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J Adv Med Biomed Res 2018, 26(118): 15-20 |
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Torabi Z, Mansouri A, Armani A, Khederlou H. Sleep Disorders in Children of Zanjan City (Northwest, Iran) Kindergartens. J Adv Med Biomed Res 2018; 26 (118) :15-20
URL: http://journal.zums.ac.ir/article-1-4874-en.html
URL: http://journal.zums.ac.ir/article-1-4874-en.html
1- Dept. of Pediatrics, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
2- Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
3- Dept. of Psychiatrist, Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
4- Student Research Center, Zanjan University of Medical Sciences, Zanjan, Iran ,ham_khed@yahoo.com
2- Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
3- Dept. of Psychiatrist, Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
4- Student Research Center, Zanjan University of Medical Sciences, Zanjan, Iran ,
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| Abstract (HTML) (148862 Views)
This was a cross-sectional descriptive study on children aged 2-5 years in the kindergartens of Zanjan in 2016.
Out of the 345 children under study, 304 (88.1%) had sleep disorders. 87 subjects (25.3%) had at least one sleep disorder and one subject (0.3%) had all ten sleep disorders
According to BEARS questionnaire, fear of sleeping alone (59.4%), improper timing of sleeping and waking (44.4%) as well as disorders with bedtime (30.4%) were the most common sleep disorders among children (Table 1).
Table1. Frequency and prevalence of sleep disorders based on BEARS questionnaire
The subjects included 158 girls and 187 boys amongst whom 88.87% and 87.7% had at least one sleep disorder, respectively. Most children under study were three years old. The highest prevalence of sleep disorders was observed amongst two-year-olds. There was no significant association between sleep disorders and age (P=0.412) nor between sleep disorders and gender (P=0.473) (Table 2).
Sixty percent of the children under study were firstborns, 34% were the second-borns and 6% were third-borns in their families, and 91% of the firstborns, 84% of the second-borns and 89.9% of the third-borns had sleep disorders. There was no significant relationship between sleep disorders and a child's rank in their family (firstborns, second-borns or third-borns) (P=0.061), nor between sleep disorders and the number of siblings (P=0.096).
Table 2. Frequency of sleep disorders in subjects by gender and age
Table 3. The frequency of sleep disorders based on the use of mass media and dietary habits
Table 4. Frequency of sleep disorders based on maternal education and occupation
In this study, the prevalence of sleep disorders was 88%. The prevalence of sleep disorders has been reported in various international studies (16, 17). This difference in the prevalence of sleep disorders can be due to cultural differences, the studied society and different instrument and methods of study.
In this study, we did not find a significant association between sleep disorders and gender. This result was in accordance with the results of other studies (18, 19).
As with other studies (20- 22), this study showed that the use of mass media increased the amount of sleep disorders. There are several hypotheses about the relationship between using mass media and sleep disorders. Firstly, it causes the child to stay awake until midnight. Secondly, the emitted light reduces the secretion of melanin in the eyes, and as a result, impairs sleep. Additionally, the usage of television causes mental conflicts and anxiety (23).
Although the prevalence of sleep disorders was high in children with inappropriate food habit in our study, findings showed that dietary behaviors had no significant effect on sleep disorders. This finding contradicted results of other studies (24), which could be due to different categories of dietary behaviors and different food cultures.
The results of this study showed that a correlative relationship is not present between a mother's occupation and a child’s sleep disorders. Such results are quite similar to the findings in other studies (25, 26). There was a significant relationship in maternal education and sleep disorders, with children who had mothers of graduate or post-graduate education with the highest prevalence of sleep disorders. This can be attributed to the high sensitivity of mothers with high education and their more attention to their children (26).
This study showed that there is no relationship between the number of siblings and sleep disorders; some studies have reached similar conclusions (26). Yet, other studies have reported a reduction in the prevalence of sleep disorders of children with a few siblings (27).
Fear of sleeping alone was the most common disorder in the studied children, which can be seen in collected data elsewhere (28, 29). In other studies, sleep talking was the most commonly reported disorder (30), while, it`s prevalence in our study was at 21.4%. Additionally, in a few other studies, waking during nighttime was reported as the most common disorder (31), whereas its prevalence in our study was at 13.9%. Some others studies reported drowsiness during daytime as the most common disorder (32, 33), yet, its prevalence in our study was at 14.2%.
Despite the fact that snoring marked the lowest sleep disorder, it is the most common complaint of mothers (34, 5). Snoring can be attributed to sleep-related respiratory disorders, such as Aden tonsillar hypertrophy, which is highly prevalent in the age range of 2-6 years old (35).
The high prevalence of sleep disorders in our study implicated that these psychological disorders require special attention from pediatricians and pediatric psychiatrists. Therefore, a multi-disciplinary team of pediatricians, pediatric psychiatrists and public health professionals, as well as providing evidence-based clinical guides for specialists and general practitioners should be considered.
We hereby appreciate the support of the authorities in the Education Department of Zanjan Province and the cooperation of our honorable parents.
Authors declared no conflict of interests.
✅ The high prevalence of sleep disorders in this study suggests that such psychological problems require special attention on the part of pediatricians, pediatric psychiatrists and general health professionals with an orientation towards teamwork.
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Introduction
Sleep plays an important role in physical and mental health, growth and daily activities of children (1). Sleep disorders occur during NREM (Non-Rapid Eye Movement) sleep and are more frequent in the early hours of sleep with the highest prevalence among pre-school children (2).
In a general classification, sleep disorders are divided into sleep-related diseases and sleep problems. Sleep-related diseases including obstructive airway disease, narcolepsy and insomnia. Sleep problems include maintenance of an appropriate bedtime, somnambulism, sleep deprivation and sleep-related anxiety (3). Sleep behaviors of children have an important influence on their quality of life (4), and sleep-related disorders, including inadequate and interrupted sleep, as well as associated mood and behavioral disorders, are amongst the main concerns of parents (5). 25-30% of children experience sleep disorders regardless of age (6), which can be seen as the most common complaint in pediatric medicine (2, 7).
A sleep disorder first appears in the form of mood disorder (8). However, the most obvious and serious complication associated with childhood sleep disorders is disruption of cognitive abilities and emotional regulations, which results in the risk of school failure, family problems and psychiatric disorders (2, 9).
The diagnosis of sleep disorders is a clinical matter (10). Some studies have shown that primary care physicians in children have little knowledge of sleep disorders (11), which results in poor management and improper treatment of sleep disorders and its related outcomes such as emotional, behavioral, and cognitive disorders (12, 13). Therefore, the screening of sleep disorders should be considered important for health providers (4). A formula for healthy sleep habits and Behavioral effects is the cornerstone for the prevention and treatment of sleep disorders (2), which requires awareness of the prevalence of sleep disorders and the factors affecting it. The aim of this study was to investigate the prevalence of sleep disorders amongst preschool children, in order to encourage more awareness and attention on this matter to parents and health care providers.
In a general classification, sleep disorders are divided into sleep-related diseases and sleep problems. Sleep-related diseases including obstructive airway disease, narcolepsy and insomnia. Sleep problems include maintenance of an appropriate bedtime, somnambulism, sleep deprivation and sleep-related anxiety (3). Sleep behaviors of children have an important influence on their quality of life (4), and sleep-related disorders, including inadequate and interrupted sleep, as well as associated mood and behavioral disorders, are amongst the main concerns of parents (5). 25-30% of children experience sleep disorders regardless of age (6), which can be seen as the most common complaint in pediatric medicine (2, 7).
A sleep disorder first appears in the form of mood disorder (8). However, the most obvious and serious complication associated with childhood sleep disorders is disruption of cognitive abilities and emotional regulations, which results in the risk of school failure, family problems and psychiatric disorders (2, 9).
The diagnosis of sleep disorders is a clinical matter (10). Some studies have shown that primary care physicians in children have little knowledge of sleep disorders (11), which results in poor management and improper treatment of sleep disorders and its related outcomes such as emotional, behavioral, and cognitive disorders (12, 13). Therefore, the screening of sleep disorders should be considered important for health providers (4). A formula for healthy sleep habits and Behavioral effects is the cornerstone for the prevention and treatment of sleep disorders (2), which requires awareness of the prevalence of sleep disorders and the factors affecting it. The aim of this study was to investigate the prevalence of sleep disorders amongst preschool children, in order to encourage more awareness and attention on this matter to parents and health care providers.
Materials and Methods
This was a cross-sectional descriptive study on children aged 2-5 years in the kindergartens of Zanjan in 2016.
Sampling Method
The health of children regarding growth and development was considered as the inclusion criteria but the developmental problems such as mental retardation, cerebral palsy, psychosis, hyperactivity, autism and single parenting were regarded as the exclusion criterion. In this study, the cluster sampling method was used, with a study sample size of 345 by applying the cluster coefficient of 1.5.
Data Collection Tool
Initially, a permission was obtained from the Ethics Committee (ZUMS.REC.1393.79 ethics code). Then after explaining the importance of the subject to parents and kindergarten authorities, they were asked to accurately respond to BEARS questionnaire. A written informed consent was obtained from all participants’ legal guardians. The questionnaire consisted of two parts. The first part of the questionnaire was approved by two pediatricians, a psychiatrist, and a social medicine specialist. The first part included demographic information, social and economic family status, leisure time, mass media (a tool used in a society for communicating messages, expressing thoughts and transferring concepts to others such as radio, television, press, cinema, satellite dishes, computer and video) and dietary habits of children (child’s reaction to nutritional preferences in terms of type, volume and variety of food) (14). The second part was a Persian translation of BEARS questionnaire verified for reliability and validity (15), including options such as: difficulty of going to bed (insomnia), fatigue and drowsiness throughout the day, frequent disruption of night sleep, order of waking and sleeping and snoring.
Method of Questionnaire Validity and Reliability Determination
Internal consistency of the questionnaire was calculated in a pilot study of 30 samples using Cranach’s alpha (0.44). The reliability of the study was calculated using test-retest for each item in the questionnaire, and the correlation coefficient for all items was calculated as 0.7.
Data Analysis Method
Chi-square test was used to determine the relationship between anthropometric characteristics and sleep problems. Data was analyzed using SPSS 19 (SPSS Inc., Chicago, Ill., USA) with a significant level of 0.05
Results
Out of the 345 children under study, 304 (88.1%) had sleep disorders. 87 subjects (25.3%) had at least one sleep disorder and one subject (0.3%) had all ten sleep disorders
According to BEARS questionnaire, fear of sleeping alone (59.4%), improper timing of sleeping and waking (44.4%) as well as disorders with bedtime (30.4%) were the most common sleep disorders among children (Table 1).
Table1. Frequency and prevalence of sleep disorders based on BEARS questionnaire
| Frequency (%) | Sleep Disorders | ||||
| No | Yes | ||||
| 303 (87.7) | 42 (12.2) | Waking up horrified | |||
| 271 (78.6) | 74 (21.4) | Sleep talking | |||
| 304 (1.88) | 41 (11.9) | Teeth grinding | |||
| 140 (40.6) | 205 (59.4) | Fear of sleeping alone | |||
| 240 (69.6) | 105 (30.4) | Probl em with bedtime |
|||
| 279 (80.9) | 66 (19.1) | Difficulty falling sleep | |||
| 296 (85.4) | 49 (14.2) | Daytime drowsiness | |||
| 192 (55.6) | 153 (44.4) | Improper sleeping and waking time | |||
| 315 (91.3) | 30 (8.7) | Snoring | |||
| 297 (86.1) | 48 (13.9) | Waking during night sleep | |||
The subjects included 158 girls and 187 boys amongst whom 88.87% and 87.7% had at least one sleep disorder, respectively. Most children under study were three years old. The highest prevalence of sleep disorders was observed amongst two-year-olds. There was no significant association between sleep disorders and age (P=0.412) nor between sleep disorders and gender (P=0.473) (Table 2).
Sixty percent of the children under study were firstborns, 34% were the second-borns and 6% were third-borns in their families, and 91% of the firstborns, 84% of the second-borns and 89.9% of the third-borns had sleep disorders. There was no significant relationship between sleep disorders and a child's rank in their family (firstborns, second-borns or third-borns) (P=0.061), nor between sleep disorders and the number of siblings (P=0.096).
Table 2. Frequency of sleep disorders in subjects by gender and age
| Variable | Number | Sleep disorders | Frequency (%) | P-Value |
| Gender | ||||
| No | 0.473 | |||
| Female | 158 | 1 | 19 (12.02) | |
| 2≤ | 38 (24.05) | |||
| No | 101 (63.90) | |||
| Male | 187 | 1 | 23 (12.30) | |
| 2≤ | 49 (26.20) | |||
| Age | 115 (61.50) | |||
| No | 0.412 | |||
| years2 | 57 | 1 | 5 (8.70) | |
| 2≤ | 16 (28.07) | |||
| No | 36 (1.63) | |||
| 3 years | 99 | 1 | 13 (13.10) | |
| 2≤ | 28 (28.30) | |||
| No | 58 (58.60) | |||
| 4 years | 98 | 1 | 17 (17.30) | |
| 2≤ | 18 (18.40) | |||
| No | 63 (64.30) | |||
| 5 years | 91 | 1 | 7 (7.70) |
Table 3. The frequency of sleep disorders based on the use of mass media and dietary habits
| Variable | Number | Sleep Disorders | Frequency (%) | P-Value |
| Mass media | ||||
| Non-users | 70 | No | (3.14) 10 | 0.027 |
| Yes | (7.85) 60 | |||
| users | 275 | No | (4) 11 | |
| Yes | (96) 264 | |||
| Dietary behavior | ||||
| Inappropriate | 66 | No | (7.6) 5 | 0.226 |
| Yes | (92.40) 61 | |||
| Acceptable | 219 | No | (12.80) 28 | |
| Yes | (87.20) 191 | |||
| Proper | 59 | No | (13.60) 8 | |
| Yes | (86.40) 51 |
Parent's education and its relationship with the prevalence of childhood sleep disorders was also studied. The majority of children had parents with a bachelor's degree. There was no significant relationship between sleep disorders and maternal occupation (P=0.191); however, there was a significant relationship between maternal education and sleep disorders (P=0.008). The lowest prevalence of sleep disorders was seen among children whose mothers had a bachelor's degree and the highest prevalence seen among children whose mothers had a graduate or post-graduate education. No significant relationship was found between a father's education and sleep disorders (P=0.226) (Table 4).
Table 4. Frequency of sleep disorders based on maternal education and occupation
| Variable | Number | Sleep disorders | Frequency (%) | P-Value |
| Education | ||||
| Below a High School Diploma | 21 | No | 2 (0.57) | 0.008 |
| Yes | 19 (5.5) | |||
| High School Diploma | 82 | No | 5 (1.4) | |
| Yes | 77 (22.30) | |||
| Bachelor's Degree | 185 | No | 32 (9.20) | |
| Yes | 153 (3.44) | |||
| Graduate Degree | 57 | No | 2 (0.57) | |
| Yes | 55 (15.90) | |||
| Occupation | ||||
| Unemployed | 115 | No | 10 (8.70) | 0.191 |
| Yes | 105 (91.30) | |||
| Employed | 229 | No | 31 (13.50) | |
| Yes | 198 (86.50) |
Discussion
In this study, the prevalence of sleep disorders was 88%. The prevalence of sleep disorders has been reported in various international studies (16, 17). This difference in the prevalence of sleep disorders can be due to cultural differences, the studied society and different instrument and methods of study.
In this study, we did not find a significant association between sleep disorders and gender. This result was in accordance with the results of other studies (18, 19).
As with other studies (20- 22), this study showed that the use of mass media increased the amount of sleep disorders. There are several hypotheses about the relationship between using mass media and sleep disorders. Firstly, it causes the child to stay awake until midnight. Secondly, the emitted light reduces the secretion of melanin in the eyes, and as a result, impairs sleep. Additionally, the usage of television causes mental conflicts and anxiety (23).
Although the prevalence of sleep disorders was high in children with inappropriate food habit in our study, findings showed that dietary behaviors had no significant effect on sleep disorders. This finding contradicted results of other studies (24), which could be due to different categories of dietary behaviors and different food cultures.
The results of this study showed that a correlative relationship is not present between a mother's occupation and a child’s sleep disorders. Such results are quite similar to the findings in other studies (25, 26). There was a significant relationship in maternal education and sleep disorders, with children who had mothers of graduate or post-graduate education with the highest prevalence of sleep disorders. This can be attributed to the high sensitivity of mothers with high education and their more attention to their children (26).
This study showed that there is no relationship between the number of siblings and sleep disorders; some studies have reached similar conclusions (26). Yet, other studies have reported a reduction in the prevalence of sleep disorders of children with a few siblings (27).
Fear of sleeping alone was the most common disorder in the studied children, which can be seen in collected data elsewhere (28, 29). In other studies, sleep talking was the most commonly reported disorder (30), while, it`s prevalence in our study was at 21.4%. Additionally, in a few other studies, waking during nighttime was reported as the most common disorder (31), whereas its prevalence in our study was at 13.9%. Some others studies reported drowsiness during daytime as the most common disorder (32, 33), yet, its prevalence in our study was at 14.2%.
Despite the fact that snoring marked the lowest sleep disorder, it is the most common complaint of mothers (34, 5). Snoring can be attributed to sleep-related respiratory disorders, such as Aden tonsillar hypertrophy, which is highly prevalent in the age range of 2-6 years old (35).
Conclusion
The high prevalence of sleep disorders in our study implicated that these psychological disorders require special attention from pediatricians and pediatric psychiatrists. Therefore, a multi-disciplinary team of pediatricians, pediatric psychiatrists and public health professionals, as well as providing evidence-based clinical guides for specialists and general practitioners should be considered.
Acknowledgment
We hereby appreciate the support of the authorities in the Education Department of Zanjan Province and the cooperation of our honorable parents.
Conflict of Interest
Authors declared no conflict of interests.
Type of Study: Original Research Article |
Subject:
Life Science
Received: 2017/10/22 | Accepted: 2018/08/18 | Published: 2018/08/1
Received: 2017/10/22 | Accepted: 2018/08/18 | Published: 2018/08/1
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