| With the development of socioeconomic development and lifestyle changes,people’s pressure to work increases,some due to commuting,shift shift,etc.,leading to a change in their sleep pattern,and the overall sleep time of the population continues to shorten.Changes in people’s sleep patterns are also associated with health-related variables,with sleep restriction or parasomnia and sleep disturbance all contributing to performance such as longer reaction times,decreased attention,information omission,short-term memory loss,depressed mood,and reduced executive ability to operate.For children,insufficient sleep can affect their growth and development and cognition,while prolonged sleep duration contributes to increased sustained attention and improved academic performance.Even more,sleep deprivation affects the mechanisms of leptin,brain intestinal peptide,and glucose metabolism,which contribute to the occurrence of secondary obesity,hypertension,diabetes and other diseases.With the shift of medical development model and the development of sleep medicine in children,the problems of children’s sleep have gradually been concerned,but because of the limitations of medical technology and department development,the causes and more aspects of children’s sleep problems in clinical work have not been fully explored.In particular,little is known about sleep problems in children with cerebral palsy(CP).Combining the results of previous studies and analyzing the characteristics of the diseases in children with cerebral palsy itself,it is known that children with cerebral palsy have more sleep problems than healthy children.There are many ways to evaluate sleep problems,but most of the studies used questionnaires in the way of removing subjectivity and other factors and wanted to get objective and accurate sleep related data,polysomnography(PSG)provided us with technical support.However,there are few studies on the application of PSG monitoring to observe sleep problems in children with cerebral palsy because of its high cost,high requirement for specialized technicians,and relatively poor compliance.In this study,we combined the results of the children’s sleep habits questionnaire and the whole night PSG monitoring to analyze the differences in sleep problems and sleep structure between children with cerebral palsy and healthy children,and to explore the reasons,which would be beneficial to enhance the understanding of sleep problems in children with cerebral palsy and provide theoretical support for improving sleep in children with cerebral palsy.Objective:Through the questionnaire survey to understand cerebral palsy children and healthy children sleep status and differences,through PSG monitoring results compare healthy children with cerebral palsy children sleep structure difference,to explore different clinical classification and grading types of cerebral palsy children sleep structure and the difference between each other,provide the basis for improving cerebral palsy children’s sleep patterns.Methods:1.A total of 62 children with cerebral palsy aged 1-15 years who were hospitalized in the Child Rehabilitation Department of the Third Affiliated Hospital of Zhengzhou University between July 2019 and March 2021 were selected,and the control group was matched by age to select 50 healthy children who came to the child health care department of our hospital for a normal physical examination during the same period.The children’s sleep habits questionnaire fill out was conducted,and the sleep problems comparing their presence were analyzed.2.A total of 47 children with cerebral palsy who filled in the children’s sleep habits questionnaire and agreed to undergo overnight PSG monitoring and 30 healthy children who scored≤54 points on the children’s sleep habits questionnaire and agreed to undergo overnight PSG monitoring were compared for differences in sleep architecture and analyzed for reasons.3.Data on the medical history of children with cerebral palsy were collected and analyzed for sleep problems and distinctions among children with cerebral palsy with different clinical subtypes and different degrees of disease.Results:1.The rate of poor sleep quality was 46.8% in children with cerebral palsy and20.0% in healthy children,with statistically significant differences between the two groups(P<0.05);2.There were significant differences in the mean total scores of the children’s sleep habits questionnaire between children with cerebral palsy and healthy children(P<0.05),and in the six dimensions of sleep resistance,sleep delay,sleep anxiety,sleep maintenance time,night wake,daytime sleepiness(P<0.05),no significant difference was found in the parasomnia and sleep disordered breathing dimensions(P>0.05);3.When children with cerebral palsy were compared among different age groups,we found that there was a significant difference in the amount of time spent in usual sleep(P<0.05),and no significant difference between each sleep dimension(P>0.05);4.Children with cerebral palsy were divided into three groups according to the gross motor function classification system(GMFCS)criteria: mild(class I),moderate(classes II-III),and severe(classes IV-V),whereas,when comparing sleep dimensions,we found no significant difference between groups in each sleep dimension(P>0.05);5.Comparison of sleep dimensions among children with cerebral palsy who were clinically subtyped according to the nature of the movement disorder revealed no significant differences between groups for each sleep dimension(P>0.05);6.Combining the children’s own sleep and the results of whole night PSG monitoring greater than 6 hours,the incidence of sleep disturbance was 53.2% in children with cerebral palsy and 20.0% in healthy children with a score≤54 points on the children’s sleep habits questionnaire,showing a statistically significant difference between the two groups(P<0.05);7.When PSG monitoring outcome parameters were compared between cerebral palsy and healthy children,we found that children with cerebral palsy had longer sleep latency,greater percentage of N2 phase than healthy children,longer duration of R phase,and smaller percentage of R phase than healthy children,with statistically significant differences between the two groups(P<0.05),whereas total sleep duration(TST),time spent awake after falling asleep,sleep efficiency,sleep latency of R phase,duration of N1 phase,percentage of N1 phase,duration of N2 phase,duration of N3 phase,percentage of N3 phase,apnea or hypopnea index,arousal index,and periodic limb movement index there were no significant differences in any of the sleep structure parameters(P>0.05);8.Children with cerebral palsy were divided into three groups according to the GMFCS criteria: mild(class I),moderate(classes II-III),and severe(classes IV-V),whereas,after comparison of the results of the whole night PSG monitoring,the between groups were evaluated in terms of total sleep time,time spent awake after falling asleep,sleep efficiency,duration of stage N2,percentage of stage N2,duration of stage N3,percentage of stage N3,duration of stage R,percentage of stage R sleep architecture parameters,the difference between the two groups was statistically significant(P<0.05).Further pairwise comparisons revealed statistically significant differences in duration of N2 stage,percentage of N2 stage,percentage of N3 stage between mild cerebral palsy and moderate cerebral palsy(P<0.05),and differences in total sleep time,time spent awake after falling asleep,sleep efficiency,percentage of N2 stage,percentage of N3 stage,percentage of N3 stage,percentage of R stage,percentage of R stage between mild cerebral palsy and severe cerebral palsy(P<0.05),and differences in total sleep time,time spent awake after falling asleep,sleep efficiency,duration of R phase,and percentage of R phase between moderate and severe cerebral palsy(P<0.05);However,there were no significant structural differences among groups in all sleep parameters including latency time of sleep in R phase,duration of N1 phase,percentage of N1 phase,apnea or hypopnea index,arousal index,and periodic limb movement index(P>0.05);9.Children with cerebral palsy were clinically classified according to the nature of the movement disorder into spastic,mixed,involuntary motor type cerebral palsy,whereas,for comparison of the results of the whole night PSG monitoring,there were significant differences between groups in the duration of N2 phase,the percentage of N2 phase,the duration of R phase,and the percentage of R phase relative to sleep structure parameters(P<0.05),which were found after further pairwise comparisons,there were significant differences in the percentage of N2 phase and the percentage of R phase between spastic and mixed forms of cerebral palsy(P<0.05);However,there was no significant difference in all sleep parameters between groups(P>0.05)in the latent time of R-phase sleep,the duration of N1 phase,the percentage of N3 phase,the apnea or hypopnea index,the arousal index,and the periodic limb movement index.Conclusion:1.The results of the questionnaire on children’s sleep habits showed that the rate of poor sleep quality of children with cerebral palsy was higher than that of healthy children,and children with cerebral palsy had more sleep problems than healthy children.2.The results of overnight PSG monitoring showed that the incidence of sleep disorders in children with cerebral palsy was higher than that of healthy children.There were differences in several sleep structure parameters between children with cerebral palsy and healthy children,children with cerebral palsy of different disease levels and children with cerebral palsy of different clinical types. |
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