Abstract
Objective
Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB.
Methods
Parents of 1475 Colombian children, aged 9.8 ± 1.6 years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn’s post-hoc tests, based on the normality of outcome variables.
Results
Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer.
Conclusion
Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed.
Clinical significance
Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence.
1
Introduction
Sleep bruxism (SB) is a repetitive jaw-muscle activity, characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible , which is a common phenomenon in children . Some sleep behaviors, such as snoring, mouth breathing, restless sleep, drooling, body position during sleep, and inadequate sleep time, have been identified as risk or associated factors for SB in children .
An adequate sleep time and quality is important for children’s health , since it impacts behavioral and emotional functioning as well as learning skills and attention . Sleep patterns are related to sleep time (bedtime, morning wakeup time, and daily total sleep duration), which should theoretically warrant an adequate amount of sleep time in relation to the age of the subject . In children, such patterns vary among individuals and are influenced by the time going to bed and the sleep-related habits (e.g., reading or watching TV before sleeping, and going to sleep in one’s own bed or in the parents’ or siblingś bed). Alterations in sleep patterns and sleep-related habits could lead to sleep disorders , also based on the influence of psychological and social factors .
While a correlation of certain sleep behaviors with SB has been observed in children , information on the topic is still fragmental, especially as far as the possible influence of socioeconomic factors is concerned.
Based on the above premises, the present study was performed in a sample of Colombian children belonging to different social layers, by adopting parental (“proxy”)-reported tooth grinding as an indicator of SB. The study was designed to test the hypotheses that: 1. sleep behaviors are different between children with different frequencies of proxy-reported SB; and 2. the association of proxy-reported SB with sleep behaviors if existing, is different among social layers.
2
Materials and methods
2.1
Study design
Parents of Colombian children belonging to three different social layers filled out a questionnaire on sleep behaviors, viz., the Children’s Sleep Habits Questionnaire (CSHQ). An item on the report of sleep tooth grinding by the parents (“Does your child present grinding of the teeth during sleep?”) was assumed as the outcome variable, and it was referred to as “proxy-reported SB” in this investigation. Differences in sleep behaviors between children with different proxy-reported SB frequencies were explored in the total sample and in the three socioeconomic layers.
The ethics committee at CES University gave the approval for the present study, and written informed consent was obtained for each participant.
The study participants were 1500 parents of children that were randomly selected out of 155,849 potential 6–13 years old subjects, reported by the Colombian statistical system DANE (Departamento Administrativo Nacional de Estadísticas) and representative of the socioeconomic layers of the population of Medellin. Twenty-five children were excluded from the study because of their parents’ incomplete answers to the questionnaires, so that the final analysis was performed on a sample of 1475 individuals.
During meetings organized at schools, parents completed the Spanish version , of the Children’s Sleep Habits Questionnaire (CSHQ) The CSHQ is a retrospective questionnaire, which recalls the child’s sleep behaviors over a “typical” recent week.
The instrument consists of 40 items, which are rated on a 3-point frequency scale: 1 = “Rarely” if the sleep item occurs 0 or 1 time per week; 2 = “Sometimes” for 2 to 4 times per week; and 3 = “Usually” for 5 to 7 times per week. Items are grouped into 9 subscales/domains: “sleep patterns” (6 items), “bedtime resistance” (6 items), “sleep onset delay” (1 item), “sleep duration” (3 items), “sleep anxiety” (4 items), “night waking” (3 items), “sleep disordered breathing” (3 items), “parasomnias” (6 items), and “daytime sleepiness” (8 items). Domain subscores are the sum of items included in each subscale, while the total CSHQ score is the sum of all domain subscores.
According to Buxton et al. and Owens et al. , the 8 items evaluating sleep-related habits were not pertinent to a single domain. Specifically, they include five items belonging to the bedtime resistance domain (i.e., goes to bed at the same time, falls asleep in own bed, falls asleep in other’s bed, needs parents in room to sleep, struggles at bedtime), one item belonging to the daytime sleepiness domain (i.e., watches TV and/or other screens before going to bed), the item “sleeps the same amount each day” from the sleep duration domain, and the single item contained in the domain “falls asleep in 20 min”.
The CSHQ has satisfactory psychometric properties in children and has been used in investigation on sleep in children and sleep tooth grinding in children .
2.2
Statistical analysis
Descriptive analysis was performed to determine frequency distributions for categorical variables as well as mean values and measures of variation for quantitative variables.
Kolmogorov-Smirnov test was used to evaluate normal distribution of values for each item, domain and total scores in the total sample, as well as in three different socioeconomic groups: low, medium, and high ( www.dane.gov.co/files/geoestadistica; 2013).
To assess the presence of differences in sleep behaviors between children with different proxy-reported SB frequency, one-way ANOVA with Bonferroni post-hoc or Kruskal-Wallis with Dunńs post-hoc test were performed, based on the normality of the variables. The comparison between groups with different proxy-reported SB frequency was performed in the total sample as well as in the three different socioeconomic layers.
For all statistical procedures, the level of significance was set at p < 0.05. All data were analyzed with STATA© software version 13.0 (Copyright 1996–2016 StataCorp LP.TX.USA).
2
Materials and methods
2.1
Study design
Parents of Colombian children belonging to three different social layers filled out a questionnaire on sleep behaviors, viz., the Children’s Sleep Habits Questionnaire (CSHQ). An item on the report of sleep tooth grinding by the parents (“Does your child present grinding of the teeth during sleep?”) was assumed as the outcome variable, and it was referred to as “proxy-reported SB” in this investigation. Differences in sleep behaviors between children with different proxy-reported SB frequencies were explored in the total sample and in the three socioeconomic layers.
The ethics committee at CES University gave the approval for the present study, and written informed consent was obtained for each participant.
The study participants were 1500 parents of children that were randomly selected out of 155,849 potential 6–13 years old subjects, reported by the Colombian statistical system DANE (Departamento Administrativo Nacional de Estadísticas) and representative of the socioeconomic layers of the population of Medellin. Twenty-five children were excluded from the study because of their parents’ incomplete answers to the questionnaires, so that the final analysis was performed on a sample of 1475 individuals.
During meetings organized at schools, parents completed the Spanish version , of the Children’s Sleep Habits Questionnaire (CSHQ) The CSHQ is a retrospective questionnaire, which recalls the child’s sleep behaviors over a “typical” recent week.
The instrument consists of 40 items, which are rated on a 3-point frequency scale: 1 = “Rarely” if the sleep item occurs 0 or 1 time per week; 2 = “Sometimes” for 2 to 4 times per week; and 3 = “Usually” for 5 to 7 times per week. Items are grouped into 9 subscales/domains: “sleep patterns” (6 items), “bedtime resistance” (6 items), “sleep onset delay” (1 item), “sleep duration” (3 items), “sleep anxiety” (4 items), “night waking” (3 items), “sleep disordered breathing” (3 items), “parasomnias” (6 items), and “daytime sleepiness” (8 items). Domain subscores are the sum of items included in each subscale, while the total CSHQ score is the sum of all domain subscores.
According to Buxton et al. and Owens et al. , the 8 items evaluating sleep-related habits were not pertinent to a single domain. Specifically, they include five items belonging to the bedtime resistance domain (i.e., goes to bed at the same time, falls asleep in own bed, falls asleep in other’s bed, needs parents in room to sleep, struggles at bedtime), one item belonging to the daytime sleepiness domain (i.e., watches TV and/or other screens before going to bed), the item “sleeps the same amount each day” from the sleep duration domain, and the single item contained in the domain “falls asleep in 20 min”.
The CSHQ has satisfactory psychometric properties in children and has been used in investigation on sleep in children and sleep tooth grinding in children .
2.2
Statistical analysis
Descriptive analysis was performed to determine frequency distributions for categorical variables as well as mean values and measures of variation for quantitative variables.
Kolmogorov-Smirnov test was used to evaluate normal distribution of values for each item, domain and total scores in the total sample, as well as in three different socioeconomic groups: low, medium, and high ( www.dane.gov.co/files/geoestadistica; 2013).
To assess the presence of differences in sleep behaviors between children with different proxy-reported SB frequency, one-way ANOVA with Bonferroni post-hoc or Kruskal-Wallis with Dunńs post-hoc test were performed, based on the normality of the variables. The comparison between groups with different proxy-reported SB frequency was performed in the total sample as well as in the three different socioeconomic layers.
For all statistical procedures, the level of significance was set at p < 0.05. All data were analyzed with STATA© software version 13.0 (Copyright 1996–2016 StataCorp LP.TX.USA).
3
Results
3.1
Prevalence of proxy-reported SB and CSHQ scores
The sample consisted of 1475 children (718 girls and 757 boys, mean age 9.8 ± 1.6 years, range 6–13). SB was reported as “rarely” by the parents of 532 girls (74.2%) and 557 boys (73.6%); “sometimes” by the parents of 75 girls (10.4%) and 85 boys (11.2%); and “usually” by the parents of 111 girls (15.4%) and 115 boys (15.2%). The prevalence of proxy-reported SB with a frequency of two times or more per week (e.g., “sometimes” or “usually”) in the total study sample was 26.1% ( Table 1 ).
| Proxy-reported sleep bruxism | Total | |||
|---|---|---|---|---|
| Rarely | Sometimes | Usually | ||
| Gender (N, %): | ||||
| Female | 532 (74.1) | 75 (10.4) | 111 (15.4) | 718(100) |
| Male | 557 (73.5) | 85 (11.2) | 115 (15.2) | 757 (100) |
| Age (years): | ||||
| Mean ± SD | 9.9 ± 1.6 | 9.5 ± 1.6 | 9.5 ± 1.7 | 9.8 ± 1.6 |
| Median (Q 1 , Q 3 ) | 8 (8, 11) | 9.5 (8, 11) | 7.5 (8, 11) | 10 (8, 11) |
| Min − max | 6–13 | 7–12 | 6–13 | 6–13 |
| Socioeconomic status (N, %): | ||||
| Lowest | 178 (68.4) | 26 (10) | 56 (21.5) | 260 (100) |
| Medium | 509 (74.4) | 86 (12.5) | 87 (13.2) | 682 (100) |
| Highest | 402 (75.4) | 48 (9.0) | 83 (15.5) | 533 (100) |
| Place of birth of the parents (N, %): | ||||
| Medellín | 650 (73.7) | 97 (11.0) | 135 (15.3) | 882 (100) |
| Out of Medellín | 439 (74.0) | 63 (10.6) | 91 (15.3) | 593 (100) |
| Zone of birth of the parents (N, %): | ||||
| Urban | 953 (74.5) | 134 (10.5) | 191 (14.9) | 1278 (100) |
| Rural | 136 (69.3) | 25 (12.7) | 35 (17.8) | 196 (100) |
| Total (N, %): | 1089 (73.8) | 160 (10.8) | 226 (15.3) | 1475 (100) |
The total CSHQ score was found to be significantly different between the proxy-reported SB-frequencies, both in the overall sample and in all the socioeconomic layers ( Table 2 ).
| Proxy-reported sleep bruxism | F | p value | Post-Hoc Test p -value | |||
|---|---|---|---|---|---|---|
| SLEEP PATTERNS | Rarely | Sometimes | Usually | |||
| Bedtime during weekdays (mean, sd) | 20:42 (3:00) | 20:30 (4:00) | 20:50 (2:36) | 0.6 | 0.57 | – |
| Morning wakeup time during weekdays (mean, sd) | 6:32 (1:27) | 6:37 (1:40) | 6:26 (1:26) | 0.8 | 0.47 | – |
| Daily total sleep duration during weekdays (mean, sd) | 9.3 (1.5) | 9.2 (1.5) | 9.3 (1.5) | 0.7 | 0.50 | – |
| Bedtime during weekends (mean, sd) | 19:26 (7:05) | 20:26 (4:09) | 20:04 (6:19) | 2.5 | 0.08 | – |
| Morning wakeup time during weekends (mean, sd) | 8:54 (1:18) | 8:59(1:22) | 8:54 (1:17) | 0.3 | 0.73 | – |
| Daily total sleep duration during weekends (mean, sd) | 10.6 (1.3) | 10.5 (1.2) | 10.6 (1.3) | 0.3 | 0.73 | – |
| BEDTIME RESISTANCE (MEAN, SD): | 7.35 (2.0) | 7.45 (1.9) | 7.60 (2.1) | 1.5 | 0.22 | – |
| Goes to bed at the same time | 1.92 (0.9) | 1.91 (0.9) | 2.0(0.9) | 0.8 | 0.46 | – |
| Falls asleep in own bed | 1.27 (0.6) | 1.24 (0.5) | 1.12 (0.4) | 5.6 | 0.004 | 0.002 (Rarely-Usually) + |
| Falls asleep in other’s bed | 1.8 (0.68) | 1.43 (0.67) | 1.42 (0.92) | 0.5 | 0.58 | – |
| Needs parent in room to sleep | 1.27 (0.6) | 1.32 (0.7) | 1.41 (0.7) | 4.3 | 0.01 | 0.01 (Rarely-Usually) + |
| Struggles at bedtime | 1.34 (0.6) | 1.41 (0.6) | 1.54 (0.8) | 9.4 | p < 0.001 | 0.002 (Rarely-Usually) + |
| Afraid of sleeping alone | 2.03 (0.2) | 2.09 (0.3) | 2.08 (0.3) | 0.7 | 0.56 | – |
| SLEEP ONSET DELAY (MEAN, SD): | 1.99 (1.0) | 2.17 (0.9) | 2.12 (0.9) | 3.1 | 0.04 | * |
| Falls asleep in 20 min | 1.99 (1.0) | 2.16 (1.0) | 2.12 (1.0) | 3.1 | 0.04 | * |
| SLEEP DURATION (MEAN, SD): | 5.88 (0.9) | 5.90 (0.90) | 5.92 (0.9) | 0.2 | 0.85 | – |
| Sleeps too Little | 1.17 (0.55) | 1.14 (0.5) | 1.22 (0.63) | 1.2 | 0.29 | – |
| Sleeps the right amount | 2.83 (0.5) | 2.86 (0.5) | 2.78 (0.6) | 1.2 | 0.29 | – |
| Sleeps same amount each day | 1.88 (1.2) | 1.90 (1.1) | 1.92 (1.2) | 0.7 | 0.85 | – |
| SLEEP ANXIETY (MEAN, SD): | 2.78 (1.2) | 2.92 (1.24) | 3.10 (1.4) | 6.5 | 0.002 | p < 0.001 (Rarely-Usually) + |
| Needs parent in room to sleep | 1.27 (0.6) | 1.32 (0.7) | 1.41 (0.7) | 4.4 | 0.01 | 0.01 (Rarely-Usually) + |
| Afraid of sleeping in the dark | 1.34 (0.67) | 1.47 (0.75) | 1.63 (0.83) | 12.3 | p < 0.001 | * |
| Afraid of sleeping alone | 2.03 (0.2) | 2.09 (0.3) | 2.08 (0.3) | 0.7 | 0.56 | – |
| Trouble sleeping away | 1.05 (0.30) | 1.06 (0.31) | 1.12 (0.43) | 4.1 | 0.01 | 0.01 ((Rarely-Usually) + |
| NIGHT WAKINGS (MEAN, SD): | 3.38 (1.1) | 3.55 (1.1) | 4.03 (1.6) | 28.6 | p < 0.001 | ++ p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Moves to other’s bed during night | 1.18 (0.53) | 1.35 (0.56) | 1.51 (0.82) | 28.6 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Awakes once during night | 1.18 (0.53) | 1.25 (0.56) | 1.51 (0.82) | 28.6 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Awakes more than once | 1.01 (0.17) | 1.04 (0.27) | 1.02 (0.19) | 1.0 | 0.35 | – |
| SLEEP DISORDERED BREATHING (MEAN, SD): | 3.46 (1.0) | 3.8 (1.1) | 4.34 (1.4) | 60.8 | p < 0.001 | ++ p < 0.001 (Rarely-Usually) 0.01 (Rarely-Sometimes) p < 0.001 (Sometimes-Usually) |
| Snores loudly | 1.27 (0.6) | 1.44 (0.6) | 1.86 (0.9) | 69.2 | p < 0.001 | + 0.01 (Rarely-Usually) p < 0.001 (Rarely-Sometimes) p < 0.001 (Sometimes-Usually) |
| Stops breathing | 1.19 (0.4) | 1.36 (0.5) | 1.48 (0.5) | 45.7 | 0.02 | + 0.01 (Rarely-Usually) p < 0.001 (Rarely-Sometimes) 0.03 (Sometimes-Usually) |
| Snorts and gasps | 1.0 (0.0) | 1.0 (0.0) | 1.0 (0.0) | – | – | – |
| PARASOMNIAS (MEAN, SD): | 8.24 (1.5) | 9.72 (1.6) | 11.89 (2.9) | 404.3 | p < 0.001 | ++ p < 0.001 (Rarely-Usually) p < 0.001 (Rarely-Sometimes) p < 0.001 (Sometimes-Usually) |
| Wets the bed during night | 1.00 (0.0) | 1.00 (0.0) | 0.1 (0.1) | 2.7 | 0.06 | – |
| Talks during sleep | 1.05 (0.2) | 1.10 (0.3) | 1.27 (0.6) | 40.9 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Restless and moves a lot | 1.87 (0.9) | 2.15 (0.8) | 2.41 (0.8) | 36.8 | p < 0.001 | + 0.02 (Rarely-Usually) 0.02 (Rarely-Sometimes) 0.01 (Sometimes-Usually) |
| Sleep walks | 1.18 (0.5) | 1.26 (0.6) | 1.51 (0.8) | 28.6 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Awakens screaming, sweating | 1. 07 (0.3) | 1.11 (0.3) | 1.42 (0.8) | 67.3 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Alarmed by scary dream | 1.07 (0.3) | 1.10 (0.3) | 1.27 (0.8) | 27.4 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| DAYTIME SLEEPINESS (MEAN, SD): | 11.75 (1.9) | 11.68 (2.0) | 12.0(2.1) | 2.4 | 0.09 | – |
| Wakes by himself/herself | 2.1 (0.9) | 2.0 (0.9) | 2.0 (0.9) | 0.6 | 0.56 | – |
| Wakes up in negative mood | 1.72 (0.9) | 1.60 (0.8) | 1.70 (0.9) | 1.4 | 0.32 | – |
| Others wake child | 1.20 (0.6) | 1.20 (0.5) | 0.56 (0.7) | 2.3 | 0.10 | – |
| Hard time getting out of bed | 1.20 (0.6) | 1.20 (0.5) | 1.28 (0.6) | 1.9 | 0.15 | – |
| Takes long time to be alert | 1.01 (0.1) | 1.02 (0.1) | 1.01 (0.1) | 0.6 | 0.56 | – |
| Seems tired | 1.12 (0.4) | 1.63 (0.4) | 1.19 (0.4) | 2.9 | 0.05 | * |
| Watches tv and/or other screens before going to bed | 2.03 (0.9) | 2.05 (0.8) | 2.2 (0.9) | 2.7 | 0.06 | – |
| Riding in car | 1.41 (0.7) | 1.46 (0.72) | 1.36 (0.71) | 0.9 | 0.42 | – |
| TOTAL SCORE (MEAN, SD): | 43.32 (5.3) | 45.67 (5.9) | 49.4 1 (7.2) | 109.3 | p < 0.001 | p < 0.001 (Rarely-Usually) p < 0.001 (Rarely-Sometimes) p < 0.001 (Sometimes-Usually) |
In the sections below, sleep behaviors were reported separately as far as their prevalence in children with different frequency of SB is concerned.
3.2
Sleep patterns and proxy-reported SB
Sleep patterns were evaluated with 6 items, corresponding to the “sleep patterns” CSHQ domain, which refers to bedtime, morning wakeup time, and daily total sleep duration during weekdays and weekends.
Both in the total sample ( Table 2 ) and in the different socioeconomic layers ( Tables 3–5 ), sleep patterns were similar for children with a different frequency of proxy-reported SB. Independently on the social layer, children sleep a mean of 10.5 (SD 0.3) hours during weekends and less during weekdays [9.2 h (SD 1 h)]. A significant difference between groups with different proxy-reported SB frequency was observed only for the variables “bedtime during weekends” in the medium socioeconomic layer ( Table 4 ) and “bedtime during weekdays” in the high socioeconomic layer ( Table 5 ). Post-hoc comparisons showed a significant difference for “bedtime during weekends” in the medium socioeconomic layer between “rarely”-“usually” proxy-reported SB (Dunńs post-hoc = 0.04), and for “bedtime during weekdays” between “rarely”-“sometimes” proxy-reported SB (Dunńs post-hoc = 0.04).
| Proxy-reported sleep bruxism | F | p value | Dunn’s Post-Hoc Test p -value | |||
|---|---|---|---|---|---|---|
| SLEEP PATTERNS | Rarely | Sometimes | Usually | |||
| Bedtime during weekdays (Mean, SD) | 21:00 (1:50) | 21:30 (0:50) | 20:42 (2:54) | 1.2 | 0.30 | – |
| Morning wakeup time during weekdays (Mean, SD) | 6:25 (1:25) | 6:23 (1:35) | 6:16 (1:17) | 0.2 | 0.80 | – |
| Daily total sleep duration during weekdays (Mean, SD) | 9.2 (1.4) | 9.0 (1.7) | 9.1 (1.2) | 0.5 | 0.58 | – |
| Bedtime during weekends (Mean, SD) | 20:11 (6:07) | 20:46 (8:08) | 19:46 (6:56) | 0.6 | 0.56 | – |
| Morning wakeup time during weekends (Mean, SD) | 8:44 (1:11) | 8:51 (1:20) | 8:46 (1:14) | 0.1 | 0.90 | – |
| Daily total sleep duration during weekends (Mean, SD) | 10.5 (1.2) | 10.4 (0.9) | 10.4 (1.1) | 1.1 | 0.86 | – |
| BEDTIME RESISTANCE (MEAN, SD): | 7.0 (2.9) | 7.1 (1.4) | 7.07(1.7) | 0.1 | 0.93 | – |
| Goes to bed at the same time | 1.8 (0.9) | 1.8 (1.0) | 2.2 (1.0) | 5.0 | 0.007 | 0.05 (Rarely-Usually)+ |
| Falls asleep in own bed | 1.18 (0.5) | 1.07 (0.3) | 1.05 (0.3) | 1.9 | 0.15 | – |
| Falls asleep in other’s bed | 1.29 (0.6) | 1.34(0.56) | 1.32 (0.63) | 0.1 | 0.86 | – |
| Needs parent in room to sleep | 1.24 (0.6) | 1.44 (0.7) | 1.18 (0.6) | 1.5 | 0.22 | – |
| Struggles at bedtime | 1.32 (0.7) | 1.31 (0.62) | 1.30 (0.6) | 0.0 | 0.98 | – |
| Afraid of sleeping alone | 1.18 (0.5) | 1.1 (0.3) | 1.1 (0.3) | – | – | |
| SLEEP ONSET DELAY (MEAN, SD): | 1.83 (1.0) | 2.0 (1.0) | 2.30 (0.9) | 5.0 | 0.008 | 0.006 (Rarely-Usually) + |
| Falls asleep in 20 min | 1.83 (1.0) | 2.0 (1.0) | 2.30 (0.9) | 5.0 | 0.008 | 0.006 (Rarely-Usually) + |
| SLEEP DURATION (MEAN, SD): | 5.88 (1.0) | 6.0 (1.0) | 6.1 (1.0) | 1.1 | 0.34 | – |
| Sleeps too little | 1.21 (0.6) | 1.1 (0.4) | 1.1 (0.4) | 1.2 | 0.30 | – |
| Sleeps the right amount | 2.78 (6.2) | 2.92 (0.4) | 2.89 (0.4) | 1.2 | 0.30 | – |
| Sleeps same amount each day | 1.87 (1.0) | 1.92 (1.0) | 2.08 (0.9) | 1.1 | 0.34 | – |
| SLEEP ANXIETY (MEAN, SD): | 2.7 (1.1) | 2.8 (1.2) | 2.6 (1.2) | 0.3 | 0.73 | – |
| Needs parent in room to sleep | 1.24 (0.6) | 1.44 (0.7) | 1.18 (0.6) | 1.5 | 0.22 | – |
| Afraid of sleeping in the dark | 1.30 (0.6) | 1.3 (0.7) | 1.4 (0.8) | 1.0 | 0.40 | – |
| Afraid of sleeping alone | 1.18 (0.5) | 1.1 (0.3) | 1.1 (0.3) | – | – | |
| Trouble sleeping away | 1.06 (0.3) | 1.07 (0.39) | 1.16 (0.49) | 1.7 | 1.0 | – |
| NIGHT WAKINGS (MEAN, SD): | 3.4 (1.1) | 3.6 (1.2) | 5.0 (2.0) | 24.7 | p < 0.001 | ++ p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Moves to other’s bed during night | 1.18 (0.5) | 1.3 (0.6) | 1.9 (0.1) | 25.7 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Awakes once during night | 1.18 (0.5) | 1.3 (0.6) | 1.9 (0.1) | 25.2 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Awakes more than once | 1.01 (0.0) | 1.0 (0.0) | 1.0 (0.0) | 0.2 | 0.79 | – |
| SLEEP DISORDERED BREATHING (MEAN, SD): | 3.3 (1.0) | 3.8 (1.1) | 5.0 (1.4) | 39.2 | p < 0.001 | ++ 0.02 (Rarely-Sometimes) p < 0.001 (Rarely-Usually) 0.003 (Sometimes-Usually) |
| Snores loudly | 1.10 (0.5) | 1.47 (1.0) | 2.1 (1.0) | 40.7 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Stops breathing | 1.1 (0.3) | 1.42 (0.5) | 1.60 (0.5) | 35.6 | p < 0.001 | + p < 0.001 (Rarely-Sometimes) p < 0.001 (Rarely-Usually) |
| Snorts and gasps | 1.0 (0.0) | 1.0 (0.0) | 1.0 (0.0) | – | – | – |
| PARASOMNIAS (MEAN, SD): | 8.1 (1 .4) | 9.8 (1.8) | 13.3 (4.0) | 112.1 | p < 0.001 | ++ 0.002 (Rarely-Sometimes) p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Wets the bed during night | 1.0 (0.0) | 1.0 (0.0) | 1.0 (0.0) | – | – | – |
| Talks during sleep | 1.03 (0.2) | 1.07 (0.3) | 1.60 (0.1) | 34.8 | 0.04 | + 0.03 (Rarely-Usually) 0.03 (Sometimes-Usually) |
| Restless and moves a lot | 1.84 (1.0) | 2.15 (0.9) | 2.43 (0.1) | 8.1 | p < 0.001 | p < 0.001 (Rarely-Usually) + |
| Sleep walks | 1.20 (0.5) | 1.31 (0.6) | 1.91 (1.0) | 25.2 | 0.03 | + 0.03 (Rarely-Sometimes) 0.01 (Sometimes-Usually) |
| Awakens screaming, sweating | 1.04 (0.25) | 1.15 (0.46) | 1.86 (1.0) | 50.0 | p < 0.001 | + p < 0.001 (Rarely-Usually) p < 0.001 (Sometimes-Usually) |
| Alarmed by scary dream | 1.06 (0.3) | 1.1 (0.32) | 1.6 (1.0) | 24.1 | 0.04 | + 0.03 (Rarely-Usually) 0.04 (Sometimes-Usually) |
| DAYTIME SLEEPINESS (MEAN, SD): | 11.4 (1.6) | 11.4 (2.2) | 11.8 (1.9) | 0.7 | 0.48 | – |
| Wakes by himself/herself | 2.1 (1.0) | 2.2 (1.0) | 2.1 (1.0) | 0.2 | 0.85 | – |
| Wakes up in negative mood | 1.64 (1.0) | 1.34 (0.6) | 1.46 (0.7) | 2.3 | 0.11 | – |
| Others wake child | 1.16 (0.5) | 1.15 (0.5) | 1.2 (0.6) | 0.1 | 0.92 | – |
| Hard time getting out of bed | 1.15 (0.5) | 1.15 (0.5) | 1.2 (0.6) | 0.7 | 0.50 | – |
| Takes long time to be alert | 1.0 (0.0) | 1.0 (0.0) | 1.1 (0.1) | 1.8 | 0.16 | – |
| Seems tired | 1.1 (0.3) | 1.2 (0.5) | 1.1 (0.25) | 2.2 | 0.10 | – |
| Watches TV and/or other screens before going to bed | 1.98 (0.89) | 1.96 (0.91) | 2.41 (0.85) | 5.1 | 0.006 | 0.006 (Rarely-Usually) + |
| Riding in car | 1.3 (0.6) | 1.40 (0.7) | 1.30 (0.6) | 0.2 | 0.81 | – |
| TOTAL SCORE (MEAN, SD): | 42.1 (5.0) | 45.1 (5.0) | 51.4 (9.0) | 50.4 | 0.001 | p < 0.001 (Rarely-Usually) 0.003 (Someitmes-Usually) + |
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