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Research article

Sleep problems and functional disability in children with functional gastrointestinal disorders: An examination of the potential mediating effects of physical and emotional symptoms

Jennifer Verrill Schurman13*, Craig A Friesen1, Hongying Dai1, Caroline Elder Danda2, Paul E Hyman2 and Jose T Cocjin2

Author Affiliations

1 The Children’s Mercy Hospital, Kansas City, MO, USA

2 The University of Kansas Medical Center, Kansas City, KS, USA

3 Division of Developmental & Behavioral Sciences, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

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BMC Gastroenterology 2012, 12:142  doi:10.1186/1471-230X-12-142

Published: 15 October 2012

Abstract

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.

Keywords:
Sleep; Functional disability; Functional gastrointestinal disorders; Pediatrics
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