Characterizing Sleep Patterns in Youth with CP and its Impact on Mood
Creators: name: Sanguino, Hangsel D.
Publisher: name: Graduate Studies
Year: 2024
Subjects: subject: cerebral palsy
subject: CP
subject: sleep
subject: mental health
subject: neurodevelopmental disorders
subject: Educational Psychology
subject: Education--Health
subject: Mental Health

description: Background. Cerebral palsy (CP) is a lifelong neurodevelopmental condition characterized by limitations in movement and posture (Oskoui et al., 2013; Rosenbaum et al., 2007). There is a growing consensus that sleep difficulties are common and life-long in individuals with CP (Lélis et al., 2016; Newman et al., 2006; Simard-Tremblay et al., 2011). These difficulties encompass various aspects such as sleep duration, sleep quality, staying asleep, and experiencing more difficulty getting up in the morning (Lélis et al., 2016; Newman et al., 2006); however, much remains unknown about the specific sleep patterns in CP and whether they are distinct from those observed in other conditions such as autism or fetal alcohol spectrum disorder (FASD). Additionally, the link between sleep and mood in CP is not well understood (Gadie et al., 2017). While in neurotypical youth, better sleep has been linked to improvements in social, emotional, and psychological well-being (e.g., mood), the extent to which sleep may impact mood within the context of CP remains uncertain (Hamilton et al., 2007). This manuscript-based thesis aims to address these significant gaps in knowledge by examining the sleep patterns in youth with CP and investigate the subsequent temporal association between sleep and mood. Methods. For this exploratory manuscript-based thesis, we analyzed secondary data from baseline questionnaires and weekly data (accelerometers and daily sleep diaries) collected from a larger study that examined the associations between physiological factors and mental health in youth with CP. In the first study, we investigated the sleep patterns of 45 youth with CP using caregiver and youth reports, the Child/Adolescent Sleep-Wake Scale (CSWS/ASWS), Insomnia Severity Index (ISI), and measurements from actigraphs that youth wore for one week. First, the sleep characteristics were described in relation to available demographic variables (e.g., sex, age, Gross Motor Functioning Classification System level [GMFCS]), using descriptive statistics. Second, to determine the impact of the presence of a mental health diagnosis on sleep patterns and problems, a hierarchical regression analyses was conducted. In the second study, we focused on a subsample of youth (n = 32) who had sufficient daily diaries of sleep and mood. In paper 2, the impact of intraindividual variability (IIV) in sleep patterns on mood (i.e., positive and negative affect) was examined using a series of fixed-effects multi-level modelling. Analyses included age, sex, and GMFCS as covariates as these factors contribute to sleep and mood. Results. In the first study of 45 youth, the average sleep duration was 10 hours per night (SD = 0:59), ranging from 7.5 to 12.85 hours. Youth experienced an average of 14 awakenings (&gt;5 min) per night (SD = 5.3), which is substantially higher than previous literature in youth without CP. Most youth reported poor sleep quality based on sleep quality scores from the combined CSWS and ASWS (M = 3.67, SD = 1.24). Hierarchical linear regression analysis revealed a significant positive association between mental health diagnosis and insomnia severity, even after controlling for participant demographics (age, sex, GMFCS) (p = .010). For the second study, fixed-effect models were used to examine the association between IIV sleep duration and quality and next-day negative and positive affect over a 7-day period. While controlling for covariates, higher within-subjects variability of sleep quality was related to lower next-day negative mood (b = -.03, p &lt; .001) and increased next-day positive mood (b = .05, p = .018). To determine the directionality of this association, mood variability predicting next day sleep was examined; however, only higher within-subject variability of negative mood was related to next-day sleep quality (b = -1.12, p = .011). Conclusions. This thesis is the first of its kind to examine the group and individual characteristics of sleep patterns among youth with CP (Study 1) and the temporal impact of IIV sleep on daily positive and negative affect (Study 2). Sleep is a complex phenomenon, and further investigation is necessary to understand the influence of various other factors, which were not available for this thesis. Nevertheless, sleep timing and sleep consistency may be important characteristics of sleep health. Overall, more research is needed to help inform prevention of mental health issues in this already vulnerable population and to help inform the development of supports for sleep.