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Sleep disorders and sleep habits in children and adolescents with

headache

Zaburzenia snu i nawyki związane ze snem u dzieci i młodzieży z bólami głowy

Marcin Żarowski, Justyna Młodzikowska-Albrecht, Barbara Steinborn

Chair and Department of Developmental Neurology,

Poznan University of Medical Sciences, Poland.

ABSTRACT

Purpose: The purpose of the study was to investigate the

sleep habits and sleep disorders in children and adolescents with headache. Methods: Three hundred children and adoles-cents with headache and 284 children without headache were investigated using a questionnaires developed by the authors.

Results: In Our study we observed difference is all the more

important as some phenomena like bed co-sleeping (27.7%) and watching TV (20.3%) during falling asleep and sleep dis-orders awakenings from night sleep (43.7%), sleep talking (48.3%), snoring (27.3%), bruxizm (23.3%), nightmares (16.7%), sleep terror (9.0%) are observed statistically more frequently in children with headache. Conclusions: Sleep habits described by parents in the children with headache are significantly dif-ferent than those in healthy. Sleep disorders are very common in the group of children with headache. There is a need of addi-tional research to find correlation between the different types, frequency of headache and sleep habits and disorders.

Key words: sleep, sleep habits, sleep disorders, headache,

migraine, children, adolescents

STRESZCZENIE

Cel: Celem badania było określenie nawyków związanych

ze snem i zaburzeń snu występujących u dzieci i młodzieży z bólami głowy. Materiał i metody: Badaniu kwestionariuszo-wemu zostało poddana grupa 300 dzieci i młodzieży z bólami głowy oraz 284 dzieci bez bólów głowy. Wyniki:

W badaniu obserwowano znamienne statystycznie różnice pomiędzy grupą badaną i kontrolną w odniesieniu do wielu parametrów. Najważniejsze wśród nawyków związanych ze snem to: spanie we wspólnym łóżku (27,7%), oglądanie TV podczas zasypiania (20,3%). Zaburzenia snu takie jak wybudze-nia ze snu nocnego (43,7%), mówienie przez sen (48,3%), chra-panie (27,3%), bruksizm (23,3%), koszmary senne (16,7%) oraz lęki nocne (9,0%), obserwowano istotnie statystycznie częściej w grupie dzieci z bólami głowy. Wnioski: Opisywane przez rodziców nawyki związane ze snem, w grupie dzieci z bólami głowy, różnią się w sposób istotny statystycznie od opisywa-nych u dzieci bez bólów głowy. Zaburzenia snu są bardzo częste w grupie dzieci z bólami głowy. Konieczne są dalsze badania, mające na celu znalezienie korelacji pomiędzy typami bólów głowy i ich częstotliwością a nawykami związanymi ze snem i zaburzeniami snu.

Słowa kluczowe: sen, zaburzenia snu, nawyki związane ze

snem, bóle głowy, migrena, dzieci, młodzież

The c��c�m��a�ce �f sleep a�d headaches has bee� k��w� f�r ce�-�ur�es, bu� �he de�a�ls �f �ha� c��c�m��a�ce were mys�er��us [1, 2]. I� �s k��w� by cl���cal exper�e�ce �ha� var��us k��ds �f sleep d�s�r-ders are m�re freque�� �� gr�up �f ch�ldre� w��h headache �ha� �� �he ge�eral p�pula���� �f ch�ldre� [1]. �leep d�s�rders are very c�mm�� �� �he p�pula���� �f ch�ldre� [3]. The rela����sh�p be�wee� �hem seems �� have cl���cal a�d ��s�l�g�cal c���ec����s [2]. The e���l�gy �f sleep d�s�rders �s c�mplex a�d depe�ds �� var�ed fac��rs c���ec�ed w��h heal�h, e�v�r��me��, fam�ly a�d s�c�al ��flue�ces. Als� �he psych�l�g�cal pr�blems c���ec�ed w��h fam�ly l�fe have cruc�al ��flue�ce �� sleep. The ge�eral s�a�e �f heal�h seems �� have very s�g��f�ca�� ��flue�ce �� sleep. �leep hab��s wh�ch �mpac� �he qual��y �f sleep ca� c��seque��ly ���erfere w��h �he da�ly

fu�c���-�� schfu�c���-��l afu�c���-��e�da�ce a�d perf�rma�ce, da�ly acfu�c���-��vfu�c���-���es, a�d em�-����al s�a�us [8, 9]. Als� headaches have a s�g��f�ca�� �mpac� �� �he l�ves �f ch�ldre� a�d ad�lesce��s, resul���g �� sch��l abse�ce, dec-reased ex�racurr�cular ac��v���es, a�d p��r sch��l ach�eveme��s [5, 6, 10]. Th�se pa��e��s m�re freque��ly suffered fr�m paras�m��as, d�ff�cul��es a� sleep ��se�, awake���gs a�d day��me s�m��le�ce [1]. All �f �hem ca� cause ser��us c��seque�ces as: w�rse qual��y �f day ac��v��y c���ec�ed w��h pr�blems w��h a��e�����, aggress���, em�����al l�ab�l��y, hyperac��v��y, ��crease �f freque�cy a�d seve-r��y �f headache a�d ca� pr�duce c�g����ve dysfu�c���� [6, 10]. �ru�� e� all �bserved �ha� bed��me pr�blems are c���ec�ed ��� ��ly w��h fear �f fall��g asleep, bu� als� �� a smaller degree w��h p��r sleep hyg�e�e [1]. �ecul�ar sleep hab��s are �bserved �� ch�ldre�

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�bserved �� ge�eral p�pula���� �f ch�ldre� [10]. �ru�� e� all eva-lua�ed �he �mpac� �f educa���� �� sleep hyg�e�e �e.g., c��f�rm��y �f bed��me a�d wak��g ��me, regular��y �f sleep schedule �� week-days a�d weeke�ds, a�d res�r�c���� �f beverages a�d f��ds �ha� d�srup� sleep� �� headache, espec�ally �� m�gra��e [1, 8]. Ch�ldre� wh� rece�ved sleep hyg�e�e educa���� had rarer m�gra��e a��acks. The ��s�ab�l��y �f �he level �f ser������ �� b��h c��d�����s may be a c���ec���g l��k be�wee� headache a�d sleep d�s�rders [1]. Rece�� s�ud�es �� pa��e��s w��h pr�mary headache have led �� �de���f�ca-���� �f p��e���al ce��ral ge�era��rs wh�ch are als� �mp�r�a�� f�r �he regula���� �f sleep [2]. ��me��mes �� �s d�ff�cul� �� separa�e �h�se �eur�l�g�cal symp��ms because �he a�a��m�cal a�d phys��l�g�cal bas�s �s s�m�lar [1, 11]. Fragme��a���� �f sleep �s �bserved m�re freque��ly �� m�gra��e a�d �e�s��� headache �ha� �� �he ge�eral p�pula���� �f ch�ldre�. Tha� ��duces w�rse qual��y �f l�fe by day-��me s�m��le�ce, pr�blems w��h c��ce��ra����, mem�ry e�c. wh�ch super�mp�se �� headaches [1]. The c�g������ �f �he a�a��my a�d �he phys��l�gy �f b��h d�s�rders all�ws f�r effec��ve �herapeu��c ma�ageme��, espec�ally �� ch�ldre� a�d ad�lesce��s [2]. I� par��cu-lar, headache beg�����g �� �he m�r���g a�d chr���c headache ca� be ���e�s�f�ed by sleep d�s�rders, �r caused by �hem. I� �s cur��us e��ugh �ha� �he �herapy �f sleep pr�blems may rel�eve a pa��e�� fr�m headache [7]. There are ��ly several pr�fess���al publ�ca����s wh�ch c��cer� �he ep�dem��l�gy �f sleep d�s�urba�ces �� ch�ldre� a�d ad�lesce��s w��h headache [1, 6]. �ru�� e� all ����ced m�re sleep d�s�urba�ces �.e. c�-sleep��g, paras�m��as, sleep brea�h��g d�s�rders a�d �app��g �� �he s�udy gr�up �ha� �� �he c���r�l gr�up. They �bserved m�re ��gh� awake���gs a�d day��me sleep��ess �� ch�ldre� w��h headaches [1]. Als� M�ller e� all �bserved pa��e��s w��h c�ex�s���g m�gra��e a�d sleep d�s�urba�ces [8] . �ehav��ral d�s�urba�ces a�d m��d d�s�rders were m�s� freque�� �� ch�ldre� w��h headache, espec�ally �h�se suffer��g fr�m m�gra��es bu� als� depe�ded �� �he sever��y, dura���� a�d freque�cy �f pa�� [4, 12, 13]. L�kew�se Luc e� all aff�rmed �ha� �he prevale�ce �f sleep d�s�r-ders as excess�ve day��me sleep��ess, �arc�lepsy, a�d ��s�m��a was s�g��f�ca��ly h�gher �� ch�ldre� w��h headaches [6]. There are ��ly several pr�fess���al publ�ca����s d�scuss��g �he ep�dem��l�gy �f sleep d�s�rders �� ch�ldre� a�d ad�lesce��s w��h headache. The purp�se �f �he s�udy was �� ��ves��ga�e �he sleep hab��s a�d sleep d�s�rders �� ch�ldre� a�d ad�lesce��s w��h headache.

METHODS

Fr�m May 2005 �� Oc��ber 2006, 1500 ch�ldre� a�d ad�lesce��s fr�m ����a� area were ��ves��ga�ed us��g a spec�ally devel�ped ques�����a�re. The f�rs� par� �f �he survey was c��duc�ed �� �he Cha�r a�d Depar�me�� �f Devel�pme��al Neur�l�gy, ����a� U��-vers��y �f Med�cal �c�e�ces. All pa��e��s adm���ed �� �he Depar�-me�� were exam��ed us��g �he ques�����a�re. There were 300 ch�ldre� a�d ad�lesce�� wh� ma�ched �he cr��er��� �f m�gra��e headache �r �e�s��� �ype headache acc�rd��g �� �he I��er�a����al Class�f�ca���� �f Headache D�s�rders, 2�d ed����� �ICHD-2�, qua-l�f�ed �� �he s�udy gr�up [14]. The full med�cal h�s��ry �f �h�se ch�ldre� was pr�v�ded a�d all ch�ldre� �� �he ��ves��ga�ed gr�up were exam��ed by �eur�ped�a�r�c�a�s dur��g h�sp��al��a����. The �es� resul�s �f �he s�udy gr�up were c�mpared �� �he da�a �f c���r�l gr�up �CG�, c�mp�sed �f heal�hy ch�ldre�.

There were 284 ch�ldre� fr�m sch��ls a�d k��dergar�e�s w��-h�u� headache qual�f�ed �� �he CG.

The f�rs� ques�����a�re used �� �he survey was a sleep que-s�����a�re devel�ped by �he au�h�rs, f�lled �� by �he pare��s �f all ch�ldre� �� �he HG a�d �he CG. M�s� �f �he ques����s referr��g �� ch�ldre�’s sleep were a�swered by ��ck��g �he c�rrec� yes/�� b�x. The ques�����a�re ��cluded p����s rela���g �� �he ch�ld’s slee-p��g hab��s �e.g. c�-sleeslee-p��g, day��me �aps�; sleep d�s�rders �e.g. sleepwalk��g, sleep �alk��g, brux�sm, leg m�veme��s, s��r��g, brea�h��g pauses, e�c�; freque�� ��gh���me awake���gs, day��me sleep��ess, fam�ly sleep d�s�rder h�s��ry a�d dem�graph�c da�a. ��ample �f sleep-rela�ed ques����s – Appe�d�x A�

The sec��d ques�����a�re was a headache ques�����a�re f�lled �� by �he pare��s �f all ch�ldre� �� �he HG. Th�s ques�����a�re c��s�s�ed �f p����s rela���g �� �he charac�er�s��c �f �he headache, freque�cy a�d add�����al symp��ms. Da�a fr�m �h�s ques�����a�re were add�����ally used �� ver�fy �he ICHD-2 cr��er�a �� m�gra��e a�d �e�s��� �ype headache. Each ques�����a�re was acc�mpa��ed w��h a c�ver le��er descr�b��g �he s�udy. The pare��s were ass�-s�ed w��h �he ques�����a�re by �he ��ves��ga��rs. The ��ves��ga��rs were all �ra��ed �� ask ques����s a�d rec�rd a�swers �� e�sure �he qual��y �f resp��ses.

�ef�re c��duc���g �he s�udy, b��h sleep a�d headache que-s�����a�res were p�l�� �es�ed �� a sample �f 100 pa��e��s �f �he Depar�me�� �f Devel�pme��al Neur�l�gy. The s�udy was appr�-ved by �he I�s���u����al Rev�ew ��ard a� �he ����a� U��vers��y �f Med�cal �c�e�ces a�d �he l�cal Ch�ef Educa���� Off�cer �f Poznan.

The ch�2 �es� was used f�r s�a��s��cal a�alys�s purp�ses �� �he maj�r��y �f cases. �leep dura���� ��me was calcula�ed as ar��-hme��c d�ffere�ce be�wee� �he rep�r�ed bed��me a�d r�se ��me. The sleep dura���� ��me a�d ��me �f fall��g asleep were a�aly�ed us��g �he Ma��-Wh���ey �es�. The s�a��s��cal s�g��f�ca�ce was se� a� p< .05.

RESULTS

Participants. There were 160 g�rls �53.3%� a�d 140 b�ys �46.7%�,

fr�m 1 �� 18 years �f age �� �he s�udy gr�up. The c���r�l gr�up c��s�s�ed �f 147 �52.7%� a�d 132 �47.3%�, respec��vely. The mea� age �� �he s�udy gr�up was 12.6 +/- 4.0 years a�d �� CG 8.6 +/- 4.4 years. There were f�ur ca�eg�r�es crea�ed, depe�d��g �� �he age: presch��l �1-6 years �ld� – 7.3% �� �he HG vs. 31.0% �� �he CG, pr�mary sch��l �7-12 years �ld� – 42.3% �� �he HG vs. 52.8% �� �he CG, m�ddle sch��l �13-15 years �ld� – 18.3% �� �he HG vs. 8.5% �� �he CG a�d sec��dary sch��l �15-18 years �ld� – 32.0% �� �he HG vs. 7.7% �� �he CG. ��x�y f�ur ch�ldre� �21.3%� fr�m �he HG have m�gra��e headache acc�rd��g �� ICHD-2 d�ag��s��c cr��er�a. The charac�er�s��c �f �he s�udy gr�up was sh�w� �� �able 1.

Table 1. Group Characteristic

the HG the CG

Whole Group 300 284

Mean age 12.6 8.6

Age standard deviation 4.0 4.4

Girls 53.3% (n=160) 52.7% (n=147)

Boys 46.7% (n=140) 47.3% (n=132)

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Primary school 42.3% (n=127) 52.8% (n=150) Middle school 18.3% (n=55) 8,5% (n=24) Secondary school 32.0% (n=96) 7.7% (n=22)

Total duration of the night sleep. The average �f �he ���al

��gh� sleep dura���� was ab�u� 9.7 h +/- 1.3 h �� HD gr�up a�d 10.0 h +/- 1.8 h �� �he CG. The ��gh� sleep dura���� decreased �� �he �lder ch�ldre� fr�m 10.6 h �� �he presch��l gr�up �� 8.8 h �� �he sec��dary sch��l gr�up ��� �he CG fr�m 10.0 h �� 8.4 h�. I� par��cular, �he age gr�ups d�ffere�ces be�wee� �he HG a�d �he CG were ��� s�g��f�ca��.

The c�mpar�s�� �f �he mea� ��me �f sleep dura���� �� �he ��d�v�dual gr�ups �f ch�ldre� was sh�w� �� Table 2.

Table 2. The average of total sleep duration (in hours)

HG CG Average SD Average SD Whole Group 9.7 1.3 10.0 1.8 Preschool (1-6 y) 10.6 0.7 10.4 1.2 Primary school (7-12 y) 10.2 0.9 10.1 0.9 Middle school (13-15 y) 9.7 1.0 9.8 0.6 Secondary school (16-18 y) 8.8 1.3 8.4 1.6

Falling asleep. I� �he s�udy gr�up, �he mea� ��me �f fall��g

asleep �� �he wh�le gr�up was 25.5 m��u�es a�d �� ra�ged fr�m 1 m��u�e �� 120 m��u�es. The mea� ��me �f fall��g asleep was �he l��ges� �� �he presch��l gr�up – 34.1 m��u�es, decreas��g as �he age ��creased, a�d �he sh�r�es� �� �he sec��dary sch��l gr�up – 23.2 m��u�es. The d�ffere�ces be�wee� �he ��me �f fall��g asleep �f ch�ldre� �� �he HG gr�up a�d �he CG were ��� s�g��f�ca�� �� �he wh�le gr�ups �r �� �he par��cular age depe�de�� gr�up.

I� �he s�udy gr�up, 44.8% �f ch�ldre� �eeded �ver 20 m��u-�es �� fall asleep, w��h 76.2% �� �he presch��l gr�up a�d ��ly 40.9% �� �he pr�mary sch��l gr�up. I� �he CG, ��ly 30.1% �f ch�ldre� were fall��g asleep l��ger �ha� 20 m��u�es a�d �� was s�a��s��cally s�g��f�ca�� a� p=.0005. The d�ffere�ces be�wee� �he HG a�d �he CG �� �he presch��l, pr�mary sch��l a�d sec��dary sch��l gr�up were als� s�g��f�ca�� �44.8% vs.30.1%, p= .0005 f�r �he wh�le gr�up; 76.2% vs. 27.2%, p< .0000 f�r presch��l; 45.7% vs. 23.3%, p= .0487 f�r m�ddle sch��l; 42.0% vs. 10.5%, p= .0096 f�r presch��l�. The perce��age �f HG ch�ldre� �� �he pr�mary sch��l gr�up wh� �eeded �ver 20 m��u�es �� fall asleep was l�wer �ha� �� �he ��her age gr�up �40.9%� a�d �here were �� s�g��f�ca�� d�ffere�ces �� ch�ldre� fr�m �he CG �35.9%�. The ��me �f fall��g asleep �� each age gr�up was sh�w� �� Table 3.

Table 3. Time of Falling Asleep

HG CG Average [min]� Falling asleep >20 min. [%]� Ave-rage [min]� Falling asleep >20 min. [%]� Whole Group 25.5 44.8** 20.0 30.1** Preschool (1-6 y) 34.1 76.2** 19.4 27.2** Primary school (7-12 y) 26.0 40.9 18.3 35.9 Middle school (13-15 y) 24.5 45.7* 15.0 23.3* Secondary school (16-18 y) 23.2 42.0* 19.3 10.5*

Significant results are indicated in bold type; *p< .05; ** p< .005

Sleep habits. I� �ur s�udy, 27.7% ch�ldre� �f �he HG slep�

��ge�her w��h a���her pers�� �� �he bed; �� �he CG �� was ��ly 18.7%. The d�ffere�ce was s�g��f�ca�� a� p= .0101. C�-sleep��g was m�re freque�� �� case �f y�u�ger ch�ldre�, par��cularly �� �he presch��l gr�up 50.0%, a�d was decreas��g �� �he sec��dary sch��l gr�up �� 13.5%. The d�ffere�ces �� �he CG a�d �he HG �� �he par��cular age ca�eg�ry were s�g��f�ca�� �� �he presch��l �50.0% vs.18.2%; p= .0019� a�d pr�mary sch��l gr�up �34.6% vs.19.3%; p= .0039�. Ab�u� 57.7% �f ch�ldre� slep� �� �he same r��m w��h ��her fam�ly members, �� �he CG ��ly 58.1%, �he d�f-fere�ce was ��� s�g��f�ca��. I� �he ��d�v�dual age gr�ups, s�g��f�-ca�� d�ffere�ces be�wee� heal�hy a�d HG ch�ldre� were �bserved �� �he pr�mary sch��l gr�up. I� was �bserved �� 70.9%, �� c�mpa-r�s�� �� 48.0% �f �he CG gr�up �� �he same age �p= .0001�.

I� �he HG, 11.7% �f ch�ldre� had phys�cal c���ac� w��h pare��s whe� fall��g asleep, wh�le 19.7% �� �he CG, �he re�ce was s�g��f�ca�� �p= .0073�. There were �� s�g��f�ca�� d�ffe-re�ces be�wee� �he HG a�d �he CG �� �he par��cular age gr�ups. Wa�ch��g TV a�d l�s�e���g �� �he mus�c whe� fall��g asleep were m�re freque�� �� �he HG �ha� �� �he CG a�d �h�se d�ffe-re�ces were als� s�g��f�ca�� �20.3% vs. 8.1%; p< .0000 f�r TV a�d 26.7% vs. 15.1%; p= .0006 f�r mus�c�. I� �he ��d�v�dual age gr�ups, s�g��f�ca�� d�ffere�ces be�wee� heal�hy a�d HG ch�ldre� were �� �he pr�mary sch��l gr�up. Wa�ch��g TV was �bserved �� 17.3%, �� c�mpar�s�� �� 4.7% �f �he CG gr�up �� �he same age �p= .0006�.

�are��s read��g, s�f� ��ys a�d l�gh� dur��g fall��g asleep were �bserved �� �ccur m�re freque��ly �� �he CG. Appr�x�ma�ely 20% �f pare��s �f �he HG read al�ud �� ch�ldre� bef�re pu����g �hem �� sleep, wh�le 32.4% �� �he CG; �he d�ffere�ce was s�g��f�ca�� �p= .0006�. Twe��y e�gh� perce�� �f ch�ldre� fr�m �he HG had a s�f� ��y �� bed whe� fall��g asleep, �� �he CG – 43.7% �p= .0002�. The l�gh� was �� dur��g fall��g asleep �� 16.7% �f ch�ldre� fr�m �he HG a�d 27.1% fr�m �he CG �p= .0022�. All �he d�ffere�ces were s�g��f�ca��.

The sleep hab��s �� each age gr�ups were sh�w� �� Table 4.

Sleep disorders. The m�s� freque�� sleep d�s�rders rep�r�ed

�� �he s�udy gr�up as paras�m��a symp��ms were: sleep �alk��g 48.3% �38.7% �� �he CG�; brux�sm 23.3% �16.5% �� �he CG�; leg m�veme�� 20.3% �18.0% �� �he CG�; ��gh�mares 16.7% �7.4% �� �he CG� a�d sleep brea�h��g d�s�rder symp��ms l�ke s��r��g 27.3% �� �he HG gr�up �19.0% �� �he CG� a�d brea�h��g pauses 5.7% �1.4% �� �he CG�. D�ffere�ces c��cer���g sleep �alk��g, brux�sm, sleep �err�r, ��gh�mares, s��r��g, a�d brea�h��g pauses were s�g��f�ca�� �48.3% vs. 38.7%; p= .0194 f�r sleep �alk��g; 23.3% vs. 16.5%; p= .0406 f�r brux�sm; 9.0% vs. 4.6%; p= .0345 f�r sleep �err�r, 16.7% vs. 7.4%; p= .0006 f�r ��gh�mares; 23.7% vs. 19.0%; p= .0174 f�r s��r��g a�d 5.7% vs. 1.4%; p= .0057 f�r

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brea�h��g pauses�. The d�ffere�ces c��cer���g brea�h��g pauses �18.2% vs. 0.0%; p< .0000�, e�ures�s �36.4% vs. 9.2%; p= .0012�, sleep �err�r �22.7% vs. 8.0%; p= .0468� were s�g��f�ca�� �� �he presch��l gr�up als� a�d �h�se c��cer���g s��r��g �36.2% vs. 21.3%; p= .0061�, brux�sm �31.5% vs. 18.7%; p= .0134� a�d ��gh�mares �22.0% vs. 8.7%; p= .0018� were s�g��f�ca�� �� �he pr�mary sch��l gr�up. I� �he sec��dary sch��l gr�up ��ly �he d�ffere�ces c��cer���g sleepwalk��g were s�g��f�ca�� �5.2% vs. 9.1%; p= .0066�. Awake���gs fr�m ��gh� sleep were �bserved �� 43.7% ch�ldre� �f �he HG a�d 31.7% ch�ldre� �f �he CG; �h�se d�ffere�ces were s�a��s��cally s�g��f�ca�� �p= .0029�. O�her s�g��f�-ca�� d�ffere�ces �� �he prevale�ce �f awake���gs fr�m ��gh� sleep were �bserved �� �he presch��l gr�up, �81.8% vs. 55.7%; p=

.0246� a�d pr�mary sch��l gr�up �44.9% vs. 22.3%; p< .0000�. The prevale�ce �f sleep d�s�rder symp��ms �� d�ffere�� age gr�up were sh�w� �� Table 5.

I� �ur s�udy, 32.7% ch�ldre� �f �he HG had day �aps; �� �he CG ��ly 20.1%. I� was a s�g��f�ca�� d�ffere�ce a� p= .0006. The day �aps were m�re freque�� �� case �f y�u�ger ch�ldre�, par��-cularly �� �he presch��l gr�up 59.1%, a�d were decreas��g �� �he pr�mary sch��l gr�up �� 18.9%. The d�ffere�ces be�wee� �he CG a�d �he HG �� �he ��d�v�dual age ca�eg�r�es were s�g��f�ca�� �� �he pr�mary sch��l gr�up �18.9% vs. 6.0%; p= .0010� a�d m�ddle sch��l gr�up �34.5% vs. 12.5%; p= .0444�.

I� �he HG, 54.7% �f ch�ldre� were well res�ed af�er a ��gh�’s sleep �� �he sch��l days, wh�le ��ly 76.8% �� �he CG, �� was a

Table 4. Prevalence of Sleep Habits by Age

Preschool Primary school Middle school Secondary school Total [%]� the HG the CG the HG the CG the HG the CG the HG the CG the HG the CG

Bed co-sleeping 50.0** 18.2** 34.6** 19.3** 27.3 29.2 13.5 4.5 27.7* 18.7* Room co-sleeping 72.7 79.5 70.9** 48.0** 54.5 54.2 38.5 45.5 57.7 58.1 Physical contact 40.9 39.8 17.3 12.7 3.6 8.3 2.1 0.0 11.7* 19.7* Watching TV 22.7 10.2 17.3** 4.7** 18.2 8.3 25.0 22.7 20.3** 8.1** Listening to the music 13.6 12.5 11.8 13.3 25.5 12.5 50.0 40.9 26.7** 15.1** Parents reading 36.4 46.6 31.5 32.0 9.1 0.0 7.3 13.6 20.0** 32.4** Soft toys 36.4 48.9 47.2 50.7 12.7 8.3 12.5 13.6 29.0** 43.7** Light 40.9 39.8 22.8 27.3 9.1 4.2 7.3 0.0 16.7** 27.1**

Significant results are indicated in bold type; *p< .05; ** p< .005

Table 5. Prevalence of Sleep Disorder Symptoms by Age

Preschool Primary school Middle school Secondary school Total [%]� the HG the CG the HG the CG the HG the CG the HG the CG the HG the CG

Snoring 31.8 21.6 36.2* 21.3* 25.5 16.7 15.6 13.6 27.3* 19.0* Breathing pauses 18.2** 0.0** 7.1 2.7 1.8 0.0 3.1 0.0 5.7* 1.4* Sleep talking 50.0 33.0 46.5 44.7 56.4 41.7 45.8 31.8 48.3* 38.7* Bruxism 31.8 21.6 31.5* 18.7* 21.8 8.3 11.5 4.5 23.3* 16.5* Leg movement 31.8 22.7 20.5 16.0 23.6 20.8 15.6 22.7 20.3 18.0 Enuresis 36.4* 9.2* 8.7 7.3 5.5 8.3 1.0 0.0 7.7 6.3 Sleep terror 22.7* 8.0* 11.8 6.0 7.3 4.2 3.1 4.5 9.0* 4.6* Sleepwalking 0.0 2.3 7.9 6.0 10.9 4.2 5.2* 9.1* 7.0 3.9 Nightmares 9.1 8.0 22.0** 8.7** 10.9 0.0 14.6 22.7 16.7** 7.4** Awakening 81.8* 55.7* 44.9** 22.3** 38.2 16.7 35.4 22.7 43.7** 31.7**

Significant results are indicated in bold type; *p< .05; ** p< .005

Table 6. Daytime Consequences of Sleep Problems by Age

Preschool Primary school Middle school Secondary school Total [%]� the HG the CG the HG the CG the HG the CG the HG The CG the HG the CG

Day naps 59.1 42.0 18.9** 6.0** 34.5* 12.5* 43.8 36.4 32.7** 20.1**

Well rested 77.3 90.9 64.6 72.7 50.9* 75.0* 38.5 50.0 54.7** 76.8**

Well rested

(weekend) 90.9 96.9 83.5* 92.0* 72.7 79.2 75.0 72.7 79.3** 90.8**

School problems 0.0 0.0 27.6** 4.0** 32.7 25.0 19.8 13.6 24.0** 5.3**

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s�g��f�ca�� d�ffere�ce �p< .0000�. T� c�mpare, �� weeke�ds �� was 79.3% vs. 90.8% p= .0001.

Ab�u� 24.0% �f ch�ldre� �f �he HG had sch��l pr�blems, wh�le ��ly 5.3%�� �he CG, �� was a s�g��f�ca�� d�ffere�ce �p< .0000�. I� �he ��d�v�dual age gr�ups �he s�g��f�ca�� d�ffere�ces be�wee� heal�hy a�d HG ch�ldre� were �� �he pr�mary sch��l gr�up. I� was �bserved �� 27.6%, �� c�mpar�s�� �� 4.0% �f �he CG gr�up �� �he same age �p< .0000�. We d�d�’� �bserve s�g��f�-ca�� d�ffere�ces �� a�y parame�ers be�wee� ch�ldre� w��h m�gra-��e a�d ch�ldre� w��h �e�s��� �ype headache.

DISCUSSION

�leep d�s�rders are ��� �f�e� descr�bed, par��cularly �� ch�l-dre�, eve� �h�ugh �hey are es��ma�ed �� �ccur �� 25%–30% �f �he p�pula���� [15–17]. I� �he ��d�v�dual age gr�ups a h�gh prevale�ce �f sleep pr�blems was rep�r�ed �� �he presch��l ch�ldre�, ra�g��g fr�m 25 �� 50% [18]. Due �� �he freque�cy �f sleep d�s�rders �� ch�ldre� �he subjec� sh�uld be �h�r�ughly researched [19].

The prevale�ce �f pr�mary headaches was es��ma�ed as 10% �f �he p�pula���� �f ch�ldre� [20].

�are��s �f ch�ldre� w��h headache rep�r� ma�y d�ffere�� pr�b-lems �ha� �he�r ch�ldre� have w��h �he ��gh� sleep. The rep�r�ed pr�blems became a d�rec� reas�� �f �h�s s�udy. �ru�� a� all pr�ves �� ac��graph�c m�����r��g s�ud�es �ha� �he ��me �f fall��g asleep �� ch�ldre� w��h headaches �� per��ds w��h�u� pa�� a��acks �s s�g��f�-ca��ly l��ger [21]. We d�d ��� �bserve s�g��f�ca�� d�ffere�ces �� �he ��me �f fall��g asleep �measured �� m��u�es� be�wee� �he HG a�d �he CG, �e��her �� �he wh�le gr�ups ��r �� �he ��d�v�dual age gr�ups. I� �he HG gr�up s�g��f�ca��ly m�re ch�ldre� �44.8% vs. 30.1% �� �he CG� �eeded �ver 20 m��u�es �� fall asleep, �� was espec�ally ����ceable �� �he presch��l gr�up �respec��vely 76.2% vs. 27.2%�. The rela���� appl�ed b��h �� ch�ldre� w��h headache a�d �e�s��� �ype headache. The ��f�rma���� �s �mp�r�a�� because whe� �he ��me �f fall��g asleep �s l��ger �ha� 20 m��u�es, �� �s c��s�dered �� be a paras�m��a r�sk fac��r [22, 23].

I� �ur s�udy �he sleep hab��s �� ch�ldre� w��h headache were c��s�derably d�ffere�� �ha� sleep hab��s �� �he c���r�l gr�up. There have bee� pecul�ar sleep hab��s �bserved �� ch�ldre� w��h headaches a�d �� �s k��w� �ha� �hey are d�ffere�� fr�m �h�se �ccurr��g �� �he ge�eral p�pula���� �f ch�ldre� [10]. �ed c�-sleep��g �f y�u�g ch�ldre� a�d pare��s �s a c�mm�� prac��ce �� ma�y c�u��r�es all ar�u�d �he w�rld [8, 24]. There are ma�y d�f-fere�ces be�wee� �he ��d�v�dual c�u��r�es, f�r example a h�gh ra�e �59%� �s rep�r�ed �� Japa� a�d ��ly ab�u� 15% �� �he U�A [25, 26]. I� Ch��a bed shar��g was rep�r�ed a� �he level �f 18.2% [27, 28]. I� �w���erla�d, a h�gh prevale�ce was rep�r�ed f�r f�ur year �ld ch�ldre�, es��ma�ed a� 38% [29]. I� �ur s�udy, 18.7% ch�l-dre� �f �he CG slep� ��ge�her w��h a���her pers�� �� �he bed. The ra�e �s s�m�lar �� �he ��e rep�r�ed f�r Ch��a [27]. I� ch�ldre� w��h m�gra��e M�ller �bserved c�-sleep��g �� 25% �f ch�ldre� [8]. I� �ur s�udy, bed c�-sleep��g �bserved �� ch�ldre� w��h headache was a� a s�m�lar level 27.7%. There were �� d�ffere�ces be�wee� ch�ldre� w��h m�gra��e a�d �e�s��� �ype headache. I� was a s�g-��f�ca�� d�ffere�ce. C�-sleep��g was m�re freque�� �� case �f y�u�ger ch�ldre�, par��cularly �� �he presch��l gr�up 50.0%, a�d was decreas��g �� �he sec��dary sch��l gr�up, d�w� �� 13.5%. The d�ffere�ces �� �he CG a�d �he HG �� �he ��d�v�dual age

ca�-a�d sugges� �ha� c�-sleep��g �� �he HG �s ��� a ch��ce �f l�fes�yle bu� ra�her a reac���� �� cer�a�� c�rcums�a�ces. H�gh ra�e �f c�-sleep��g �� �he HG was a reac���� �� ch�ldre�’s heal�h pr�blems. L�u a� all �bserved �ha� ch�ldre� wh� shared beds w��h �he�r par-e��s were rep�r�ed �� have m�re sleep a�x�e�y �ha� ch�ldre� wh� slep� al��e [27]. The ab�l��y �� �de���fy d�ffere���al vul�erab�l���es �f �he ch�ld a�d pare�� fr�m r�sks a�d be�ef��s �f c�-sleep��g may help pr�fess���als �� gu�de pare��s �� mak��g ��f�rmed ch��ces wh�ch are �� �he�r fam�ly’s bes� ���eres� [24].

Ab�u� 58% �f ch�ldre� slep� �� �he same r��m w��h ��her fam�ly members. There was �� s�g��f�ca�� d�ffere�ce be�wee� �he CG a�d �he HG. R��m c�-sleep��g �s ra�her a ch��ce �f l�fes�yle �r a c��seque�ce �f s�c��ec���m�c c��d�����s �ha� a reac���� �� heal�h pr�blems. I� �he pr�mary sch��l gr�up 71% �f ch�ldre� w��h headache were shar��g r��m w��h a���her pers�� fr�m �he fam�ly. There was a s�g��f�ca�� d�ffere�ce be�wee� �he heal�hy a�d HG ch�ldre�. The �bserva���� was c��s�dered �� be ���eres�-��g a�d �he phe��me��� seemed ��� �� be rela�ed w��h �he cul-�ural a�d s�c��ec���m�c c��d�����.

U�fav�rable sleep hab��s, e.g. l�s�e���g �� �he mus�c �r wa�ch-��g TV, were s�g��f�ca��ly m�re freque��ly �bserved �� �he HG. Wa�ch��g TV whe� fall��g asleep �s ass�c�a�ed w��h sleep ��se� delay a�d a�x�e�y [30]. ��a��s��cally s�g��f�ca�� m�re freque�� prevale�ce �f �he me�����ed hab��s �� ch�ldre� �f �he HG may be a c��d����� caus��g m�re freque�� �ccurre�ce �f sleep pr�blems �� �h�s gr�up �f ch�ldre�. I� �s rec�mme�ded �ha� �ega��ve effec�s �f such hab��s are emphas��ed �� �he pare��s [30].

The sleep hab��s wh�ch �mpac� �he qual��y �f sleep ca� c��-seque��ly ���erfere w��h �he da�ly fu�c������g �f �he pa��e��s [1, 4–7]. I� �s par��cularly �mp�r�a�� �� case �f sch��l age ch�ldre�.. I� �s par��cularly �mp�r�a�� �� case �f sch��l age ch�ldre�.I� �s par��cularly �mp�r�a�� �� case �f sch��l age ch�ldre�. D�srup����s �� �he ��gh� sleep have s�g��f�ca�� �mpac� �� sch��l a��e�da�ce a�d perf�rma�ce, da�ly ac��v���es a�d em�����al s�a�us [8] . O�e �f �he bas�c me�h�d �f �rea���g sleep d�s�rders �� ch�l-dre� �s pare��s’ educa���� a�d �mpleme��a���� �f �he c�rrec� sleep��g hab��s [31–33]. D�scuss��g sleep pa��er�s w��h pare��s pr�v�des �pp�r�u���y �� lear� m�re ab�u� �he ch�ld a�d fam�ly a�d all�ws �� evalua�e �he behav��ral a�d fam�ly ���erve�����s [23]. I� als� makes �� p�ss�ble �� educa�e �he pare��s �� �he sleep hyg�e�e a�d me�h�ds �f preve����g m�re ser��us sleep pr�blems [34].

��me ep�dem��l�g�cal s�ud�es pay a��e����� �� a c�-�ccur-re�ce �f sleep d�s�urba�ces a�d var��us �ypes �f headache [21]. �leep d�s�urba�ces are s�g��f�ca��ly m�re freque�� �� ch�ldre� w��h headaches [35]. Th�se pa��e��s m�re freque��ly suffered fr�m paras�m��as, d�ff�cul��es a� sleep ��se�, awake���gs, a�d day��me s�m��le�ce [1].

There are ��ly few pr�fess���al publ�ca����s wh�ch c��cer� �he ep�dem��l�gy �f sleep d�s�urba�ces �� ch�ldre� a�d ad�lesce��s w��h headache [1, 6]. �ru�� e� all ����ced m�re sleep d�s�urba�ces �.e. paras�m��as, sleep brea�h��g d�s�rders, ��gh� awake���gs a�d �app��g �� �he s�udy gr�up �ha� �� �he c���r�l gr�up [1]. Als� M�ller e� all �bserved pa��e��s w��h c�ex�s���g m�gra��e a�d sleep d�s�urba�ces [8]. They came �� a c��clus��� �ha� eve� �h�ugh �he d�rec���� �f �he rela����sh�p be�wee� headaches a�d sleep was ��� �bv��us, ���erve�����s cha�ge �f �he sleep hab��s m�gh� release headache a�d als� effec��ve �herapy �f headaches �� ch�ldre� had p�s���ve �mpac� �� sleep [8, 12, 36, 37].

�leep d�s�rders �� ch�ldre� are c�mplex a�d appr�x�ma�ely 30% �f ch�ldre� have sleep pr�blem �� a� leas� ��e d�ma�� [38].

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s���ally �r sp�rad�cally �ccurr��g dur��g sleep [39, 40]. The phe��me�a are qu��e �f�e� descr�bed, �� par��cular �� ch�ldre�, a�d �hey are es��ma�ed �� �ccur �� 25% �f p�pula���� [15, 16]. ��me paras�m��as, �.e. sleep �alk��g �ccur �� ch�ldre� s� �f�e� �ha� �hey ca� be c��s�dered phys��l�g�cal phe��me�a ra�her �ha� d�s�rders [3, 16]. ��me s�ress�rs may pred�c� �he �ccurre�ce �f paras�m��as �� �h�s age gr�up [41, 42].

O� a Turk�sh sample brux�sm, ��c�ur�al e�ures�s a�d sleep �alk��g were �he m�s� c�mm�� paras�m��as am��g b��h g�rls a�d b�ys [41]. ��me research sugges� �ha� paras�m��a symp��ms are m�re freque�� �� ch�ldre� w��h pr�mary headache, espec�ally w��h m�gra��e [8]. I� �ur s�udy �he prevale�ce �f paras�m��a symp-��ms l�ke sleep �alk��g, brux�sm, sleep �err�r a�d ��gh�mares �� ch�ldre� w��h headache was s�g��f�ca��ly h�gher �ha� �he ��e �bserved �� �he CG.

I� a s�udy �� m�gra��e ch�ldre� M�ller descr�bes a prevale�ce �f brux�sm a� a h�gh level �f 29% [8]. We �bserved d�ffere�ces �� �he prevale�ce �f brux�sm, ch�ldre� w��h headache m�re �f�e� had brux�sm 23.3% ��� CG – 16.5%�. ��me da�a sugges� �ha� ch�ldre� w��h brux�sm have a h�gher ar�usal ��dex [43]. I� may be ass�c�a�ed w��h h�gher r�sk �f s�ma��c c�mpla���s �r pr�blems, as well as behav��r a�d a��e����� pr�blems [43].

Ch�ldre� wh� exper�e�ce ��gh�mares have s�g��f�ca��ly h�gher levels �f a�x�e�y �ha� ch�ldre� wh� d� ��� exper�e�ce ��gh�ma-res [44]. I� �ur s�udy we �bserved m�re freque�� prevale�ce �f ��gh�mares �� �he gr�up �f ch�ldre� w��h headaches, wha� ca� be c���ec�ed w��h h�gher levels �f a�x�e�y �� �h�s gr�up �f ch�ldre�. I� �ur s�udy prevale�ce �f sleep brea�h��g d�s�rder symp��ms �freque�� s��r��g a�d brea�h��g pauses� �� ch�ldre� w��h heada-che was als� s�g��f�ca��ly h�gher. �leep-d�s�rdered brea�h��g may affec� up �� 3% �f ch�ldre�, �s ass�c�a�ed w��h sleep fragme��a-���� a�d �mp�ses s�g��f�ca�� cl���cal m�rb�d��y, pr�mar�ly ��v�l-v��g card��vascular a�d �eur�behav��ral fu�c����s [45]. Hab��ual s��r��g var�es fr�m c�u��ry �� c�u��ry a�d has bee� �bserved �� �ccur �� 6% �� 27% [45]. The pare��al rep�r�s fr�m ques�����a-�re-based assessme��s �f s��r��g ca� be used as surr�ga�e pred�c-��rs �f sleep d�s�rder brea�h��g �� ch�ldre� [42]. I� ch�ldre� w��h m�gra��e headache M�ller ����ced s��r��g �� 23% �f ch�ldre� [8]. I� �ur s�udy we �bserved s��r��g �� 19% �f heal�hy ch�ldre� a�d 27.3% �f ch�ldre� w��h headache. Tha� ca� be a cause �f ��crea-sed sleep fragme��a���� a�d ��crea��crea-sed freque�cy �f awake���gs �bserved �� ch�ldre� w��h headache. Numer�us s�ud�es sh�w �ha� appr�x. 20-30% ch�ldre� wake up a� ��gh� [46]. I� �ur s�udy ��gh� awake���gs were �bserved �� 43.7% �f ch�ldre� fr�m �he HG a�d 31.7% �f ch�ldre� fr�m �he CG. The prevale�ce �f ��gh� awak��g was decreas��g as �he age �f ch�ldre� ��creased. The prevale�ce �f sleep d�s�rder symp��ms l�ke: s��r��g, sleep �alk��g, brux�sm, sleep �err�r, ��gh�mares, brea�h��g pauses a�d awak��g fr�m ��gh� sleep was h�gher �� �he HG gr�up �ha� �� �he CG a�d �� may have c��seque�ces �� �he fu�c������g �f ch�ldre� fr�m �ha� gr�up dur��g �he day.

The �mpac� �f sleep depr�va���� �� c�g����ve fu�c����s �s ��� well es�abl�shed espec�ally f�r ch�ldre� a�d ad�lesce��s [47]. ��me s�ud�es sugges� �ha� h�gher c�g����ve fu�c����s �� ch�ldre� are �mpa�red af�er a s��gle ��gh� �f res�r�c�ed sleep [48]. I� �h�s s�udy ch�ldre� dem��s�ra�ed def�c��s �� abs�rac� �h��k��g, verbal pr�cess��g a�d crea��v��y af�er ��e ��gh� �f sleep res�r�c����. The def�c��s were �bserved �� 50% res�r�c����s �f ���al sleep ��me dur��g ��e ��gh� eve� whe� �he r�u���e perf�rma�ce was rela��-vely ma���a��ed [48].

��me effec�s �f sleep d�s�urba�ces �� �he gr�up �f ch�ldre� w��h headache may have ��flue�ce �� pr�blems dur��g day ac��-v��y – pla����g, �ver ac��ac��-v��y �r �mpuls�ac��-v��y espec�ally a� sch��l [49, 50]. I� �ur s�udy sch��l pr�blems were �bserved m�re fre-que��ly �� �he HG �24.0%� �ha� �� �he CG �5.3%�, �� par��cular �� �he pr�mary sch��l gr�up. I� was �bserved �� 27.6%, �� c�mpa-r�s�� �� 4.0% �f �he CG �� �he pr�mary sch��l gr�up. The �bser-ved d�ffere�ce �s all �he m�re �mp�r�a�� as s�me phe��me�a l�ke bed a�d r��m c�-sleep��g, wa�ch��g TV dur��g fall��g asleep a�d sleep d�s�rders s��r��g, brux�sm, ��gh�mares, awake���gs fr�m ��gh� sleep are �bserved s�a��s��cally m�re freque��ly �� �ha� age gr�up.

�everal l�m��a����s �� �he s�udy mer�� d�scuss���. The f�rs� l�m��a���� �f �he s�udy was a rela��vely small �umber �f par��c�-pa��s. The ��d�v�dual gr�ups were ��� small, espec�ally �he gr�up �f ch�ldre� w��h m�gra��e. We are c�����u��g �� c�llec� add�����al da�a �� crea�e a larger sample �f ch�ldre�. The sec��d l�m��a���� was �he d�ffere�ces �� age d�s�r�bu����. The mea� age �� �he HG was 12.6 +/- 4.0 a�d 8.6 +/- 4.4 �� �he CG. Th�s d�ffere�ce was s�g��f�ca�� a�d m�gh� have ��flue�ce �� s�me resul�s. There were ��� few ch�ldre� �� �he m�ddle a�d sec��dary sch��l gr�up �f �he c���r�l gr�up. Th�s l�m��a���� w�ll be �verc�me whe� a larger gr�up �s crea�ed �� �he fur�her c�urse �f �he s�udy.

H�wever �he rela����sh�p be�wee� m�gra��e headaches a�d sleep has bee� f�u�d �� adul�s, research w��h ped�a�r�c p�pula-����s rema��s l�m��ed [8]. I��erve�p�pula-����s w��h ch�ldre� w��h hea-dache a�d sleep pr�blems rema�� a� �mp�r�a�� area f�r fu�ure ��ves��ga����.

��me f��d��gs sugges� �ha� ped�a�r�c�a�s a�d �eur�l�g�s�s may wa�� �� ��clude sleep h�s��ry ques����s as par� �f �he s�a�-dard exam��a���� �� ch�ldre� w��h headache [8]. I� �s a� prese�� a c�mm�� k��wledge �ha� �� ma�y cases �he d�ag��s�s a�d �rea�-me�� �f ch�ldre� sleep d�s�rders a� �he G� �Ge�eral �rac������er� level �s u�prac��cal �r eve� �mp�ss�ble, requ�r��g ���erd�sc�pl��ary appr�ach �� spec�al�s� sleep cl���cs [51, 52]. O�ly such ���erd�sc�-pl��ary appr�ach a�d a �eam �f ped�a�r�c�a�s, psych�a�r�s�s, �eur�-l�g�s�s, psych�l�g�s�s a�d lary�g�l�g�s�s ca� e�sure pr�fess���al d�ag��s�s a�d �rea�me��s �f sleep d�s�rders �� ch�ldre� [19, 51, 52].

I� �s �ecessary �� c��duc� add�����al research �� a larger gr�up �f pa��e��s w��h headache �� c�rrela�e �he prevale�ce �f sleep d�s�rder symp��ms w��h �he �ype �f pr�mary headache �m�gra��e a�d �e�s��� �ype headache� a�d ��her symp��ms.

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Appendix A.

Exemplary sleep-related questions from the questionnaire (English

translation)

Number �f pers��s sleep��g w��h �he ch�ld �� �he same bed �N�.�

Number �f pers��s sleep��g w��h �he ch�ld �� �he same r��m �N�.�

Wha� �s �he average ��me �eeded by y�ur ch�ld �� fall asleep ��� m��u�es�?

A� wha� h�ur d�es y�ur ch�ld usually g� �� sleep �� w�rk��g days?

A� wha� h�ur d�es y�ur ch�ld usually wake up �� w�rk��g days?

A� wha� h�ur d�es y�ur ch�ld usually g� �� sleep �� weeke�ds? A� wha� h�ur d�es y�ur ch�ld usually wake up �� weeke�ds? D�es y�ur ch�ld have phys�cal c���ac� w��h pare��s whe� fall��g asleep? �yes/���

D�es y�ur ch�ld wa�ch TV whe� fall��g asleep? �yes/��� D�es y�ur ch�ld l�s�e� �� �he mus�c whe� fall��g asleep? �yes/���

D� y�u read b��ks �� y�ur ch�ld whe� she/he �s fall��g asleep? �yes/���

D�es y�ur ch�ld �eed s�f� ��ys whe� she/he �s fall��g asleep? �yes/���

D�es y�ur ch�ld �eed a l�gh� whe� she/he �s fall��g asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� s��re wh�le asleep? �yes/��� Have y�u �bserved y�ur ch�ld �� s��p brea�h��g f�r a few sec��ds wh�le asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� �alk wh�le asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� have e�ures�s wh�le asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� gr��d her/h�s �ee�h wh�le asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� walk wh�le asleep? �yes/��� Have y�u �bserved y�ur ch�ld �� awake fr�m a ��gh�’s sleep? �yes/���

Have y�u �bserved y�ur ch�ld �� have ��gh�mares wh�le asleep? �yes/���

Have y�u �bserved y�ur ch�ld �� have ��gh� �err�rs wh�le asleep? �yes/���

H�w �f�e� d�es y�ur ch�ld awake fr�m a ��gh�’s sleep? D�es y�ur ch�ld have day �aps? �yes/���

H�w ma�y �aps d�es y�ur ch�ld have dur��g a day? �N�.� H�w l��g are y�ur ch�ld’s �aps? ��� m��u�es�

D�es y�ur ch�ld have sch��l pr�blems? �yes/���

Are �here a�y fam�ly members wh� s��re wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� s��p brea�h��g f�r a few sec��ds wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/��� Are �here a�y fam�ly members wh� �alk wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� have e�ures�s wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� gr��d her/h�s �ee�h wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� walk wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� have ��gh�mares wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

Are �here a�y fam�ly members wh� have sleep �err�rs wh�le asleep? �yes [wh�: fa�her, m��her, s�bl��gs]/���

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Correspondence address:

Chair and Department of Developmental Neurology Poznan University of Medical Sciences. 60-355 Poznan, 49 Przybyszewskiego St., Poland

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