Factors Associated with Sleep Disturbance among Pre-School Children with Sleep-Related Breathing Disorders in Bangkok, Thailand

Abstract

Sleep is one of the essential activities for living. When asleep, various organs receive rest and thereby repair parts of the body. Sleep is very significant for children because a deep and continuous sleep affects the release of growth hormone, particularly in pre-school children, with the ultimate development of the physical and nervous system. Sleep-related breathing disorders (SRBD) are a common problem in pre-school children, which cause sleep disturbance that directly affects sleep quality. Therefore, when experiencing airway obstruction for any reason, deep sleep is interrupted, thereby reducing sleep quality. This can cause problems with a child’s growth, intellectual development, behavior, and physical and mental health. 

This research aimed to investigate the association between factors associated with sleep disturbance among pre-school children with SRBD in Bangkok, including respiratory tract infections, allergic rhinitis, asthma, tonsillar hypertrophy, obesity, and history of cigarette smoke exposure. This study used a cross-sectional analytical study design. The sample consisted of 212 pre-school children with SRBD at fifty kindergartens in Bangkok, recruited by multi-stage sampling. The research instruments included a demographic data questionnaire, the SRBD scale, the Sleep Disturbance Scale for Children (SDSC), and a physical examination form to record weight, height, and the size of the tonsils. The researcher screened 2,027 pre-school children using the SRBD scale and found that 534 (26.3%) pre-school children in Bangkok suffered from SRBD. 212 of the affected pre-school children were then recruited for this study. Data were analyzed using descriptive statistics and multiple binary logistic regression. Similar numbers of females and males were included, and the mean ±SD age was 5.21 ± 0.73 years. The percentages of pre-school children who had infrequent respiratory tract infections (1-2 times per 3 months) and had frequent respiratory tract infections (3 times and above per 3 months) were 47.2% and 16.5%, respectively. 16% had a history of allergic rhinitis and 5.2% had a history of asthma. 64.6% of the pre-school children were diagnosed with tonsillar hypertrophy (grade 2-4), including 8.5% children in grade 4, 30.2% of children in grade 3, and 25.9% of children in grade 2. The percentages of pre-school children who were obese and overweight were 10.4% and 7.1%, respectively. Over 55.2% of the children had a history of cigarette smoke exposure in the family, while 69.2% of smokers were fathers who smoked 11-20 cigarettes per day. Overall, 77.8% of pre-school children experienced sleep disturbance. After adjusting for other factors, frequent respiratory tract infections (AOR 4.6; 95% CI 1.26, 16.27, p = 0.02) and profoundly enlarged tonsils (grade 3-4) (AOR 2.8; 95% CI 1.07, 7.47, p = 0.03) were strongly associated with sleep disturbance among pre-school children with SRBD, while other factors were not associated with sleep disturbance. In this regard, frequent respiratory tract infections and profoundly enlarged tonsils were 4.6 and 2.8 times more likely to cause sleep disturbance, respectively. Therefore, educational programs on appropriate care and prevention of frequent respiratory tract infections and tonsillar hypertrophy in pre-school children with SRBD must be considered in these children, to achieve good quality sleep.