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Published on: April 7, 2020
Sleep and daytime functioning in children with tourette syndrome: A two-week case-control study with actigraphy and
Lisa Keenan1, Jessica Bramham1, Maria Dinca1
1School of Psychology, University College Dublin, Ireland.
Insights
Children with Tourette syndrome (TS) experience significant sleep problems, including longer sleep onset and lower efficiency. Actigraphy monitoring confirms these sleep disturbances are common and impact daily functioning in pediatric TS.
Area of Science:
- Neuroscience
- Pediatric Sleep Medicine
- Child Neurology
Background:
- Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics.
- Sleep disturbances are increasingly recognized as prevalent in children with TS.
- Traditional sleep assessment via polysomnography (PSG) has limitations for capturing daily sleep variability.
Purpose of the Study:
- To investigate sleep-wake patterns in children with TS using a naturalistic, longitudinal design.
- To examine the relationship between sleep disturbances, tic severity, and daytime functioning in pediatric TS.
- To assess the feasibility of using actigraphy for sleep monitoring in children with TS.
Main Methods:
- A cohort of 34 children (8-12 years; 12 with TS, 22 controls) participated.
- Wrist actigraphy was used to track sleep-wake cycles over two weeks.
- Standardized scales and cognitive assessments measured sleep quality, tic severity, and daytime functioning.
Main Results:
- Children with TS showed increased time in bed, sleep onset latency, and reduced sleep efficiency compared to controls.
- Subjective sleep quality was lower in the TS group, with 83.33% meeting clinical criteria for a sleep disorder.
- Despite comparable cognitive performance, parent-reports indicated greater emotional, behavioral, and executive difficulties in children with TS.
- Tic severity at bedtime did not correlate with increased sleep onset latency.
Conclusions:
- Sleep disturbances are a significant clinical issue in children with Tourette syndrome, affecting daily functioning.
- Actigraphy is a feasible method for assessing sleep in pediatric TS, supporting its broader application.
- Further large-scale research is needed to confirm these findings and inform clinical management strategies.
Abstract:
There is increasing recognition of the high prevalence of sleep issues in children with Tourette syndrome (TS), a condition characterised by motor and vocal tics. Overnight polysomnography (PSG) has been the primary mode of sleep assessment in the TS literature, despite the extensive use of actigraphy in other neurodevelopmental populations. As a result, there are existing research gaps surrounding day-to-day variability of sleep in TS and links to daytime functioning. This study adopts a naturalistic, intensive longitudinal design to examine sleep in children with TS while considering potential links to tic severity and daytime functioning. Participants were 34 children aged between 8 and 12 years (12 with TS, 22 neurotypical controls). Wrist actigraphs tracked sleep-wake cycles across two weeks and a battery of scales and cognitive assessments measured sleep disturbances and daytime functioning. Mixed models using N = 476 nights of actigraphy data found that relative to controls, children with TS had significantly increased time in bed, increased sleep onset latency, reduced sleep efficiency, lower subjective sleep quality, but comparable actual sleep time. Higher self-report tic severity at bedtime did not predict increased sleep onset latency. In the sleep disturbance scale, 83.33 % of children with TS met the clinical cut-off for a sleep disorder. Parent-report emotional, behavioural, and executive difficulties were greater in the TS group relative to controls, but performance on cognitive tasks was comparable between groups. Together, findings highlight sleep disturbances as an important clinical factor to consider in the management of TS, though further research is required to substantiate findings in larger-scale studies. This study demonstrates the feasibility of assessing sleep via actigraphy in children with TS, supporting more widespread use in the future.
