicine, Cincinnati, Ohio, USA | 3Department of Pediatrics, Universidad del Valle, Cali, Colombia | 4Universidad Libre, Cali,
Colombia | 5Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA | 6Division
of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA | 7Division of Neurolog y, Cincinnati Children's Hospital
Medical Center, Cincinnati, Ohio, USA | 8Division of Pulmonary – Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,
USA | 9Division of Pediatric Gastroenterolog y, Hepatology, and Nutrition, University of Miami School of Medicine, Miami, Florida, USA
Correspondence: Neha R. Santucci (nehasantucci@gmail.com; neha.santucci@cchmc.org)
Received: 11 April 2024 | Revised: 12 November 202 4 | Accepted: 12 December 2024
Funding: Dr. Neha R. Santucci was supported by the National Institutes of Health—National Institute of Diabetes and Digestive and K idney Disease
(1K23DK135797- 01).
Keywords: daytime sleepiness| Latin America| parasomnia| pediatric functional abdominal pain disorders| sleep disturbance
ABSTRACT
Background: There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk
for chronic pain, while chronic pain can interfere with sleep. Hence, we assessed the subjective sleep characteristics of youth
with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal
symptoms.
Methods: We included youth ages 10–18 years without a sleep or organic GI disorder diagnosis from a large private school.
Participants completed demographics, sleep history, and validated questionnaires: sleep quality (ASWS- SF), insomnia (PISI),
daytime sleepiness (ESS), sleep disturbance (PROMIS SD), sleep- related impairment (PROMIS SRI), and Rome 4 diagnostic
questionnaire. Cases (FAPDs) completed abdominal pain index (API), nausea severity (NSS), anxiety, depression (PROMIS), and
functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and
gender.
Results: Of 120 youth (60 cases and 60 controls), the mean age was 13.5 ± 1.9 years and 50% were females. Youth with FAPDs had
higher insomnia, sleep disturbance, sleep- related impairment, daytime sleepiness, sleep hygiene, gasping, and nightmares than
healthy youth (p < 0.05). Higher insomnia severity was associated with worse abdominal pain (r = 0.41, p < 0.01), hig her day time
sleepiness with a family history of disorders of gut- brain interaction (DGBIs, OR = 14.7, p = 0.002), and higher sleep- related im-
pairment (OR = 5.6, p = 0.02) a nd depress ion (OR = 6.1, p = 0.01) with black race.
Conclusion: Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdom-
inal pain. Future studies could focus on determining mechanisms by which sleep disturbances affect abdominal pain and vice
versa.
© 2024 J ohn Wiley & Sons Ltd .
Prior Ab stracts and Pre sentations: Neha R . Santucci, Car los Alberto Velasc o- Benitez, Ch ristopher King , Kelly Byars, T homas Dye, Mig uel Saps. Child ren with abdomina l pain predomina nt
disorder s of gut- brain intera ction have more sleep di sturbances. F irst of a kind school st udy. Oral presentat ion at the American Neu rogastroenter ology and Motilit y Society (AN MS) Annual
Meeting 2 023 and Digesti ve Disease Week (DDW) A nnual Meeting 2 023.
ResearchGate has not been able to resolve any citations for this publication.
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Background Multiple psychological factors influence disorders of gut–brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs. Methods We included children ages 8–18 years without organic medical conditions from largest regional public schools in Colombia. Children completed Spanish versions of Rome III diagnostic questionnaire for DGBIs, State Trait Anxiety Inventory for Children (STAIC), Children's Somatization Inventory (CSI), and a measure of coping efficacy. These data, demographic and socioeconomic characteristics, were compared between children with DGBIs and healthy peers. Exploratory analyses investigated differences between youth with symptoms of functional abdominal pain disorders (FAPDs) compared with healthy peers. Key Results Of 1496 children, 281 (mean age 12.9 ± 2.2 years, 49.8% females) self‐reported criteria for DGBIs and 125 reported (44.5%) FAPDs. Children with DGBIs had higher trait anxiety, emotional sensitivity, somatization including GI, non‐GI, pain‐related, and non‐pain‐related subscales (p < 0.001 each) and lower coping efficacy (p = 0.02) compared to healthy peers. Females had higher trait anxiety and somatization (p = 0.04 and p = 0.005, respectively). State and trait anxiety and coping efficacy differed based on location in children with DGBIs (p = 0.02, p = 0.03, and p < 0.001, respectively). Children with FAPDs had higher trait anxiety (p = 0.02) and somatization (p < 0.001) compared to healthy youth. Conclusions & Inferences Children with DGBIs had higher anxiety, emotional sensitivity, and somatization, and lower coping efficacy compared with healthy youth. This highlights the importance of appraising psychological distress characteristics as well as incorporating conflict resolution, assertiveness training, and resilience building during the treatment of DGBIs.
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Background Percutaneous electrical nerve field stimulation (PENFS) improves symptoms in adolescents with functional abdominal pain disorders (FAPDs). However, little is known about its impact on sleep and psychological functioning. We evaluated the effects of PENFS on resting and evoked pain and nausea, sleep and psychological functioning, and long‐term outcomes. Methods Patient ages 11–19 years with FAPD requiring PENFS as standard care were recruited. Evoked pain was elicited by a Water Load Symptom Provocation Task (WL‐SPT) before and after four weeks of treatment. Pain, gastrointestinal symptoms, sleep, somatic symptoms, and physical and psychological functioning were assessed. Actigraphy was used to measure daily sleep–wake patterns. Key Results Twenty patients (14.3 ± 2.2 years old) with FAPD were enrolled. Most patients were females (70%) and white (95%). During pain evoked by WL‐SPT, visual analog scale (VAS) pain intensity and nausea were lower following PENFS compared with baseline (p = 0.004 and p = 0.02, respectively). After PENFS, resting VAS pain unpleasantness (p = 0.03), abdominal pain (p < 0.0001), pain catastrophizing (p = 0.0004), somatic complaints (0.01), functional disability (p = 0.04), and anxiety (p = 0.02) exhibited significant improvements, and some were sustained long‐term. Self‐reported sleep improved after PENFS (p's < 0.05) as well as actigraphy‐derived sleep onset latency (p = 0.03). Conclusions and Inferences We demonstrated improvements in resting and evoked pain and nausea, sleep, disability, pain catastrophizing, somatic complaints, and anxiety after four weeks of PENFS therapy. Some effects were sustained at 6–12 months post‐treatment. This suggests that PENFS is a suitable alternative to pharmacologic therapy.
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  • Jun 2021
Background: Nonrestorative sleep is commonly reported by individuals with fibromyalgia, but there is limited information on the reliability and responsiveness of self-reported sleep measures in this population. Objectives: (1) Examine the reliability and validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in women with fibromyalgia, and (2) Determine the responsiveness of the PROMIS sleep measures to a daily transcutaneous electrical nerve stimulation (TENS) intervention in women with fibromyalgia over 4 weeks compared with other measures of restorative sleep. Methods: In a double-blinded, dual-site clinical trial, 301 women with fibromyalgia were randomly assigned to utilize either Active-TENS, Placebo-TENS, or No-TENS at home. Measures were collected at baseline and after 4 weeks of treatment. To assess self-reported sleep, the participants completed three PROMIS short forms: Sleep Disturbance, Sleep-Related Impairment, Fatigue, and the Pittsburgh Sleep Quality Index (PSQI). To assess device-measured sleep, actigraphy was used to quantify total sleep time, wake after sleep onset, and sleep efficiency. Linear mixed models were used to examine the effects of treatment, time, and treatment*time interactions. Results: The PROMIS short forms had moderate test–retest reliability (ICC 0.62 to 0.71) and high internal consistency (Cronbach's alpha 0.89 to 0.92). The PROMIS sleep measures [mean change over 4 weeks, 95% confidence interval (CI)], Sleep Disturbance: −1.9 (−3.6 to −0.3), Sleep-Related Impairment: −3 (−4.6 to −1.4), and Fatigue: −2.4 (−3.9 to −0.9) were responsive to improvement in restorative sleep and specific to the Active-TENS group but not in the Placebo-TENS [Sleep Disturbance: −1.3 (−3 to 0.3), Sleep-Related Impairment: −1.2 (−2.8 to 0.4), Fatigue: −1.1 (−2.7 to 0.9)] or No-TENS [Sleep Disturbance: −0.1 (−1.6 to 1.5), Sleep-Related Impairment: −0.2 (−1.7 to 1.4), Fatigue: –.3 (−1.8 to 1.2)] groups. The PSQI was responsive but not specific with improvement detected in both the Active-TENS: −0.9 (−1.7 to −0.1) and Placebo-TENS: −0.9 (−1.7 to 0) groups but not in the No-TENS group: −0.3 (−1.1 to 0.5). Actigraphy was not sensitive to any changes in restorative sleep with Active-TENS [Sleep Efficiency: −1 (−2.8 to 0.9), Total Sleep Time: 3.3 (−19.8 to 26.4)]. Conclusion: The PROMIS sleep measures are reliable, valid, and responsive to improvement in restorative sleep in women with fibromyalgia. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT01888640.
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Article
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Study objectives: Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in FGID school-age children and to assess relationships with demographic characteristics and gastrointestinal (GI) symptoms. Methods: Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared to published normative samples, and children above and below clinical cutoff were compared on demographics and FGID symptoms. Results: Of the sample, 61% were above clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African American participants were more likely to be above clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Conclusions: Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.
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Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia—Integrating a Behavioral Intervention
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  • NEUROMODULATION
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Importance of sleep quality in functional abdominal pain disorder in pediatric patients
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The incidence of sleep problems is increasing in children, and they are thought to contribute to pain in functional abdominal pain disorder (FAPD). In this study, we aimed to evaluate the pattern of sleep disturbance in children with FAPD and identify the associated factors. We retrospectively analyzed patients aged 12–18 years who were diagnosed with FAPD based on the Rome IV criteria. To assess sleep problems, we used the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). To evaluate factors associated with sleep disturbances, we used the odds ratios (OR) estimated in logistic regression models. Among the 66 patients evaluated, 57.6% (38/66) had a total PSQI-K score > 5, indicating a significant disturbance in sleep, 52.6% (20/38) had irritable bowel syndrome (IBS), and 47.4% (18/38) had functional abdominal pain-not otherwise specified. The mean PSQI-K score was 7.2 ± 6.0, and longer sleep onset latency was noted (26.33 ± 19.44 min) in all patients than healthy controls. Almost all PSQI-K subscales scores were elevated in patients with IBS. In univariate analysis, abdominal pain score > 7 and IBS were associated with poor sleep quality. In multivariate analysis, only IBS was associated with sleep disturbance. A relatively large proportion of patients with FAPD had sleep problems and these were more common in patients with IBS. Thus, interventions for improving sleep quality should also be considered in patients with FAPD with severe abdominal pain and IBS.
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The Utility of an Anxiety Screening Measure in Youth With Functional Abdominal Pain Disorders and Clinical Characteristics Associated With Presence of Anxiety
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Objectives: Anxiety is common in youth with functional abdominal pain disorders (FAPD) and is related to increased pain-related impairment. However, it is unknown if self-reported anxiety on a clinical screener represents a true anxiety disorder diagnosis in youth with FAPD. Further, little is known about clinical characteristics in youth with FAPD and comorbid anxiety (ANX). Therefore, we evaluated whether the clinical cutoff on the Screen for Anxiety and Related Disorders (SCARED) corresponded with presence of an anxiety disorder. We predicted a more clinically complex profile (e.g., increased pain-related impairment, psychological problems, and family risk factors) in youth with FAPD+ANX compared to youth with FAPD alone. Methods: Participants completed measures of anxiety, functional disability, pain intensity, pain catastrophizing, and mood, and underwent a semi-structured diagnostic interview to assess for psychological disorders. Caregivers completed family characteristics and caregiver distress measures. Analyses of group differences were conducted using chi-squared and multivariate tests. Results: The SCARED is a good proxy for an anxiety disorder in youth with FAPD, particularly for generalized anxiety disorder and social anxiety disorder. Youth with FAPD+ANX reported higher rates of pain-related disability and depressive symptoms compared to those with FAPD alone, but other clinical characteristics and family risk factors were comparable across groups. Discussion: Findings support use of the SCARED as a proxy for an anxiety disorder diagnosis in youth with FAPD and suggest youth with FAPD+ANX may have a more complex clinical profile categorized by greater mental health and health-related impairment as compared to youth with FAPD alone.
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Autonomic Dysfunction in Parasomnias of REM Sleep
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  • Feb 2021
Autonomic dysfunction is common in the rapid eye movement (REM) parasomnias. There are several reasons for this association, including the neuroanatomical proximity of REM sleep and autonomic control nuclei, and the dynamic state of autonomic activity during REM sleep. REM sleep behavior disorder (RBD), the most common REM parasomnia, affects 1% of the world’s population and is associated with a high rate of conversion to neurodegenerative disease. Autonomic dysfunction is highly prevalent in RBD and occurs early in the disease course, most commonly in the form of sympathetic impairment. Nightmare disorder and sleep paralysis are other disorders associated with parasomnias of REM sleep that are characterized by sympathetic hyperactivity and reduced heart rate variability. We also briefly mention trauma-associated sleep disorder (TSD), which shares some characteristics of RBD. This chapter summarizes the current literature on autonomic dysfunction in the REM parasomnias, and the value of assessing the autonomic nervous system as a marker of disease severity and progression.
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Diagnostic Accuracy of the Rome IV Criteria for the Diagnosis of Functional Gastrointestinal Disorders in Children
Article
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The diagnosis of functional gastrointestinal disorders (FGIDs) centers on symptoms-based criteria (Rome criteria). The last edition of the criteria was published in 2016. Still, few data on its validity support its use in children. We conducted a study aimed at determining the diagnostic accuracy of the Rome IV criteria through the application of questionnaires (Questionnaire of Pediatric Gastrointestinal Symptoms-Rome IV QPGSIV) to diagnose FGIDS in children. We hypothesized that the Rome IV criteria has adequate diagnostic accuracy supporting its use for diagnosing FGIDs in children. Methods: Schoolchildren 10-18 years from Cali (Colombia) completed the Spanish version of the QPGS-IV. Children with FGIDs were matched with a group of children without FGIDs. Both groups had a medical consultation with a blinded experienced pediatric gastroenterologist (gold standard) who provided his diagnosis. The questionnaire-based diagnoses were compared with the consultation's diagnoses. Results: Of 487 schoolchildren surveyed with the QPGS-IV, 97 (20.8%) had FGIDs. Eighty-nine with FGIDs were matched with 92 children without FGIDs (mean age 13.1 years (± 1.3). We found a higher prevalence of FGIDs during the medical visit than using the self-report QPGS-IV (66.3% vs. 49.2%, p = .001), mainly in abdominal pain disorders (19.3% vs. 10.5%, p = .013). The Rome IV diagnostic criteria using the QPGS-IV had a sensitivity of 75% (95% CI, 59%-79%) and 90% specificity (95% CI, 83%-98%). PPV 85.8%. NPV 79.9%. Conclusion: Our study suggests that the QPGS-IV has adequate diagnostic accuracy.
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