SPECIAL ARTICLE
Increased Nocturnal Activity and Impaired Sleep Maintenance in Abused Children

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ABSTRACT

Objective

Previous studies have suggested that sleep disturbance may be the “hallmark of posttraumatic stress disorder,” although several investigations have failed to find evidence for sleep disruption. The purpose of this study was to determine whether intense averse stimulation during early development, in the form of physical and/or sexual abuse, led to disruption of sleep and nocturnal activity.

Method

Nineteen prepubertal children with documented abuse were compared with 15 nonabused normal controls and 10 depressed children. All subjects received a complete semistructured diagnostic interview. Ambulatory activity monitoring was used to evaluate sleep-related activity for three consecutive nights. Data were analyzed for nocturnal activity and algorithmic estimation of sleep initiation and continuity.

Results

Abused subjects were twice as active at night as normal and depressed children, and abused subjects emitted a greater percentage of their total daily activity during the night. Actigraph-derived sleep measures suggested that abused children had prolonged sleep latency and decreased sleep efficiency. Physically abused children had more impaired sleep efficiency than sexually abused children.

Conclusions

Abused children have higher levels of nocturnal activity than normal controls or depressed children and appear to have more difficulty falling and staying asleep. Physical abuse appears to be the salient factor rather than posttraumatic stress disorder.

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      Two studies only included female participants (Calhoun et al., 2007; Ulmer et al., 2009), and one study included only males (Theal et al., 2019). Traumatic exposure of participants included motor vehicle collision accidents (Klein et al., 2003), subway fire accidents (Lee et al., 2008), physical or sexual abuse during childhood (Glod et al., 1997), and traumatic experience during military deployment (Dagan et al., 1997; Slightam et al., 2018; Stout et al., 2017; Talbot et al., 2015; Theal et al., 2019; Ulmer et al., 2009). Other studies did not specify the type of traumatic exposure (Calhoun et al., 2007; Kobayashi et al., 2012; Kobayashi et al., 2014).

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    Supported by NRSA NR06807 from NINR, awards from the American and Massachusetts Nurses Foundations/Unity Exchange and Sigma Theta Tau International, and R01 MH48343 from NIMH (to Dr Teicher). The authors thank Cynthia McGreenery and Mairav Cohen-Zion for their assistance with this study.

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