Insomnia Symptoms Linked With Medical Complaints in Young School-Aged Children

A study in the December 15th issue of the Journal of Clinical Sleep Medicine indicates that significant associations exist between parent-reported insomnia symptoms and medical complaints of gastrointestinal distress (regurgitation) and headaches in young school-aged children

Results of the study show that parent-reported insomnia was 3.3 times more likely in children with gastrointestinal regurgitation and 2.3 times more likely in children with headaches. Nineteen percent of children met the criteria for insomnia, which was defined as often having trouble falling asleep and/or waking up often in the night. Gastrointestinal problems were reported in 7.5 percent of children with insomnia and two percent of children who did not have sleep disturbances. Headaches were reported in 24.4 percent of children with insomnia and 13.2 percent of children without disturbed sleep.

The research team from the department of Psychiatry at Penn State College of Medicine in Hershey, Pa., reported that children who have insomnia symptoms should be screened by their physician for underlying medical conditions, stating "The first and most important step in children with medical complaints and sleep disturbances would be an evaluation for underlying medical disorders and providing treatment. If the associated sleep disturbances do not improve despite improvement in medical complaints the disturbances should be further assessed and treated."

Data from 700 children between the ages of 5 and 12 years were collected from the Penn State Children's Cohort for this cross-sectional study. All children underwent a medical and psychiatric history, physical examination, overnight polysomnography and neuropsychological testing. Comprehensive sleep and development questionnaires were completed by a parent. To assess gastrointestinal regurgitation the parent was asked, "Does food or liquid come back up into your child's mouth or does your child complain of tasting food or liquid back up in his mouth?"

Children with sleep disturbances had significantly more parent-reported complaints of gastrointestinal symptoms (heartburn, pain, colic and regurgitation), headaches and bedwetting. After controlling for demographic variables; apnea-hypopnea index; learning, psychiatric and behavioral disorders; and socioeconomic and minority status, gastrointestinal regurgitation and headaches most significantly remained associated with insomnia symptoms.

The authors suggest that future studies should explore the possible underlying patho-physiological causes of the relationship between insomnia symptoms and medical complaints in children. These studies should explore whether treatment of sleep complaints improves the associated medical complaints and vice versa.

The AASM (American Academy Of Sleep Medicine) published "Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children" in the journal SLEEP in 2006. About 94 percent of the studies that were reviewed reported that behavioral interventions as a whole produced clinically significant improvements in bedtime resistance and night waking.

In 2003 an AASM task force of sleep experts examined the use of medications to treat insomnia in children. A consensus meeting summary was published in 2005 in the Journal of Clinical Sleep Medicine. The task force emphasized that behavioral treatment approaches to bedtime struggles and night waking in children have a well-documented empirical basis and are the mainstay of treatment, and that pharmacologic approaches should be largely considered adjuncts in the treatment of pediatric insomnia.


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