Nigerian Journal of Paediatrics 2012;39(1): 14 - 17
ORIGINAL
Ofovwe GE
Prevalence and pattern of sleep disorder
Ofovwe CE
Okunola P
among children with neurological
diseases in University of Benin Teaching
Hospital, Benin City, Nigeria.
DOI: http://dx.doi.org/10.4314/njp.v39i1.3
Received: 4thApril 2011
Abstract
Background:
Sleep
Children were judged to have sleep
Accepted:3rd November 2011
disorders significantly affect the
disorder if the symptom were
quality of live and may impair
present frequently or very
Ofovwe GE
( )
cognitive development. Sleep
frequently. Variables were
Okunola P
disorders are reported to be
aggregated as simple proportions
Department of Child Health,
common in children with
and differences determine using
Ofovwe CE
neurological diseases. However no
chi-square test.
Department of Mental Health
r e p o r t h a s e v a l u a t e d t h e
Results:
One hundred and fifty
University of Benin Teaching
prevalence of sleep disorders
children aged 17years and below
Hospital,
a m o n g
c h i l d r e n
c h r o n i c
consisting of 98 (65.3%) males and
P. M. B. 1111, Benin City,
neurological diseases in Nigeria.
52 (34.7%) were evaluated. The
Nigeria.
This study therefore sort to
most common sleep disorders
Email: gofo@childhealthuniben.com
determine the prevalence and
found include restlessness during
ofovwegabriel@yahoo.com
types of sleep disorders among
children with neurological
sleep 68.7%, frequent awakening
diseases seen Child neurology
66.0%, snoring 57.3%, excessive
clinic of University of Benin
day time sleepiness 53.3% and
Teaching Hospital (UBTH), Benin
sleep walking among others. Sleep
City.
disorders were more common in
Subjects and methods : This was a
boys than in girls and those aged 5
questionnaire based cross
years and below than older children.
sectional study. Parents/caregivers
Conclusion:
Sleep disorders are
of children attending the Child
very common among children with
Neurology Clinic of UBTH were
neurological diseases. These
recruited and a structured
problems have great potential of
questionnaire was administered to
further impairing cognitive
evaluate the presence of sleep
development and quality of life in
disorders in the children they have
these children.
brought to the clinic. Response
scale ranged from never, rarely,
Key
words:
sleep disorder,
occasional, frequent and very
children, neurological diseases,
frequent.
Benin City.
Introduction
presence of other problems which may not be
apparent except searched for by concerted effort. One
such problem is sleep disorder. Sleep problems
1
Chronic neurological disorders in children are
challenging conditions because of the emotional,
among children with neurological disorders is
reported to be extremely common.
2,3,4
physical, psychological and financial stress they
In Nigeria, very
place on the primary care givers and the society as a
few people are aware of sleep disorders and even so
result of the enormous resources required to manage
their knowledge is limited to insomnia whereas
these children. To benefit maximally and to live to
1
disorders of sleep has expanded to include a lot of
the best possible quality of life, management of these
problems associated with sleep.
children requires a holistic approach to identify
15
Lack of adequate and refreshing sleep may reduce
Majority of the children 65 (57%) were in the age
day time alertness whereas problems such as sleep
group of 1 5 years while 40 (35.1%) were aged 6 10
apnea may result in reduce oxygen supply to the
years and 9 (7.9%) above 10 years respectively. The
brain and neuronal dysfunction which are capable of
most common type of sleep disorder was restlessness
impacting negatively on cognitive development and
during sleep which was present in 103 (68.7%) of
function especially in children.
4,5
For children with
children, followed by frequent awakening during
neurological diseases who are already faced with
sleep 99 (66.0%), snoring 86 (57.3%), excessive
challenges of cognitive development and
daytime sleepiness 80 (53.3%) and sleep walking 59
functioning, the presence of sleep disorders may
(39.3%). The relative frequency of the various types
further worsen their learning difficulty.
of sleep disorders among the study population is
shown inTable 1.
This study was therefore undertaken to determine
the prevalence and types of sleep disorders among
Table 1 . Relative frequency of type of sleep disorder
children with neurological diseases in Benin City
among children with neurological diseases.
and provide data for adequate intervention.
Type of sleep disorder
n
%
Restless during sleep
103
68.7
Patients and Methods
Frequent wakening during sleep
99
66.0
Snoring
86
57.3
The study was carried out in the Child Neurology
Excessive day time sleepiness
80
53.3
Clinic of the Department of Child Health, University
Sleep walking
59
39.3
of Benin Teaching Hospital, Benin City, Nigeria
Talking during sleep
44
29.3
from October 2008 to November 2009. The
Nightmares
38
25.3
University of Benin Teaching Hospital is a referral
Habitual teeth grinding
28
18.7
centre serving Edo, Delta, Kogi and Ondo States.
Sleep apnea
13
8.7
The child neurology clinic runs once a week with an
Shake to breath during sleep
8
5.3
average of 6 new cases weekly and attends to
Head banging
14
9.3
patients 17 years of age and below.
Sit up during sleep
10
6.7
Shaken to breath during sleep
8
5.3
New cases were consecutively recruited after
informed verbal consent from their parents or care
Among those who snore during sleep, 17 (11.3%)
givers. A sleep disorder questionnaire developed by
were habitual snorers while 69 (46.0%) were non-
the Kosair's Pediatric Sleep Research Centre,
habitual snorers. Likewise, among those with
Louisville, Kentucky, U.S.A was administered to
excessive daytime sleepiness 45 (30.0%) were
parents/caregivers by research assistants who were
habitual daytime sleepers while 35 (23.3%) were
House Officers rotating through the Department of
non-habitual excessive daytime sleepers. 29 (19.3%)
Child Health. The questionnaires were administered
of those with sleep walking were habitual sleep
after initial evaluation of the patients and before
walkers compared to 30 (20.0%) who were non-
medication were started. Patients who were on
habitual sleep walkers. Eight (5.3%) of those with
medication with sedative effect such as diazepam
sleep apnea require shaking to breath during sleep.
and anti-epileptic drugs prior to presentation to the
All the types of sleep disorders were more common
clinic were excluded from the study. Information
among boys than girls although the differences were
from the sleep questionnaire was transferred to
not statistically significant.
Microsoft excel sheet and checked for accuracy and
then exported to SPSS 13.0 for descriptive analysis.
Results
A total of one hundred and fourteen children with
neurological diseases were recruited consisting of
76 (66.7%) boys and 38 (33.3%) girls. The age of the
children from 1 to 17 years with a mean of 5.5 ± 3.3
years. The mean age of boys was 5.8 ± 3.5 years
while that for girls was 4.7 ± 2.6 years.
16
Table 2 : Gender distribution of the more common
Table 3 shows the distribution of the various types of
sleep disorders among children with neurological
sleep disorders among age groups. Restlessness
diseases.
during sleep was significantly more common in
children aged 5 years or below 59 (57.3%) compared
Gender
SleepDisorders
Male
Female
Total
χ 2
Pvalue
to 37 (35.9%) of those aged 6 - 10 years and 7 (6.8%)
of those aged above 10 years respectively (χ = 9.839;
2
n(%)
n(%)
P=0.02). Talking during sleep was significantly
Restless duringsleep
68(66.0)
35(44.0)
103
0.794
NS
equally more common among children age 5 years
Frequentawakening
64(64.6)
35(35.4)
99
1.451
NS
and below and those aged 6 - 10 years than among
Snoring
57(66.3)
29(33.7)
86
0.080
NS
those older than 10 years (χ = 8.520; P = 0.03).
2
EDS
51(63.8)
29(36.2)
80
0.190
NS
Sleepwalking
42(71.2)
17(28.8)
59
1.471
NS
Though the other types of sleep disorders were more
Talkduringsleep
31(70.5)
13(29.5)
44
0.721
NS
common among children aged 5 years and below than
Teethgrinding
18(64.3)
10(35.7)
28
0.017
NS
the other age groups the differences were not
Headbanging
9(64.3)
5(35.7)
14
0.007
NS
statistically significant.
Sleepapnoea
9(69.2)
4(30.8)
13
0.017
NS
Situpduringsleep
9(90.0)
1(10.0)
10
2.878
NS
EDS = Excessive daytime sleepiness.
NS = Not significant.
Table 3: Age group distrubution of sleep disorders among children with neurological diseases
Age group
Sleep disorder
0 – 5 years
6 – 10 years
>10 years
Total
χ
2
P value
n (%)
n (%)
n (%)
Restless during sleep
59 (57.3)
37 (35.9)
7 (6.8)
103
9.839
0.02
Frequent awakening
55 (55.6)
35 (35.4)
9 (9.0)
99
8.232
NS
Snoring
48 (55.8)
30 (34.9)
8 (9.3)
86
2.602
NS
EDS
45 (56.2)
25 (31.3)
10 (12.5)
80
1.142
NS
Sleep walking
31 (52.5)
20 (34.0)
8 (13.5)
59
1.884
NS
Talk during sleep
21 (47.7)
21 (47.7)
2 (4.6)
44
8.520
0.03
Teeth grinding
13 (46.4)
13 (46.4)
2 (23.2)
28
3.566
NS
Head banging
8 (57.1)
4 (28.6)
2 (14.3)
14
0.282
NS
Sleep apnoea
8 (61.5)
3 (23.1)
2 (15.4)
13
0.733
NS
Sit up during sleep
6 (60.0)
3 (30.0)
1 (10.0)
10
0.132
NS
EDS = Excessive daytime sleepiness.
NS = Not significant.
poor sleep hygiene practices
6
and the inherent
neurological disease itself. However it may also
Discussion
indicate the presence of restless leg syndrome or the
periodic limb movement disorder of sleep among this
This is the first study evaluating the prevalence of
group of children. Restlessness during sleep may also
sleep disorders among children with neurological
be a contributing factor to the high prevalence of
diseases in Benin City and perhaps in Nigeria to our
frequent awakening among 66% of the children in
best knowledge. The study reveals a high prevalence
this study thus causing un-refreshing and fragmented
sleep with consequent reduced daytime alertness.
7
of various types of sleep disorders among this group
of patients comparable to previous reports.
2,5
Snoring in children is to a large extent ignored in our
Common among the sleep disorder in this study were
environment and indicates obstruction to air flow in
restlessness during sleep, frequent awakening,
the upper airway due commonly to enlarged tonsils
snoring, excessive day time sleepiness, sleep
and adenoids or muscle weakness leading to the
walking (somnabulism), talking during sleep,
tongue falling backward into the pharynx as is seen in
children with Down's syndrome.
6
nightmares and habitual teeth grinding.
1,2,3,4
Restlessness during sleep may be due to several
The importance of snoring lies in the fact that it may
factors ranging from environmental conditions such
result in sleep apnea as revealed in this study with a
as ambient room temperature (which is high in our
high proportion of the children (57.3%) snoring
Environment), number of children sharing a bed,
during sleep and 13 (8.7%) suffering from sleep
apnea.
8,9
The implication of this in children with
17
already compromised neurological status is not far
Conclusion
fetched. Snoring and sleep apnea often result in
hypoxia and reduced oxygen supply to the brain. On
sleep disorders are very prevalent among children
a chronic basis this may lead to neuronal loss or poor
with neurological diseases and capable of further
development further impairing cognitive function.
impairing cognitive development in them. Concerted
The high prevalence of excessive daytime sleepiness
effort should be made to search and manage these
(EDS) among this group of children is the product of
problems during routine evaluation of these children
the effects of the various sleep disorders which result
to improve their quality of live and eliminate further
in fragmentation and un-refreshing sleep.
7,
8,
9
impediments to cognitive development.
Optimizing cognitive development to the best level
possible is a very important key in the management
of children with neurological diseases if they are to
live to their fullest potential and high quality of life.
Acknowledgment
Problems such as sleep disorders are usually pushed
to the background or totally ignored in the
We acknowledge with gratitude the assistance of
management of these children.
David Gozal MD and Valerie Crabtree both of whom
were in the Kosair's Pediatrics Sleep Research
Centre, Louisville, KY, USA, for providing the sleep
disorder questionnaires. We also thank the
parents/care givers for their patience and the research
assistants for their cooperation.
Reference
1. Quine L. Severity of sleep
4. Rajna P, Veres J. Correlation
7. Valerie Crabtree, Anna
problems in children with
between night sleep duration
Ivanenko, Louise Margaret
severe learning difficulties:
and seizure frequency in
O'Brien and David Gozal.
description and correlates. J
temporal lobe epilepsy.
Periodic limb movement
Community Appl Soc
Epilepsia 1993;34: 574579.
disorder of sleep in children.
Psychol 1992;2:247268.
5. Szentkiralyi A, Madarasz C. Z
J Sleep Res. 2003; 12; 73-
2. Quine L. Sleep problems in
and Novak M. Sleep
81 .
children with mental
Disorders: Impact on daytime
8. Osarogiagbon O.W and
handicap. Journal of
functioning and quality of
Oviawe O. Obstructive sleep
Intellectual Disability
life. Expert Rev
apnea syndrome in children.
Research, 1991; 35: 4: 269-
Pharmacoeconomics Res.
JMBR Dec 2009;8(2), 15-19
290.
2009;9(1):49-64
9. David Gozal, Mei Wang and
3. Zucconi M, Bruni O. Sleep
6. Ofovwe G. E, Ofovwe C. E.
Dennis W. Pope. Objective
disorders in children with
Sleep Hygiene in Nigerian
sleepiness measure in
neurological diseases. Semin
Children. Ife Psychologia.
pediatric obstructive sleep
Pediatr Neurol
2008; 16; 2; 113 119.
apnea. Pediatrics
2001;8:258275.
2001;108(3), 693-7