Sleep disturbances in Norwegian children with fetal alcohol spectrum disorders (FASD) with and without a diagnosis of attention-deficit hyperactivity disorder or epilepsy

Thorsten Gerstner; Hans Inge Saevareid; Åse Ribe Johnsen; Gro Løhaugen; Jon Skranes

doi:10.1111/acer.15009

Sleep disturbances in Norwegian children with fetal alcohol spectrum disorders (FASD) with and without a diagnosis of attention-deficit hyperactivity disorder or epilepsy

Alcohol Clin Exp Res (Hoboken). 2023 Mar;47(3):589-599. doi: 10.1111/acer.15009. Epub 2023 Feb 21.

Authors

Thorsten Gerstner^{1

2}, Hans Inge Saevareid³, Åse Ribe Johnsen³, Gro Løhaugen¹, Jon Skranes^{1

2}

Affiliations

¹ Regional Competence for Children with Prenatal Alcohol/Drug Exposure, Department of Pediatrics, Sørlandet Hospital, Arendal, Norway.
² Department of clinical and molecular medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
³ Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.

PMID: 36811179
DOI: 10.1111/acer.15009

Abstract

Background: Fetal alcohol spectrum disorder (FASD) describes a combination of developmental, cognitive, and behavioral disabilities in children with prenatal exposure to alcohol. The literature suggests that there are higher rates of sleep disturbances in these children. Few studies have investigated sleep disturbances in relation to common comorbidities of FASD. We examined the prevalence of disturbed sleep and the relationship between parent-reported sleep problems in different FASD subgroups and comorbidities like epilepsy or attention-deficit hyperactivity disorder (ADHD) and impact on clinical functioning.

Methods: In this prospective cross-sectional survey, caregivers of 53 children with FASD completed the Sleep Disturbance Scale for Children (SDSC). Information about comorbidities was collected, and EEG and assessment of IQ, daily-life executive and adaptive functioning were performed. Group comparisons and ANCOVA interaction models were used to test the associations between different sleep disturbances and clinical factors that could interfere with sleep.

Results: An abnormal sleep score on the SDSC was very common, affecting 79% of children (n = 42) with equal prevalence in all FASD subgroups. Difficulty falling asleep was the most common sleep problem, followed by difficulty staying asleep and waking early. The incidence of epilepsy was 9.4%, with an abnormal EEG seen in 24.5%, and a diagnosis of ADHD in 47.2% of children. The distribution of these conditions was equal in all FASD subgroups. Children with signs of sleep disturbance had poorer working memory, executive function, and adaptive functioning. Children with ADHD had a greater prevalence of sleep disturbance than those without ADHD (OR 1.36; 95% CI 1.03 to 1.79).

Conclusion: Problems with sleep are very common in FASD children and seem independent of FASD subgroup and the presence of epilepsy or a pathological EEG finding, while those with ADHD had more sleep problems. The study underscores the importance of screening for sleep disturbances in all children with FASD as these problems may be treatable.

Keywords: ADHD; BRIEF; IQ; epilepsy; fetal alcohol Spectrum disorder; sleep.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Attention Deficit Disorder with Hyperactivity* / psychology
Child
Cross-Sectional Studies
Epilepsy* / complications
Epilepsy* / diagnosis
Epilepsy* / epidemiology
Female
Fetal Alcohol Spectrum Disorders* / diagnosis
Fetal Alcohol Spectrum Disorders* / epidemiology
Humans
Memory Disorders
Pregnancy
Prospective Studies
Sleep
Sleep Wake Disorders* / diagnosis
Sleep Wake Disorders* / epidemiology
Sleep Wake Disorders* / etiology