ABSTRACT
Objective:
This study aimed to determine the prevalence of sleeprelated breathing disorders (SRBDs) among school children in Kars, Turkey. A recently published study conducted in Kars province examined the SDBRs among elementary school children. In this study, the socio-demographic characteristics of children and their relationship with SRBDs were also examined. This brief report aims to introduce this published study inland.
Materials and Methods:
Six different schools were determined as the universe of the research, and a total of 1,421 children aged 6-13 were included in the study. A fourteen-item data collection form was used to evaluate the socio-demographic characteristics of the participants. An education and information seminar program on sleep disorders was conducted by the researchers before starting the data collection. The Pediatric Sleep Questionnaire (PSQ) was used on parents to determine SRBDs after this training program.
Results:
The mean age of the study group’s was 9.37±1.91 years (54.2% girls), the prevalence of SRBDs was 17.2%. The PSQ scores were significantly higher in boys and older age groups (9-13 years). Associations were observed between low academic achievement and breathing problems, snoring, morning headache, attention deficit/hyperactivity disorder, growth retardation, nocturnal enuresis, and obesity categories.
Conclusion:
Sleep is as crucial as nutrition in children. Children with adequate sleep patterns develop better mental and physical health. Recognizing sleep problems in the early age period and establishing good sleep practices in childhood will enable them to live healthy for many years.
Introduction
As every living creature feels, sleep is essencial for the body to renew itself, and gather energy. Physical growth and mental development can be possible with adequate sleep in children and adolescents. Sleep directly effects growth, especially in early infancy. Growth hormone is produced when children are asleep. Children during periods of rapid growth often need more sleep. In toddlers, sleep is necessary for motor skill development and executive attention sleep requırements is age-dependent and sleep pattern change as children get older the health, well-being, learning, behavior and even weight of children who do not get enough and quality sleep are adversely affected (1). It has been reported that sleep problems in childhood and adolescence impair learning capacity and reduce academic achievement (2,3). Sleep deficiency at an early age can lead to long-term sleep problems in later life. For this reason, it’s substantial to comprehend the sleep problems of children, in order to detect in the early period and prevent negative consequences. In addition to harming physical and mental development, sleep deprivation also causes behavioral problems (3). Contrary to popular belief, sleep disorders are not uncommon among children. The prevalence of sleep disorders is between 20% to 40% in children aged 1 to 5 years. Several studies reported that sleep related breathing disorders (SRBDs) are highly prevalent among school children (2-4). A recently published study conducted in Kars province examined the SDBRs among elemantary school children (5). The Kars province, is located in relatively less developed district of Turkey. Social development indicators, such as education, prosperity, and health are rank below national averages. Also schooling rate in elemantary and middle education is less than 70% while in the western area more than 90% (6). It is crucial to assess the frequency and related factors of SRBDs in school-aged children due to their impact on academic achievement, particularly in developing regions of Turkey that need well trained human resources. Besides to evalute prevalance and related factors of SRBDs, this study also aimed to attract attention of parents about children’s sleep problems. With this purpose the researches were organised an educational seminary program prior to study for parents and children about sleep disorders at the schools.
Materials and Methods
Six different schools were determined as the universe of the research, and a total of 1,421 children aged 6-13 were included in the study. A fourteen-item data collection form was used to evaluate the socio-demographic characteristics of the participants. An education and information seminar program on sleep disorders was conducted by the researchers before starting the data collection. The Pediatric Sleep Questionnaire (PSQ) was used on parents to determine SRBDs after this training program (7). The respondents were investigated in eight categories [daytime sleepiness, respiratory problems, snoring, nocturnal enuresis, morning headache, growth retardation, attention deficit/hyperactivity disorder (ADHD) and obesity]. Parents were investigated whether their children had a diagnosis of growth retardation and ADHD. Weight and height measurements were determined to calculate the body mass index. Parents answered the PSQ and socio-demographic data form. In addition, data were collected through teachers.
The study was approved by Kars Provincial Education Regional Director and Kafkas University Faculty of Medicine Ethics Committee (protocol number: 80576354-050-99/77), and all participants provided verbal informed consent.
Statistical Analysis
As descriptive statistics, percentage, frequencies, arithmetic means, distributions, and standard deviations were examined. Data were adjusted for gender and age. To compare variables pearson’s chi-square and Fisher’s Exact tests were performed. Odds ratio values were calculated for risk assessment among categorical variables.
Results
The mean age of the study group’s was 9.37±1.91 years (54.2% girls), the prevalence of SRBDs was 17.2%. The PSQ scores were significantly higher in boys and older age group (9-13 years). Associations were observed between low academic achievement and breathing problems, snoring, morning headache, ADHD, growth retardation, nocturnal enuresis, and obesity categories. It has been observed that there is a strong relationship between the ADHD and family’s economic status, and education level. The results are boradly summarized in Table 1.
Discussion
According to the PSQ, the prevalence of SRBDs among school-aged children in Kars, Turkey was relatively low compared to results reported worldwide (8-10). The findings of this study showed an association between SRBDs and frequent infections. It has been found that boys had a higher prevalence of SRBD than girls in this study. The most striking association was observed in this study between low academic achievement and ADHD, snoring, respiratory problems, and nocturnal enuresis; these results are in agreement with previous studies (2,3,10). This study also aimed to raise awareness of the importance of sleep disorders in parents, who are responsible for the growth of a healthy generation. Such education with parents was expected to encourage the practice of good sleep hygiene in their children. Due to its negative impact on academic performance, good sleep behavior should be taught to children at an early age. The unique aspects of this study are, to the best of our knowledge, that it is the first study of this issue to be made in this specific region, and even in Turkey. The large sample size was the strength of this study. In this study, it was also aimed to raise awareness about the importance of sleep disorders in the population. Because of its impact on health and academic performance, good sleep behavior should be acquired to children at an early age. For this, parents should be made aware of sleep health and they should be encouraged to provide their children with the necessary sleep hygiene.
Conclusion
It is crucial to know that insufficient or fragmented sleep can impair children’s physical and mental health, while adequate sleep could increase their academic success. The most important contribution of this study to the region was to draw the attention of parents about children’s sleep problems by organizing a educational seminary program for parents and children about sleep disorders at the schools. Sleep disorders are often neglected among physicians as well as in society. To the best of our knowledge, this is the first study of its kind to be conducted in this specific region in. The findings of our study, which provides data-based evidence, are expected to attract the attention of health care providers.
Acknowledgments
We would like to thank all the parents who trusted us and accepted the study, and the school administrations who provided an environment for the training seminar.
Ethics
Ethics Committee Approval: The study was approved by Kars Provincial Education Regional Director and Kafkas University Faculty of Medicine Ethics Committee (protocol no: 80576354-050-99/77, date: 13.05.2015).
Informed Consent: All participants provided verbal informed consent.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Concept: H.Ç., S.A., Design: H.Ç., S.A., Data Collection or Processing: H.Ç., Analysis or Interpretation: H.Ç., Literature Search: H.Ç., Writing: H.Ç., S.A.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.