Sleep, behaviour and health-related quality of life in preschool-and school-aged children with cerebral palsy
Notice bibliographique
Résumé
Cerebral Palsy (CP) is a neurodevelopmental disorder of movement and posture resulting from a non-progressive brain lesion during fetal or infant development. In addition to the primary motor impairments, children with CP have a high prevalence of significant comorbidities which also may increase their risk of sleep problems, behavioural difficulties and reduced health-related quality of life (HRQoL) compared to typically developing children. Manuscript 1 of this thesis reports the results of a systematic review and meta-analysis of studies on the prevalence of sleep problems in children with CP. Manuscripts 2, 3 and 4 report on the results of a cross-sectional study of 150 children with CP aged 3-12 years who were prospectively recruited from hospital clinics, a clinical database and the Canadian Cerebral Palsy Registry. Caregivers completed five questionnaires: 1) the Sleep Disturbance Scale for Children (SDSC) to assess overall and specific sleep problems, 2) a questionnaire on sleep-related characteristics to provide additional information on children's sleep, 3) the Strengths and Difficulties Questionnaire (SDQ) to assess children's behavioural difficulties, 4) the Pediatric Quality of Life Inventory (PedsQL) Generic Core Module, to assess children's overall HRQoL and 5) the PedsQL CP Module, to assess children's CP-specific HRQoL. All 23 studies included in our systematic review were cross-sectional and used caregiver-completed sleep measures (SDSC most common in 9 studies); our meta-analysis of these studies found a pooled prevalence of 23.4% (95% CI 18.8-28.4-%) for an abnormal total score and 26.9% (95% CI 21.5-32.7-%) for disorders of initiation and maintenance of sleep (DIMS), the most prevalent sleep problem reported. Our quality assessment revealed that selection, coverage, classification and/or confounding biases were present in all 23 studies. In Manuscript 2 we report that an abnormal total score on the SDSC was found in 20.7% of children with CP aged 3-12 years; 44.0% had ≥1 sleep disorder. The most common sleep problem, DIMS, was found in 26.0% of children. Pain was the strongest predictor of having an abnormal total score and DIMS, with adjusted ORs (95% CIs) of 6.5 (2.2-18.9) and 3.4 (1.3-9.3), respectively.In Manuscript 3 we report that, in a subset of children with CP aged 4-12 years, the prevalence of behavioural difficulties on the SDQ was twice as high in school-aged compared to preschool-aged children. Rates of behavioural difficulties in preschool-aged children with CP were double those previously reported for typically-developing children (~20% vs. 10%). In children with CP, sleep problems and nighttime pain increased the likelihood of behavioural problems by 9- and 4-fold, respectively. Behavioural difficulties were associated mainly with sleep problems relating to DIMS.In Manuscript 4 we report that a large proportion of children with CP aged 3-12 years have impaired HRQoL on the PedsQL. Whereas non-ambulatory status was associated with impaired Physical HRQoL, sleep problems were most strongly associated with impaired Psychosocial HRQoL. Specific sleep problems on the SDSC relating to DIMS increased the odds of impaired emotional functioning (subscale of Psychosocial HRQoL). Pain-related HRQoL was more impaired with a greater number of/more severe sleep problems.More studies examining sleep in children with CP using validated questionnaires in large well-described, broadly-recruited samples are needed. Our cross-sectional study reports that sleep disorders are prevalent in preschool- and school-aged children with CP. Nighttime pain is the most important factor associated with sleep problems. Sleep problems and pain are important risk factors for behavioural difficulties and sleep problems are an important risk factor for impaired HRQoL. Health care professionals should routinely inquire about sleep problems and pain to manage these issues and promote the health of children with CP.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,009 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».