Children with chronic physical illness or disorder

Acute physical illnesses disturb sleep but only for the duration of the illness in most cases. By comparison, chronic illness is commonly complicated by long-standing sleep disturbance caused in various ways.

• Pain or discomfort at night (e.g. malignancy or severe atopic dermatitis).

• Occurrence (and sometimes worsening) of symptoms during sleep causing sleep disruption, such as asthma and epilepsy.

• Upper airway obstruction and/or central apnoea in some forms of cerebral palsy, neuromuscular disease, craniofacial abnormalities, and various congenital syndromes in which the upper airway and/or brainstem structures are affected such as spina bifida and hydrocephalus.

• Severe visual impairment in which the main environmental cue to time of day is absent causing circadian sleep-wake rhythm disorders.

Additional factors include the following.

• Admission to hospital especially for intensive care, the psychological consequences of which can be long-standing.

• Some forms of paediatric medication.

In studies of children with asthma, (29 atopic dermatitis, (21> and also chronic fatigue syndrome in teenagers,(22) the main abnormality has been frequent disruption of sleep continuity by awakenings which are often of such brief duration that they would be underestimated by ordinary clinical reporting. Improvement in nocturnal symptoms in children with asthma is associated with fewer awakenings and improved daytime psychological function. (2.9 The findings are in keeping with the notion that impaired psychological function may be corrected in various groups of children if the quality of their night time sleep can be improved.

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