Sleep problems and functional disability in children with functional gastrointestinal disorders: an examination of the potential mediating effects of physical and emotional symptoms.
BACKGROUND
Sleep disturbances are increasingly recognized as a common problem for children and adolescents with chronic pain conditions, but little is known about the prevalence, type, and impact of sleep problems in pediatric functional gastrointestinal disorders (FGIDs). The objectives of the current study were two-fold: 1) to describe the pattern of sleep disturbances reported in a large sample of children and adolescents with FGIDs; and, 2) to explore the impact of sleep by examining the inter-relationships between sleep disturbance, physical symptoms, emotional problems, and functional disability in this population.


METHODS
Over a 3-year period, 283 children aged 8-17 years who were diagnosed with an FGID and a primary caretaker independently completed questionnaires regarding sleep, emotional functioning, physical symptoms, and functional disability during an initial evaluation for chronic abdominal pain at a pediatric tertiary care center. A verbal review of systems also was collected at that time. Descriptive statistics were used to characterize the pattern of sleep disturbances reported, while structural equation modeling (SEM) was employed to test theorized meditational relationships between sleep and functional disability through physical and emotional symptoms.


RESULTS
Clinically significant elevations in sleep problems were found in 45% of the sample, with difficulties related to sleep onset and maintenance being most common. No difference was seen by specific FGID or by sex, although adolescents were more likely to have sleep onset issues than younger children. Sleep problems were positively associated with functional disability and physical symptoms fully mediated this relationship. Emotional symptoms, while associated with sleep problems, evidenced no direct link to functional disability.


CONCLUSIONS
Sleep problems are common in pediatric FGIDs and are associated with functional disability through their impact on physical symptoms. Treatments targeting sleep are likely to be beneficial in improving physical symptoms and, ultimately, daily function in pediatric FGIDs.
The Children's Mercy Hospital, Kansas City, MO, USA. jschurman@cmh.edu
Jennifer Verrill
JV
Schurman
Craig A
CA
Friesen
Hongying
H
Dai
Caroline Elder
CE
Danda
Paul E
PE
Hyman
Jose T
JT
Cocjin
D015746:Abdominal Pain / Q000150:complications*; D000293:Adolescent; D000342:Affective Symptoms / Q000150:complications*; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D004415:Dyspepsia / Q000150:complications*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008297:Male; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012574:Schools; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications; D012893:Sleep Wake Disorders / Q000150:complications*; D058992:Social Participation; D011795:Surveys and Questionnaires