Avalia??o das caracter?sticas do sono e preval?ncia de dist?rbios em crian?as e adolescentes brasileiros : estudo de base populacional

• Ano de defesa: 2017
• Autor(a) principal: Almeida, Geciely Munaretto Foga?a de
• Orientador(a): Nunes, Magda Lahorgue
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontif?cia Universidade Cat?lica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a
• Departamento: Escola de Medicina
• País: Brasil
• Palavras-chave em Português: Sono; Dist?rbios do Sono; Crian?a; Adolescente
• Palavras-chave em Inglês: Sleep; Sleep Disorders; Child; Adolescent
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/8805

Introduction: Brazil is a continental country with more than 207 million habitants, with approximately 30 million children and 35 million adolescents. Brazilian socioeconomic inequality and multiculturalism in the different regions of the country interfere in several aspects of human development and in the health of the population in general. Sleep disorders (DS) are common in childhood and adolescence. Prevalence rates in different places in the world vary from 20 to 40%, but in Brazil, this number is still little known. SDs are related to behavioral, environmental and social aspects, and their early recognition for appropriate clinical management is important. Objectives: to describe the characteristics of sleep in Brazilian children and adolescents, to verify the prevalence of DS and the association with perinatal aspects, Brazilian regions and socioeconomic levels. Method: An exploratory, transversal and contemporary study involving Brazilian children and adolescents, aged 0 to 19 years, investigated by age groups, regions of the country and socioeconomic levels. The study sample consisted of 1,180 individuals, and the age groups stratified according to the assessment instruments (0-3 years, 4-12 years and 13-19 years), the 5 regions of Brazil (North, Northeast, Central (Low, medium low, medium high and high), according to data from the Brazilian Institute of Geography and Statistics (IBGE). All subjects within the stipulated age range were included in the study, with parental and / or guardian consent and child / adolescent consent. The data were collected online, using specific sleep evaluation instruments, in the versions validated for use in Brazil: 0-3 years (Brief Infant Sleep Questionnaire - BISQ); 4-12 years ("Sleep Disturbance Scale for Children - SDSC"); 13-19 years ("Epworth Sleepiness Scale - ESS" and "Pittsburgh Sleep Quality Index - PSQI"). The data were analyzed in SPSS 11.0 for Windows Software. Categorical variables were presented in frequency and percentage. Continuous variables were presented as mean, standard deviation, minimum value and maximum value. Bivariate analyzes were conducted by simple logistic regression and used in the multiple logistic regression model using the Wald statistic. The variables with P?0,150 (methodical backward selection) were one by one, eliminated from the model, compared by the likelihood ratio test. The possible interactions between the variables and those with significance higher than 0.05 were studied as possible confounding factors, considering them as such if the coefficient change percentage was greater than 15%. Statistical significance was considered for P?0.05. Sleep disturbances were classified according to the original criteria of the scales used. Results: 1.250 questionnaires were filled out, 70 were excluded with incomplete data, totaling a sample of 1.180 individuals, of which 350 were from 0 to 3 years (90 to 1 year of age), 450 from 4 to 12 years and 380 from 13 to 19 years. The co-bedtime rate was 38.9% in children under 1 year and 16.9% in children aged 1 to 3 years. Regarding the sleeping position, 68.8% of children under 1 year old sleep belly down or sideways. Inadequate pre-bedtime habits were observed in children up to 3 years of age, such as watching television (10.9%). The mean nocturnal sleep time (9h30min) was below the appropriate parameters. Although 78% of those responsible did not consider the child's sleep a problem, 44.3% of them ask about sleep to the pediatrician. However, only 15% of pediatricians always question the child's sleep during routine visits. In children aged 4 to 12 years, 64.8% presented inadequate habits before bed, especially those who watch television (25.6%). The co-bedtime rate was 47.1% (eventual), 13.5% (frequent) and 10.9% (always). The mean total nocturnal sleep time (9h15min) may be considered below the recommended parameters. In this age group, 42.2% of those responsible question the pediatrician eventually about the child's sleep and only 10% of the pediatricians always ask about the child's sleep during routine visits. In adolescents aged 13 to 19, when they assessed sleep habits before bedtime, it was observed that 69.7% watched television, 61.1% used computers, 50.5% used cell phones and 49.7% played video games. The average nighttime sleep time of adolescents (8 hours) is at the lower limit recommended. Our study found 25.5% (N = 301) as mean DS prevalence throughout the study sample, being 20% (N = 70) between 0 and 3 years old (8% with "more than 3 nocturnal awakenings", 11.4% with an "agreed-upon night period greater than 1 hour" and 6.6% with "total sleep time less than 9 hours"); 23% (N = 104) between 4 and 12 years ("Sleep onset and sleep disturbance": 22.7%; "Sleep-wake transition disorder": 18.4%, "Respiratory sleep disorder": 17 , "Sleep Disorder": 9.1%) and 33.4% (N = 127) between 13 and 24 hours, 19 years, with 52.9% (N = 201) presenting with mild diurnal drowsiness and 27.9% excessive daytime drowsiness. In addition, important sleep components were considered poor in quality (21.6%), latency (34.7%), duration (10.8%) and efficiency (6.8%), with 18.4% % reported difficulty sleeping and 29.7% reported daytime dysfunction. In the age range of 0-3 years, there was a significant increase in the risk of DS associated with the current health problems (OR: 3.72 [1.43-9.66], P <0.01) and those considered responsible the child's sleep problem (OR: 9.83 [4.74-20.41], P <0.01). In children aged 4 to 12 years, there was a significant increase in the risk of SD associated with the variables hospitalization after birth (OR: 1.86 [1.03-3.37], P <0.05), sleep in parents' bed (OR: 2.46 [1.27-4.79], P <0.01) and in those who the caregiver asked the pediatrician about the child's sleep during routine visits (OR: 2.28 [1.26 - 4,12], P <0.01). Among adolescents aged 13 to 19 years, there was a significant increase in the risk of SD associated with medication use variables (OR: 2.94 [1.48 - 5.84], P <0.01), a habit of playing videogame before (OR: 1.28 [1.14 - 1.54], P <0.01) and to use the cell phone (OR: 1.49 [0.88 - 2.53], P <0.05). In relation to the regional distribution of DS prevalence, higher rates were observed in children from 0 to 3 years in the southeast region (26.1%), from 4 to 12 years in the northeast region (36.2%) and from 13% 19 years in the central-west region (44.7%), however, there was no statistically significant difference between the regions in any of the age groups. Regarding the socioeconomic level (NSE), there was a significant increase in the risk of DS in children from 0 to 3 years old with low SES (OR: 3.07 [0.80-11.78] P <0.05), from (OR: 5.36 [1.84-15-62] P <0.01) and from 13 to 19 years with high SES (OR: 3.81 [1.64- 8.85] P <0.01). Conclusion: according to this study, Brazilian children and adolescents present inadequate sleeping habits in all age groups surveyed, with mean values of total nocturnal sleep time below the recommended level. Parents and pediatricians eventually worry about children's sleep in routine consultations. The prevalence of DS in Brazilian children and adolescents can be considered similar to international rates and is related to perinatal aspects and current health. DS are more prevalent in some regions of the country and with higher risk in certain socioeconomic levels. These aspects point to the need for greater attention in routine consultations, with diagnosis and early treatment, minimizing the risks to the health of the pediatric population.