Διαταραχές ύπνου παιδιών με ΔΕΠ-Υ και γονεϊκό στρες

Τα παιδιά που έχουν λάβει διάγνωση Διαταραχής Ελλειμματικής Προσοχής -Υπερκινητικότητας αντιμετωπίζουν συχνά διαταραχές ύπνου, οι οποίες με βάση ερευνητικά ευρήματα από διάφορες κλινικές ομάδες φαίνεται να συσχετίζονται με το γονεϊκό στρες. Σκοπός της παρούσας μελέτης καθίσταται λοιπόν η διερεύνηση της σχέσης των διαταραχών ύπνου των παιδιών με ΔΕΠ-Υ με το γονεϊκό στρες. Επιπλέον, λαμβάνει χώρα η ιεράρχηση των παραγόντων που προκαλούν το γονεϊκό στρες και εκείνων που συνδέονται με τις διαταραχές ύπνου, ενώ εξετάζεται και ο ρόλος των δημογραφικών στοιχείων. Για τη διεξαγωγή της έρευνας χρησιμοποιήθηκε ερωτηματολόγιο, το οποίο αποτελείται από ερωτήσεις για τα δημογραφικά στοιχεία των γονέων, των παιδιών τους, καθώς και δύο δημοσιευμένες κλίμακες, την CSHQ (Children’s Sleep Habits Questionnaire) για την εξέταση της συμπεριφοράς των παιδιών την ώρα του ύπνου και την PSI-SF (Parenting Stress Index – Short Form) για τη διερεύνηση του στρες που συνδέεται με τη γονεϊκότητα. Το δείγμα της παρούσας μελέτης αποτέλεσαν 81 γονείς παιδιών ηλικίας 4 έως 12 ετών, τα οποία είχαν λάβει διάγνωση ΔΕΠ-Υ. Σύμφωνα με τα πορίσματα φαίνεται πως οι διαταραχές ύπνου των παιδιών με ΔΕΠ-Υ συσχετίζονται θετικά με το γονεϊκό στρες. Ακόμη, προέκυψε ότι οι βασικότεροι παράγοντες διαταραχών ύπνου είναι: 1. τα προβλήματα παραϋπνιών, αναπνοής και ημερήσιας υπνηλίας και 2. η αντίσταση και η ανησυχία την ώρα του ύπνου. Επίσης, οι δύο βασικές παράμετροι του γονεϊκού στρες που αναδύθηκαν είναι: 1. το γονεϊκό στρες που βασίζεται στον τομέα «δύσκολο» παιδί και 2. η γονεϊκή δυσφορία, ανάμεσα στις οποίες μάλιστα εμφανίζεται θετική συσχέτιση. Μεταξύ των προβλημάτων παραϋπνιών, αναπνοής και ημερήσιας υπνηλίας και της συνήθους διάρκειας ύπνου του παιδιού κάθε βράδυ εντοπίστηκε αρνητική συσχέτιση, ενώ με τη συνήθη διάρκεια ύπνου του παιδιού την ημέρα, θετική. Επιπροσθέτως, διαπιστώθηκε πως τα προβλήματα ύπνου διαφέρουν μεταξύ των βαθμίδων εκπαίδευσης, ενώ με τους υπόλοιπους δημογραφικούς παράγοντες δεν υπήρξε στατιστικά σημαντική σχέση. Συνεχίζοντας, θετική ήταν η συσχέτιση του γονεϊκού στρες που βασίζεται στον τομέα «δύσκολο» παιδί με τα προβλήματα παραϋπνιών, αναπνοής και ημερήσιας υπνηλίας, όπως και της γονεϊκής δυσφορίας με την αντίσταση και ανησυχία την ώρα του ύπνου. Τέλος, παρατηρήθηκε ότι η γονεϊκή δυσφορία διαφέρει ανάλογα με το μορφωτικό επίπεδο του γονέα, χωρίς οι υπόλοιποι δημογραφικοί παράγοντες που εξετάστηκαν να επηρεάζουν το γονεϊκό στρες.Children who have been diagnosed with Attention Deficit Hyperactivity Disorder often experience sleep disorders, which based on research findings from various clinical groups seem to be associated with parenting stress. The current research aims to investigate the relation of sleep disorders of children with ADHD to parenting stress. Furthermore, are classified the factors that cause the parenting stress and those associated with sleep disorders, while the role of demographic elements is being examined. For the research, a questionnaire was used, which consists of questions about the demographics of the parents, their children and two published scales, the CSHQ (Children’s Sleep Habits Questionnaire) to examine the behavior during sleeping and the PSI-SF (Parenting Stress Index- Short Form). The sample of this study were 81 parents of children aged 4 to 12 years old, who have been diagnosed with ADHD. According to the results, sleep disorders of children with ADHD are positively correlated with parenting stress. Additional, it resulted that the major factors of sleep disorders are : 1. parasomnias, sleep disordered breathing and daytime sleepiness and 2. bedtime resistance and sleep anxiety. Also, the two basic parameters of parenting stress are : 1. difficult child domain and 2. parental distress among which appears a positive correlation. Between parasomnias, sleep disordered breathing and daytime sleepiness the child’s usual amount of nighttime sleep was detected a negative correlation, while the child’s usual amount of sleep at daytime, positive. Furthermore, it was found that sleep disorders differ among the grades of education, while with the other demographic factors did not have a statistically significant relation. There was positive correlation of parenting stress based on difficult child domain and parasomnias, sleep disordered breathing and daytime sleepiness, also parental distress with bedtime resistance and sleep anxiety. Finally, it was observed that parental distress differs according to the parent’s educational level, without the other demographic factors considered to affect parenting stress

Endocrine and neurophysiological examination of sleep disorders in Williams syndrome

Background: A high rate of sleep disturbances have been reported in individuals with Williams syndrome (WS), but the underlying aetiology has yet to be identified. Melatonin and cortisol levels are known to affect and regulate sleep/wake patterns. We investigated the changing levels of these hormones in order to explore any relationship with sleep disturbances in children with WS. Methods: Twenty seven children with WS and 27 typically developing (TD) children were recruited. Sleep was monitored using actigraphy and pulse oximetry. Parents completed Children’s Sleep Habit Questionnaire (CSHQ). Saliva and first void morning urine samples were collected from the children. Saliva was collected at three time points: 4-6pm, before bedtime and first thing after awakening. Levels of salivary melatonin and cortisol were analysed by enzyme linked immunoassays. For determination of melatonin, cortisol and their metabolites in urine samples, specific Ultra-High Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-MS/MS) method was developed. Results: CSHQ and actigraphy indicated that children with WS were significantly affected by several types of sleep disturbances, including: abnormally high sleep latency and excessive night waking. Children in WS group had shallower falls in salivary cortisol levels and less pronounced rises in salivary melatonin at bedtime compared to TD controls (p < 0.01 and p = 0.04 respectively). Furthermore, it was found that children with WS also had significantly higher levels of bedtime cortisol compared to TD controls (p = 0.03). Using UHPLC-MS/MS analysis it was shown that children with WS secrete less melatonin during the night compared to healthy controls (p < 0.01). Also, levels of cortisone, a metabolite of cortisol were significantly higher in the WS group (p = 0.05). Conclusions: We found that children with WS had significant sleep disturbances which may be associated with their increased bedtime cortisol and lower evening melatonin. Both hormones play a significant role in the circadian rhythm and sleep/wake cycle, therefore it was necessary to look closely at these endocrine markers in individuals suffering from sleep disorders. Sleep problems in children with WS may adversely affect daytime activity and the quality of life, as well as social, emotional, health and economic functioning of the entire family. Hence, finding their cause is of great importance for affected children and their families

Association between Low Serum Ferritin and Restless Legs Syndrome in Patients with Attention Deficit Hyperactivity Disorder

ONER, P., DIRIK, E.B., TANER, Y., CAYKOYLU, A. and ANLAR, O. Association between Low Serum Ferritin and Restless Legs Syndrome in Patients with Attention Deficit Hyperactivity Disorder. Tohoku J. Exp. Med., 2007, 213 (3), 269-276 - Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity. It has been suggested that ADHD symptoms are associated with restless legs syndrome (RLS), which is a neurological condition that is defined by an irresistible urge to move the legs. Increasing evidence suggests iron deficiency may underlie common pathophysiological mechanisms in subjects with ADHD and with RLS. To further define the relationship between iron deficiency and RLS in children and adolescents with ADHD, we evaluated 87 ADHD subjects: 79 boys and 8 girls with age 9.3 +/- 2.5 years (6-16 years). Various psychopathologies and the severity of the ADHD symptoms and serum ferritin levels were assessed. Diagnosis of RLS was made according to the International RLS Group criteria. The patients were evaluated for the iron deficiency (ferritin < 12 ng/ml). RLS was found in 29 (33.3%) of the 87 ADHD subjects. Parent-and teacher-rated behavioral and emotional problems and the severity of ADHD symptoms were not significantly different between ADHD subjects with RLS and those without RLS (n = 58). The rate of iron deficiency was significantly higher in ADHD subjects with RLS (n = 6, 20.7%) when compared with ADHD subjects without RLS (n = 1, 1.7%, p = 0.005). Our results showed that depleted iron stores might increase the risk of having RLS in ADHD subjects. Iron deficiency, which is associated with both ADHD and RLS, seems to be an important modifying factor in the relationship between these two conditions. restless legs syndrome; attention deficit hyperactivity disorder; iron deficiency; ferritin; doparnme (c) 2007 Tohoku University Medical Press