番茄社区

ORLANDO -- Injury to a parent may result in sleep issues for children and teens, researchers said here.

Following a parental injury, such as post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI), children (ages ≤17) had a 17% increased rate of outpatient care for sleep disorders for issues such as circadian rhythm disorder, insomnia, narcolepsy, restless leg syndrome and unspecified sleep disorders, reported Capt. Saira Ahmed, MD, of the Walter Reed National Military Hospital in Washington, and colleagues.

Also, teenagers had a 37% (incidence rate ratio 1.37, 95% CI 1.25-1.50) increase in sleep visits, they said in a presentation at the American Academy of Pediatrics (AAP) annual meeting.

Ahmed reported at an AAP press conference that her group accessed records from the Military Health System, and determined there was an overall 48% increase (IRR 1.48, 95% CI 1.33-1.63) in sleep visits among the children of parents who experienced PTSD and TBI.

She told 番茄社区 that only a small percentage of the parental injuries were related to combat. "These were common injuries...such as vehicular accidents or falls around the home, and therefore it is likely that the findings are applicable to the general population," Ahmed stated.

"It is important that medical providers ask about stressors in the home, such as an injury to a parent, and ask how their child has been sleeping," she said. "These conversations are important to help the family catch and treat sleep issues early to avoid physical and emotional problems down the road."

The researchers identified 485,002 children of 272,211 parents who were injured from 2004 to 2014. About 39% of the parents experienced PTSD or TBI. The median child age at time of parental injury was 7.9 years. The median length of parental deployment was 1.14 years.

Children whose parents were injured were more likely to experience:

• Circadian rhythm disorders: adjusted IRR 1.91 (95% CI 1.42-2.57)
• Insomnia: IRR 2.13 (95% CI 1.99-3.23)
• Narcolepsy: IRR 2.56 (95% CI 1.41-4.64)
• Restless leg syndrome: IRR 1.56 (95% CI 1.23-1.96)

In terms of medication, children had a 29% decrease in sleep medication days while teenagers had a 32% (IRR 1.32, 95% CI 1.05-1.65) increase in sleep medication days. The former may be because physicians seeing a young pediatric patient for the first time may wean the child off sleep medications, and begin behavior modification and non-pharmacological efforts to reduce sleep disorders, according to the authors.

As for teenagers, they may have more difficulty adjusting to the parental injury because of sleep schedule that is already altered by puberty or the challenges of school, Ahmed noted.

Wendy Sue Swanson, MD, of Seattle Children's Hospital, told 番茄社区, said it was not surprising that sleep specialists were able to reduce the use of sleep medications. "We don't tend to use a lot of medicine in treating kids," she said. "That is more of an adult strategy. We know that sleep can be improved with interventions such as bedtime consistency, exercise during the daytime, no caffeine after 3 p.m. -- those kinds of things can be very productive."

Swanson, who was not involved in the study, noted that the findings "are a reminder that we, as clinicians, have to take into consideration that sleep may be disturbed. We can ask about transitions in the family: 'How can I help restore wellness?' A huge part of wellness is getting good sleep."

"We need to optimize sleep hygiene in families that are going through transitions, and try to get ahead of it instead of waiting for more troubling manifestations of sleep disturbances," she emphasized.