Children ’ s sleep : is it given its due importance ?

Objective: Verify the importance given to sleep disorders in children. Methods: crosssectional study, observational and retrospective, based on reviews of exams for the title of Specialist in Pediatrics available on the official website of the Brazilian Society of Pediatrics in order to check how many questions addressed the theme of “sleep”. Results: a total of 853 questions were analyzed; two were sleep-related, one in 2004 and one in 2006, related to night terrors. Conclusion: the need of knowledge by the pediatrician about sleep disorders in childhood is not given importance despite its high prevalence and its various bio-psychosocial consequences.


INTRODUCTION
Sleep is characterized by a reversible alteration of perception of the external environment with modification of the level of consciousness and the intense reorganization of the central nervous system. 1 These changes may interfere with the general health, 2,3 especially in relation to growth, behavior, neuropsychomotor development, cognition, and the family relationships of the child, therefore, its recognition is important for appropriate clinical management. 4Some longitudinal studies have shown that sleep problems, often neglected in infancy, can evolve and cause severe psychiatric and medical problems in adulthood. 5n 2011, the Joint Specialties Committee of the Federal Council of Medicine approved the creation of the area of practice in Sleep Medicine for the specialties of Otolaryngology, Psychiatry, Neurology, and Pulmonology; 6 and considered the role of the pediatrician fundamental for the prevention and treatment of sleep disorders in the childhood.

DISCUSSION
This evaluation reveals how the theme "sleep medicine" was valued and addressed on exams for obtaining the TEP in the last 10 years, drawn up by the Brazilian Society of Pediatrics.The choice in the exam agenda for specialists reveals, of course, the value that each specialty gives and requests from their respective specialists.
In 14 tests of titles of the Brazilian Society of Pediatrics and among 853 questions, only two questions concerning sleep medicine were encountered, both about night terrors.These constitute 0.23% of the questions and concern only one disorder belonging to sleep disorders.The score of correct answers from specialist candidates varied from 56.6 to 67.8%.This score was recorded in less than two-thirds of the candidates in the subject of high prevalence and the various biopsychosocial consequences related.
It was not possible to compare the study data because there are no articles in the literature with the same objective of this study.This finding should serve as a warning to give more importance to the understanding of sleep-related disorders considering that healthy sleep is essential to the normality of human organic and psychic functions.

ACKNOWLEDGEMENTS
To Professor Ana Elisa Ribeiro Fernandes, to Kely, and the League of Pediatrics at UNIFENAS -BH.
Sleep disorders are the most common complaints throughout childhood and among the five most concerning by parents.They occur in 17 to 41% of children, being usually recurring, 7 however, they are poorly described in the health basic assistance including in the pediatric office.This may be explained because parents do not consider sleep problems as medical issues and, for the most part, are unaware of what is the normal pattern of sleep. 8In addition, sleep problems are little questioned or diagnosed by doctors. 9,10leep disorders can cause several health problems in children, 2,3 especially: growth alteration; 11 impairment of the immune function; 2 atopias; 12 headache; 12 imbalance between the sympathetic and parasympathetic functions with sympathetic dominance; 13 obesity; 2, 3, 13-16 reduction of insulin sensitivity; 14 increased grelinemia; 14 decreased leptinemia; 13 daytime fatigue; 17 restricted physical capacity; 17 motor maladjustment; 2 predisposition to accidents, 12,18 including in adolescence; 19 bad school performance; 12, 20, 21 cognitive 22 and attention deficit; 2,22-25 hyperactivity; 2,26 memory damage; 23,24 excessive sleepiness; 18 mood disorders; 2 behavioral problems; 2,25 anxiety; 14, 24, 26-28 depression; 14,22,26,27 and emotional stress. 17Parents of children with sleep disorders are more susceptible to stress, to present less affection for their children, and to experience marital discordance. 18n view of the possible and numerous complications of sleep disorders in children and their parents, it is considered necessary that the pediatrician knows the physiological characteristics of sleep in different age groups and their possible interpersonal variations; 1 the appreciation of sleep disorders in childhood should be a priority in the pediatric care. 29- 30The acquisition of specific knowledge in relation to infant sleep disorders by health professionals improves their prophylaxis, diagnosis, and therapy. 1 The aim of this study was to verify, by means of the evaluation instrument for obtaining the Title of Specialist (TEP) from the Brazilian Society of Pediatrics, 30 the importance given to this relevant subject.

METHODOLOGY
This was a transversal, observational, and retrospective study.Revisions of TEP evaluations available on the official website of the Brazilian Society of Pediatrics were conducted to verify how many questions  Night terrors and nightmares are frequent in preschoolers and schoolchildren.Characteristically night terrors happen in the first few hours of sleep, being common in this situation that the child presents shaking, screaming, seems scared and does not remember the event.Nightmares are most common in the final period of sleep and the memory of their content is frequent and vivid.The nocturnal epilepsy, in turn, is often associated to daytime sleepiness.

Table 1 -
Description of questions regarding the exam for proof of titles for obtaining the degree of pediatrician by the Brazilian Society of Pediatrics on the basis of the relative value placed on sleep disorders