Exploring The Current Situation And Influencing Factors Of Sleep Disorders In School-age Children With Asthma Based On The Theory Of Symptom Management

Objective:This study aimed to investigate the status of sleep disorders among school-age children with asthma,to explore the influencing factors of sleep disorders in school-age children with asthma,thus providing a theoretical foundation for improving sleep disorders in patients with asthma.Methods:250 school-age children with asthma were enrolled from five tertiary hospitals in Jinan,Shandong Province from February 2018to December 2018.The questionnaires included children and their parents'general information questionnaire,the Sleep disturbance scale for children(SDSC),asthma medication adherence scale,asthma knowledge questionnaire,the Childhood asthma control test(CACT),the Asthma control test(ACT),children's anxiety,depression,fatigue,peer relationship questionnaires,Beliefs about Medicine Questionnaire(BMQ)and General Functioning Sub-scale of McMaster Family Assessment Device(GF-FAD)based on the theory of symptom management.Data were analyzed using SPSS 24.0 software.The statistical methods includes:descriptive statistics,independent sample t-test,one-way ANOVA,Pearson correlation,Spearman correlation and multiple linear stepwise regression.Results:1.Socio-demographic and clinical information among patients with asthmaA total of 250 school-age children with asthma were enrolled in this study.The age of patients with asthma ranged from 8 to 14,with the median of age was 9.64.4%of patients were male.2.Status of each dimension of sleep disorders in school-age children with asthmaA total of 117 cases(46.8%)of sleep disorders were detected.The detection rate of sleep disorders ranged from 4%to 22%.The rates of six sub-scales from high to low were sleep breathing disorders(SBD),sleep-wake transition disorders(SWTD),difficulty in initiating and maintaining sleep(DIMS),disorders of excessive somnolence(DOES),sleep hyperhidrosis(SH),disorders of arousal(DoA).The average score of SDSC was(39.35±6.09),ranging from 26 to 62;The average score of DIMS dimension was(10.40±2.42),ranging from 7 to 20;the average score of SBD dimension was(4.11±1.36),ranging from 3 to 8;the average score of DoA dimension was(3.57±0.85),ranging from 3 to 7;the average score of SWTD dimension was(10.55±2.57),ranging from 6 to 20;the average score of DOES dimension was(6.61±1.77),ranging from 5 to 14;the average score of SH dimension was(4.11±2.03),ranging from 2 to 10.3.Univariate analysis of sleep disorders in school-age asthmatic childrenThe total scores of sleep disorders in asthmatic children with middle or lower performance in school were higher than those with above average or excellent performance in school(F=13.511,P<0.001).The total scores of sleep disorders in asthm,atic children with asthma who spent 5 hours or more in extra-curricular learning and interesting classes per week were higher than that in children with asthma who spent less than 5 hours(F=38.171,P<0.001).The total scores of sleep disorders in children with mild,moderate or severe persistent asthma were higher than that in children with mild intermittent asthma(F=11.458,P<0.001).The total scores of sleep disorders of asthmatic children whose physical activities were partially affected was higher than that of children who were not affected(F=3.371,P=0.036).Children whose learning was sometimes or frequently affected had higher total scores of sleep disorders than children whose learning was never or occasionally affected(F=12.581,P<0.001).The total scores of sleep disorders of asthmatic children with different sleeping patterns during weekends,holidays and workdays or irregular sleep patterns were higher than that of children with regular sleep pattern(F=6.240,P=0.002).Pearson correlation analysis showed that the scores of sleep disorders in school-age children with asthma were negatively correlated with the knowledge of asthma questionnaire scores,asthma medication compliance scores,the score of asthma control test scale and parents'BMQ scores(r=-0.379,P<0.001);r=-0.331,P<0.001;r=-0.290,P<0.001;r=-0.576,P<0.001).It indicates that school age children with asthma who have worse knowledge level,medication compliance,asthma control and parents' medication belief had more serious sleep disorders.The scores of sleep disorders in school-age asthmatic children were positively correlated with the scores of family GF-FAD,anxiety,depression and fatigue scales(r=0.368,P<0.001;r=0.126,P=0.046;r=0.239,P<0.001;r=0.215,P=0.001).It indicates that the poorer family function,anxiety,depression and fatigue level of asthmatic children are,the more serious the sleep disorder is.It indicates that school age children with asthma who have poorer family function,anxiety,depression and fatigue had more serious sleep disorders.'4.The multivariate analysis of sleep disorders in school-age asthmatic childrenThe multivariate analysis showed that the positively related factors affecting the scores of SDSC were GF-FAD scores,academic performance,depression scores and fatigue scores.The negatively related factors were parents' BMQ scores,ACT or CACT scores,asthma knowledge scores.The adjusted R2 indicated the equation explains 58.3%of variation of sleep disorders.The positively related factors affecting the scores of DIMS were the time for weekly extra-curricular study or interesting class,GF-FAD scores,depression scores,sleep patterns and whether using electronic devices 30 minutes before going to bed or not.The negatively related factors were parents' BMQ scores.The adjusted R2 indicated the equation explains 31.7%of variation of the scores of DIMS.The positively related factors affecting the scores of SBD were physical activity limitation,GF-FAD scores.The negatively related factors were CACT or ACT scores and asthma knowledge scores.The adjusted R2 indicated the equation explains 11.4%of variation of the scores of SBD.The positively related factors affecting the scores of DoA were the sleep problems of fathers,sleep patterns.The negatively related factors were children's age and medication compliance scores.The adjusted R2 indicated the equation explains 6.8%of variation of the scores of DoA.The positively related factors affecting the scores of SWTD were the time for weekly extracurricular study and interesting class,illness severity and medical cost of asthma in the past year.The negatively related factors were parents'BMQ scores,siesta habit and sleep posture.The adjusted R2 indicated the equation explains 27.3%of variation of the scores of SWTD.The positively related factors affecting the scores of DOES were the time for weekly extracurricular study,GF-FAD scores and learning affected.The negatively related factors were parents'BMQ scores.The adjusted R2 indicated the equation explains 15.4%of variation of the scores of DOES.The positively related factors affecting the scores of SH were the time for depression and procrastination.The negatively related factors were parents'BMQ scores,asthma knowledge scores and children's age.The adjusted R2 indicated the equation explains 19.7%of variation of the scores of SH.Conclusion:1.The incidence of sleep disorders is relatively high in school-age children with asthma.The detection rates of six sub-scales from high to low were sleep breathing disorders(SBD),sleep-wake transition disorders(SWTD),difficulty in initiating and maintaining sleep(DIMS),disorders of excessive somnolence(DOES),sleep hyperhidrosis(SH),disorders of arousal(DoA).respectively.2.Influencing factors of total scores of SDSC in school-age children with asthma were:parents'BMQ,time for weekly extracurricular study and interesting class time,ACT or CACT,GF-FAD,knowledge of asthma,academic performance,depression and fatigue.Factors influencing the scores of DIMS were:the time for weekly extracurricular study and interesting class,GF-FAD,parents'BMQ,depression,,sleep patterns,and exposure to electronic devices 30 minutes before going to bed.Factors influencing the scores of SDB were:physical activity limitation,GF-FAD,knowledge of asthma and ACT or CACT.Factors influencing the scores of DoA were:fathers*sleep problems,sleep patterns,children's age and medication compliance.Factors influencing the scores of SWTD were:sleep posture,parents'BMQ,the time for weekly extracurricular study and interesting class,siesta habit,medical costs of asthma in the past year and illness severity.Factors influencing the scores of DOES were:parents' BMQ,the time for weekly extracurricular study,GF-FAD scores and learning affected.Factors influencing the scores of SH were:parents' BMQ,asthma knowledge,age,depression,and procrastination.