title: The family role in children׳s sleep disturbances: Results from a cross-sectional study in a Portuguese Urban pediatric population.
abstract: BACKGROUND
  Sleep Disorders (SlD) are frequently undervalued complaints in childhood. Several factors influence sleep, particularly socio-cultural environment and medical conditions such as breathing disorders. Poor sleep hygiene has physical, educational and social consequences. In Portugal, there are few published studies about children׳s sleep habits and rarely based on validated questionnaires.
  
  
  OBJECTIVE
  To study the prevalence of SlD and associated factors, in an outpatient pediatric population of a Primary Health Care Center (PHCC).
  
  
  METHODS
  Cross-sectional study of children admitted to a PHCC on a suburban area of Lisbon. Children Sleep Habits Questionnaire, validated for the Portuguese population (CSHQ-PT) for the screening of SlD (cut-off=44), was applied to parents, as well as a demographic inquiry. Body mass index z-score was evaluated. Children scoring 44 or above were sent to Pediatric Sleep Disorders consultation (PSDC). Parametric and non-parametric tests were used whenever appropriate.
  
  
  RESULTS
  From 128 children, 57.8% were male; the median age was 6.0 years (P 25=5.0; P 75=8.0). The median of cohabitants per family was 4.0 (P 25=3.0; P 75=5.0); 21.1% lived in a single-parent family. From CSHQ-PT, 59.4% (76) scored above the cut-off. Data showed that children from a single-parent family have more SlD (p=0.048), particularly parasomnia (p=0.019). Children with sleep disordered breathing (SDB) suffer more daytime sleepiness (p=0.034). From 63 children sent to PSDC, 33 attended. Regarding these children, a difference was found between BMI z-scores of those with and without SDB (p=0.06).
  
  
  CONCLUSIONS
  Family structure plays a non-negligible role in children's sleep habits. Daily performance of children with SDB may become compromised.
authors.affiliation: Hospital Professor Doutor Fernando Fonseca, Pediatric Department, IC 19, 2720-276 Amadora, Lisbon, Portugal.
authors.forename: Andreia Luís
authors.initials: AL
authors.lastname: Martins
authors.affiliation: Monte Abraão Primary Health Care Center, Av. da Liberdade, 36 and 37, 2745-300 Queluz, Sintra, Portugal.
authors.forename: Petra
authors.initials: P
authors.lastname: Chaves
authors.affiliation: CEAUL, NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
authors.forename: Ana Luísa
authors.initials: AL
authors.lastname: Papoila
authors.affiliation: Hospital Professor Doutor Fernando Fonseca, Pediatric Department, IC 19, 2720-276 Amadora, Lisbon, Portugal.
authors.forename: Helena Cristina
authors.initials: HC
authors.lastname: Loureiro
keywords: BMI, body mass index; BTR, bedtime resistance; CSHQ-PT, Portuguese Children Sleep Habits Questionnaire; Children Sleep Habits Questionnaire; DTS, daytime sleepiness; Family; NW, night awakenings; OSA, obstructive sleep apnea; PHCC, Primary Health Care Center; PS, parasomnia; PSG, polysomnography; Pediatric Sleep Disorder; SA, sleep anxiety; SDB, sleep disordered breathing; SDur, sleep duration; SOD, sleep onset delay; SlD, Sleep Disorders