Victorian Fetal Alcohol Service, Developmental Pediatrics, Monash Children's Hospital, Monash Health, Melbourne, Australia.
Department of Pediatrics, Monash University, Melbourne, Australia ; and.
J Dev Behav Pediatr. 2024;45(4):e358-e364. doi: 10.1097/DBP.0000000000001282. Epub 2024 Jul 10.
Sleep disturbance is an important feature of fetal alcohol spectrum disorder (FASD). We sought to describe sleep patterns in school-aged children with FASD, in comparison with a typically developing community group, and investigate the relationship between sleep and neurodevelopmental profiles.
The FASD cohort (N = 36) was recruited from a tertiary Australian FASD diagnostic center, and the typically developing group (N = 36) was previously recruited as a control cohort for a separate study. Sleep disturbance was assessed with the caregiver-completed Sleep Disturbance Scale for Children (SDSC) questionnaire. Neurodevelopmental assessment results for the 10 domains impaired in FASD were used for correlations with sleep disturbance.
In the FASD group, 80% of children scored above the SDSC cutoff, compared with 22% of the control group ( p < 0.001). Statistically significant group differences were seen for all 6 subscales of the SDSC ( p < 0.05). The most frequently affected domains in the FASD group related to difficulties with initiating and maintaining sleep (58%), sleep-wake transition disorders (44%), and disorders of arousal (42%). A statistically significant relationship was not found between sleep and the severity of neurodevelopmental impairment or impairment of a particular domain, acknowledging the limitations of our small sample size. Half of the FASD sample (52%) were taking a pharmaceutical agent to support sleep, which was not associated with lower SDSC scores.
In this small study, sleep disturbances were frequently reported by carers of children with FASD, independent of the severity of their neurodevelopmental impairments. Persistent sleep disturbance despite the use of sleep medications highlights the need for prospective studies exploring sleep interventions in this population. Integration of behavioral sleep medicine into management is recommended for all children with FASD.
睡眠障碍是胎儿酒精谱系障碍（FASD）的一个重要特征。我们旨在描述患有 FASD 的学龄儿童的睡眠模式，并与典型的发育社区组进行比较，并研究睡眠与神经发育特征之间的关系。
FASD 队列（N=36）是从澳大利亚 FASD 诊断中心招募的，而典型发育组（N=36）是作为另一项研究的对照组之前招募的。使用 caregiver 完成的儿童睡眠障碍量表（SDSC）问卷评估睡眠障碍。FASD 受损的 10 个领域的神经发育评估结果用于与睡眠障碍的相关性分析。
在 FASD 组中，80%的儿童的 SDSC 评分高于临界值，而对照组为 22%（p<0.001）。SDSC 的 6 个分量表均存在统计学显著的组间差异（p<0.05）。FASD 组中最常受影响的领域与入睡和维持睡眠困难（58%）、睡眠-觉醒转换障碍（44%）和觉醒障碍（42%）有关。由于我们的样本量较小，承认存在局限性，因此未发现睡眠与神经发育损伤严重程度或特定领域损伤之间存在统计学显著关系。FASD 样本中有一半（52%）正在服用药物以支持睡眠，但 SDSC 评分并未降低。
在这项小型研究中，尽管儿童的神经发育损伤严重程度不同，但 FASD 儿童的照顾者经常报告睡眠障碍。尽管使用了睡眠药物，但仍存在持续的睡眠障碍，这突出表明需要对该人群进行前瞻性睡眠干预研究。建议所有 FASD 儿童都将行为睡眠医学纳入管理中。
