1. logo Correlation between Sleep disturbance in Malaysian
Children with Cerebral Palsy and their Care Givers
logo
Shivani Rajasegaran1, Sharon Anne Khor Keat Sim1,
Nurul Farhanah bt Mohd Fu’ad1 and Aisyah bt Ali2
1 Department of Rehabilitation Medicine, Hospital Sultan Ismail Johor, Malaysia
2 Clinical Research Centre, Hospital Sultan Ismail Johor, Malaysia
INTRODUCTION
Results
Sleep disturbance (SD) among cerebral palsy (CP) children is a recognised concern and extensive research has been done to govern the elements contributing to SD 1,2. Factors commonly associated with SD among children with CP include muscle spasms, pain, drugs that cause day time drowsiness, nocturnal seizures, visual impairment affecting melatonin secretion, behavioural problems, poor sleep hygine and use of night splints1,2,3.
Figure 2: Distribution of CP
children by age (n=99)
Figure 1: Distribution of CP
children by races (n=99)
OBJECTIVES
Primary objective: To compare frequency and type of sleep disturbances (SD) among children with cerebral palsy (CP) and their association with SD in their main care givers.
Secondary objectives: To determine association of several factors eg. CP type, Gross Motor Function Classification System (GMFCS) level, epilepsy, bed sharing, visual loss, use of night orthoses, sedative drugs and carer vocation with sleep disturbances in these children.
Figure 3: Distribution of CP children by CP types (n=99)
Materials and Methods
This is a prospective cross sectional study involving 99 children between the age of 4-18 years with CP and their main caregivers. Only children with confirmed diagnosis of CP were included and main caregivers were identified as any person who devotes the most number of hours tending to the child. Written informed consent was acquired as a prerequisite to answering 2 questionnaires. SD was assessed using Sleep Disturbance Scale for Children (SDCS) in CP children and Pittsburg Sleep Quality Index (PSQI) in caregivers. Pearson Chi Square test and Fisher’s exact test was used to analyze association between SD and associated factors.
Figure 4: Percentage of Normal and Pathological Sleep Disorders
among CP children and carers (n=99)
Table 1: Distribution of SD among CP children and caregiver by SDSC and PSQI
Table 2: Association of sleep parameters of Sleep Disturbances with other factors
Results
Figure 1, 2 and 3 showed distribution of CP children which majority were Malays (62.6 %), age group between 3 to 8 years old (57.6%) and Quadriplegic CP type (45.5 %).
Main SD in CP children is difficulty initiating and maintaining sleep (26.3%) and 71% of carers have pathological SD (Table 1).
Children with quadriplegic type CP (P= 0.031), concomitant seizures (P= 0.003) and bed sharing with carers(P= 0.005) had statistically significant association with SD (P<0.05). Association between SD and other factors e.g.: GMFCS level, use of orthoses, visual impairment and sedative medication was insignificant (Table 2).
SD in caregivers had significant correlation with children having pathological sleep (p=0.035).
Conclusions
A high number of CP patients and their carers have SD, therefore screening of SD in CP children and their caregivers is important. Whether SD in children caused SD in carers or vice versa could not be confirmed. Our study shows that use of night orthoses and use of sedative medication e.g. Anti-epilieptics or baclofen does not affect sleep. This should convince parents of common misconceptions on factors that affect their child’s sleep.
References
Atmawidjaja RW, Wong SW, Yang WW, Ong LC . Sleep disturbances in Malaysian children with cerebral palsy.Dev Med Child Neurol Jul;56(7):681-5.
2. Romeo DM, Brogna C, Quintiliani M, Baranello G, Pagliano E, Casalino T, Sacco A, Ricci D, Mallardi M, Musto E, Sivo S, Cota F, Battaglia D, Bruni O, Mercuri E. Sleep disorders in children with cerebral palsy: neurodevelopmental
and behavioral correlates. Sleep Med Feb;15(2):213-8.
3. Angriman M., Caravale B., Ferri R., Bruni O. Sleep in Children with Neurodevelopmental Disabilities. Review article. Neuropediatrics 2015;46:
4. Adiga et al. Sleep disorders in children with cerebral palsy and its correlation with sleep disturbance in primary caregivers and other associated factors. Ann Indian Aad. Neurol Oct- Dec; 17(4) :