Impact of confrontation to patient suffering and death on wellbeing and burnout in professionals: a cross-sectional study.

BACKGROUND: Palliative care and oncology generate a risk of burnout and psychological distress in professionals. The purpose of this study is to identify both psychopathological and positive factors related to mental health at work. It aims (i) to explore the extent to which these professionals are confronted with suffering, illness, and death; and to explore the prevalence of psychological distress and/or burnout, (ii) to identify potential determinants of burnout and psychological wellbeing at work, (iii) to develop an integrative model of mental health; and to identify frequency and impact of confrontations with death, and (iv) to identify profiles of professionals are at risk of developing a mental health disorder or, conversely, characterized by wellbeing. METHODS: A cross-sectional questionnaire study was conducted in palliative care and oncology evaluating confrontations with death, coping, burnout, psychological distress, personality, self-esteem, well-being and meaning at work. Regressions, clustering, and structural equation modeling analyses were performed. RESULTS: 109 professionals participated (58% from oncology and 42% from palliative care), of which 79% were female, and 65% were between 30 and 49 years old. Aim i: 30% witnessed an intolerable suffering at least 9 times a month, 45% reported moderate to high levels of burnout, 39% suffered from anxiety and 11% from depression. Aim ii: the determinants of burnout were the personality traits conscientiousness and neuroticism, low meaning of work, and low wellbeing (R2 = 0.44). The determinants of wellbeing were work meaning, depersonalization, self-esteem, fulfillment and low emotional exhaustion (R2 = 0.71). Aim iii: the integrative model included both well-being (self-esteem, conscientiousness) and psychopathology (neuroticism, anxiety) parameters, and strongly satisfied the standard SEM goodness of fit indices (e.g., CFI, IFI, and TLI ≥ 0.95). Aim iv: three profiles were identified: (a) a "distressed profile" with a majority of professionals at the patient's bedside, (b) a "disengaged profile" with professionals working as second-line consultants, (c) a "wellbeing profile" contains profiles of caregivers insensitive to psychological distress and with a high level of positive Impact of confrontation on different areas of their lives. CONCLUSIONS: An integrative approach is essential to understand the full range of mental health issues for professionals. Meaning of work is a key factor in professional interventions that should primarily affect front-line professionals with limited experience.

Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review.

This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.

Validation and Psychometric Properties of the German Operational and Organizational Police Stress Questionnaires.

CONTEXT: Working in the police force is an operationally and organizationally stressful job. Suitable psychometric tools are needed to detect and study the psychosocial risks of these professionals. The original version contains 40 items, which may be too long for clinical use or as a research control measure. The main aim of this study is to validate the Police Stress Questionnaire (PSQ) in German. The secondary objective is to validate a shorter version. METHOD: After translation and counter translation of the PSQ-G by a committee of experts, 10 participants pre-tested the comprehension of an intermediate version, allowing the development of a final version that was submitted to a psychometric validation plan with 2314 German-speaking officers. Structure, reliability, and convergent, divergent, and discriminant validities were tested for each sample. RESULTS: The German version of the PSQ performed well psychometrically. We have created a short version of 14 items with good psychometric properties, 7 items for each subscale: operational stressors and organizational stressors. CONCLUSION: This study validated a German version of the PSQ and provides a reliable measure of stress processes in the police force. A short version is now available.

Neurocognitive evaluation of children with down syndrome and obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) treatment has been shown to improve cardiac behavioral and cognitive functions in typically developing children. Early OSAS diagnosis in children with Down syndrome (DS) would be important to prevent its complications, especially cognitive ones, but remains overlooked. The main objective of our study was to assess the cognitive function of children with DS, with and without OSAS. The second objective was to determine the impact of the therapeutic intervention on the cognitive function of children with OSAS. This study included 41 children with DS who underwent polysomnography for OSAS diagnosis and a cognitive evaluation. They were aged between 3.4 and 17.3 years and 24 (59%) were boys. Their median OAHI was 2.6 (0-31)/h of sleep, 30 (73%) were diagnosed with OSAS (15 had mild OSAS, and 15 had moderate/severe OSAS). Some scores of the Raven's colored progressive matrices were negatively correlated with the respiratory arousal index, OAHI tended to be positively correlated with Reiss behavioral problems. 24 (59%) patients received a treatment. Even if we were unable to demonstrate this formally due that only 16 children (39%) accepted a follow-up visit, some displayed improvement in their neuropsychological scores, especially those with moderate/severe OSAS after treatment. Children with DS have low intellectual abilities and more risk of developing OSAS compared to the general population, which may lead to further neurocognitive impairment. Early screening and management are important in this population to prevent any further neurocognitive delay in their development.

Profiling Police Forces against Stress: Risk and Protective Factors for Post-Traumatic Stress Disorder and Burnout in Police Officers.

Police officers are frequently exposed to highly stressful situations at work and have an increased risk to develop symptoms of post-traumatic stress disorder (PTSD) and burnout (BO). It is currently not well understood which officers are most at risk to develop these disorders. The aim of this study was to determine which coping strategies and personality traits could act as protective or risk factors in relation to PTSD and BO. The second aim, in the interest of designating preventive and therapeutical measures, was to determine whether certain profiles of police officers could be identified as high risk for developing mental disorders. Herein, 1073 French-speaking police officers in Switzerland reported in an online survey about their PTSD and BO symptoms, anxiety, depression, suicide ideation, coping strategies, occupational stress, and personality factors. The cluster analysis highlighted three principal profiles of police officers: those who are not at risk of developing pathologies because they are not exposed or insensitive to these stressors, and those who are, among which personality and coping strategies oriented the risk of developing PTSD or BO. These same protective and risk factors were also corroborated in the linear and logistic regression analyses. These results may suggest that a crucial opportunity for mitigating mental health issues in the force could consist of screening recruits for risk-related personality traits and orienting them towards psychological training programs for the development of functional coping strategies.

Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study.

OBJECTIVE: To assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. METHODS: The Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. RESULTS: Compared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). CONCLUSIONS: This study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.

Pulse transit time as a diagnostic test for OSA in children with Down syndrome.

STUDY OBJECTIVES: Children with Down syndrome (DS) are at risk of obstructive sleep apnea (OSA), but the access to sleep lab polysomnography (PSG) is limited. Simplified techniques are needed, such as polygraphy coupled with pulse transit time (PTT-PG) that detects respiratory events and the total autonomic arousals index (PTTAI). Our objective was to assess the ability of PTT-PG compared with PSG to diagnose OSA in children with DS. METHODS: In this prospective multicenter study, patients with DS underwent a full-night PSG coupled with PTT. Sleep questionnaires (Sleep Disturbance Scale for Children and Pediatric Sleep Questionnaire) were filled by parents. PSG and PTT-PG results were compared to test their sensibility and specificity to diagnose OSA. RESULTS: A total of 53 patients with DS were included; their median age was 9.3 years. An obstructive apnea-hypopnea index (OAHI) by PSG > 1 event/h was found in 36 (68%) patients, OAHI was > 1 and < 5 events/h in 18 patients (34%), ≥ 5 and < 10 events/h in 11 patients (21%), and ≥ 10 events/h in 7 patients (13%). OAHI was larger on PSG than on PTT-PG (P = .0005). For OSA diagnosis, the sensitivity was excellent for OAHI by PTT-PG if the added total PTTAI was > 1 event/h (1.0) and the specificity was high for the Pediatric Sleep Questionnaire (0.88) and OAHI > 1 event/h on PTT-PG (1.0). CONCLUSIONS: More than two-thirds of children with DS referred for screening by a genetics specialist had OSA diagnosed by PSG. With its excellent sensitivity and specificity, PTT-PG could be a good and simplified alternative to PSG to diagnose OSA in children with DS. CITATION: Ioan I, Weick D, Sevin F, et al. Pulse transit time as a diagnostic test for OSA in children with Down syndrome. J Clin Sleep Med. 2022;18(1):119-128.

The Interaction between Lockdown-Specific Conditions and Family-Specific Variables Explains the Presence of Child Insomnia during COVID-19: A Key Response to the Current Debate.

It is still debated whether lockdown conditions in response to the coronavirus disease 2019 (COVID-19) health crisis seriously affected children's sleep. For young children, some studies identified more insomnia, while others only transient disturbances, or even no effect. Based on the premise of mother-child synchrony, a well-known dynamic established in child development research, we hypothesized that principally, the children whose mothers perceived the lockdown as stressful and/or responded maladaptively, suffered sleep disturbances. The main objective of this study was to identify the family profiles, variables, and lockdown responses most linked to insomnia in young children. The sample consisted of 165 mothers, French vs. Swiss origin (accounting for different lockdown severities), of children 6 months to 5 years old. Validated sleep, stress, and behavior scales were used. Multiple regression, age-matched clustering, and structural equation modeling analyses provided evidence that insomnia in young children is indeed strongly linked to the mother's reaction to the pandemic and lockdown. Specifically, reactions such as COVID-19 fear/anxiety and obsessive COVID-19 information seeking coincide with heightened vigilance, cascading into reduced child social contact, outings, and increased screen viewing, ultimately culminating in child insomnia and behavioral problems. Mother education level and child day care quality (e.g., home-schooling) were also identified as strong insomnia predictors.

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders.

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.

Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance.

OBJECTIVES: The aim of this study was twofold. First, to confirm the deleterious aspect of evening screen exposure in school-aged children, in particular the effect of screens in the bedroom. Second, to explore the three-way association between degree of screen exposure, sleep disturbance, and ADHD symptoms. Solid evidence exists on the link between sleep disturbance and ADHD symptoms, and screen exposure and sleep disturbance. However, no studies have formally assessed the impact of screen exposure on ADHD symptoms in children, as a function of sleep disturbance. METHODS: Parents of 374 French children (201 girls, 173 boys, mean age of 10.8 ± 2.8 years old) completed the Sleep Disturbance Scale for Children (SDSC), the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale, and a questionnaire about their children's screen habits (total hours in the morning, afternoon, and evening per day). Correlational analyses between evening screen exposure, sleep quality and behavioral problems were conducted. Then, formal mediation analyses were run in order to quantify the relationship between variables. RESULTS: School-aged children with screens in their bedrooms demonstrated more sleep and behavioral problems. Evening TV exposure was associated with higher SDSC and ADHD scores. Furthermore, the Structural Equation Modelling approach confirmed that evening screen exposure is directly associated with more disrupted sleep, which in turn is directly associated with behavioral problems. CONCLUSIONS: These findings encourage families to avoid putting screens in their children's bedrooms, and limit evening screen exposure. They furthermore demonstrate the importance of taking into account screen exposure time (morning, afternoon, evening) and location (bedroom or elsewhere) in future studies.

Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial.

Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values-based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third-wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty-two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3-month waiting list before receiving the four "acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia" treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post-treatment and 6-month follow-up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post-treatment endpoint in acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6-month follow-up. Wait-list participants increased their use of hypnotics, whereas acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web-based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.

Methodological Recommendations to Control for Factors Influencing Dream and Nightmare Recall in Clinical and Experimental Studies of Dreaming.

In order to ensure robust relationships between the dependent and independent variables in clinical dream/nightmare studies, the major factors which influence the frequency of reported dreams must be controlled. This article sets out methodological recommendations to both researchers seeking to ensure the equivalence of experimental groups of participants in group-matching designs, and to clinicians who wish to check that any change in frequency of reported nightmares over the course of a psychological or a pharmacological intervention is not caused by factors other than the experimental treatment itself. The main factors influencing the frequency of dream recall are presented: demographic variables, psychological characteristics, pathological dimensions, and substance consumption. A series of questionnaires is proposed for easily measuring these control variables.

Sleep during development: Sex and gender differences.

Sleep occupies a substantial proportion of life. Sleep modifications parallel brain development during childhood. Sex and gender differences have been reported in brain development and many clinical and psychosocial conditions. This narrative review provides insight into the differences between girls and boys in terms of brain maturation and plasticity related to sleep and sleep characteristics (physiology, sleep duration) during development.

French validation of the sleep disturbance scale for children (SDSC) in young children (aged 6 months to 4 years).

The sleep disturbance scale for children (SDSC) has been translated and adapted into several languages and its psychometric properties are good. Notably, a French version has been validated for 4- to 16-year olds. The objective of the current study was therefore to adapt and validate the SDSC for French young children (aged 6 months to 4 years). METHOD: 421 French-speaking mothers of children aged between 6 months and 4 years completed the SDSC and the Brief Infant Sleep Questionnaire (BISQ) which is specifically for young children. Of these, 105 children were diagnosed with sleep disorders (clinical group) during a sleep consultation, and 316 completed the SDSC and BISQ in a network of nurseries (control group). Several factor analyses were conducted to identify the most consistent factor structure for this sample. RESULTS: Three items from the previous version were deleted due to lack of clinical relevance for this age group. The best factor analysis revealed six factors, comparable to the Italian version of the SDSC for children: Disorders of Initiating Sleep, Disorders of Maintaining Sleep, Sleep Hyperhidrosis, Sleep Breathing Disorders, Parasomnias, and Non-Restorative Sleep and Excessive Somnolence. This psychometric structure is reliable and aligned with expert diagnoses. The convergent validity, and divergent and internal reliability were acceptable. CONCLUSION: This study validates a 22-item SDSC for French young children. Coupled with some questions from the BISQ, the SDSC could therefore be used to facilitate the detection of sleep disturbances in children aged between 6 months and 4 years old.

Mind-wandering, or the allocation of attentional resources, is sleep-driven across childhood.

Mind-wandering or the spontaneous, uncontrolled changes in the allocation of attention resources (lapses) may cause variability in performance. In childhood, the relationship between the activation state of the brain, such as in attentional performance, and sleep has not been explored in detail. We investigated the role of sleep in attentional performance, and explored the most important parameters of their relationship. We objectively measured momentary lapses of attention of 522 children and correlated them with sleep schedules. In the subgroup of young children (age 7.1 ± 0.6 years; 60.8% girls), increasing age, long sleep duration and assessment closer to the previous night's sleep period was associated with impaired performance speed and consistency. From pre-adolescence (age 9.4 ± 0.8 years; 50.5% girls) onwards somno-typologies may develop. As a result, in adolescence (age 13.4 ± 1.2 years; 51.3% girls) not only sleep duration but also sleep midpoint and sleep regularity influence the individual speed and stability of attention. Across development, regularity of sleep, individual sleep midpoint and bedtime become increasingly important for optimal performance throughout the day. Attentional performance and sleep shared almost half of their variance, and performance was sleep-driven across childhood. Future studies should focus on intra- and inter-individual differences in sleep-wake behavior to improve performance or decrease mind-wandering in youth by targeting sleep habits.

The French Sleep Disturbance Scale for Children.

OBJECTIVE: The psychometric properties of the Sleep Disturbance Scale for Children (SDSC) have been shown to be accurate, even when translated into several languages. The aim of the present study was to translate, adapt, and validate the SDSC for a French-speaking population. METHODS: After forward- and back-translation, the tool was further translated and adapted into the French language. It was then pretested in terms of clarity on 33 French-speaking parents. Pretesting demonstrated that the questionnaire was well understood, indicating good clarity. During the validation phase, a total of 447 French-speaking parents of children aged between 4 and 16  years completed the SDSC. Among these, 66 children were diagnosed with sleep disorders by a pediatric specialist after a sleep consultation and polysomnographic recordings. RESULTS: The factor analysis revealed five factors: difficulty in initiating and maintaining sleep (DIMS), sleep breathing disorders (SBD), disorders of excessive somnolence (DOES), parasomnias (PARA) and non-restorative sleep (NRS). This psychometric structure is reliable and logical in comparison with the experts' diagnoses. Convergent validity, divergent and internal reliability are very good. Inter-parental concordance in scoring the child's sleep problem does show differences in the ways in which parents report their children's sleep patterns. Cut-off was calculated for the total score (45). CONCLUSION: This study validated a 25-item French version of the questionnaire. The French SDSC could therefore be used to aid screening of sleep disorders in the general population.