Original article

Kim al. • Sleep

DS, JetPediatr
Korean problems in children and adolescents at pediatric clinics
2017;60(5):158-165
https://doi.org/10.3345/kjp.2017.60.5.158
pISSN 1738-1061•eISSN 2092-7258
Korean J Pediatr

Sleep problems in children and adolescents at

pediatric clinics
Dong Soon Kim, MD1, Cho Long Lee1, Young Min Ahn, MD2
1
Department of Medicine, Graduate School, Eulji University, Daejeon, 2Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul,
Korea

Purpose: To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Corresponding author: Young Min Ahn, MD
Gyeonggi provinces. Department of Pediatrics, Eulji General Hospital, 68,
Hangelbiseok-gil, Nowon-gu, Seoul 01830, Korea
Methods: Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric Tel: +82-2-970-8221
outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. Fax: +82-2-976-5441
Results: Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The E-mail: aym3216@eulji.ac.kr
participant’s mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93
Received: 3 August, 2016
(466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The Revised: 30 December, 2016
prevalence of habitual snoring in children <2 years and those between 2–5 years was 9% and 18%, Accepted: 2 January, 2017
respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia
was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%,
19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night
terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia
was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both
preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and
insomnia did not vary significantly with gender. However, snoring was more prevalent in boys.
Conclusion: Sleep problems are frequent among children in Korea. Children with snoring have an
increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children’s
sleep habits to improve their health.

Key words: Sleep problems, Child, Questionnaires, Prevalence

Introduction
Although the biological function of sleep is still largely unknown, sleep is seen as an
important part of the healing process and is considered essential to life in the physical,
neurological, and emotional areas. There are short- and long-term effects on life in sleep
deprivation. The short-term effects include poor attention and concentration, reduced
quality of life, low productivity and an increased absence in class or work, while long-term
effects include higher morbidity and mortality due to car accidents, coronary artery disease,
heart failure, hypertension, obesity, type-2 diabetes, stroke, depression, memory loss, and
decreased immune function1).
Copyright © 2017 by The Korean Pediatric Society
Sleep problems in children and adolescents cause serious conditions, medically and
psychologically2). Severe sleep breathing disorders may lead to left ventricular hypertrophy, This is an open-access article distributed under the
terms of the Creative Commons Attribution Non-
arrhythmia, cardiac pulmonary syndrome, heart failure, growth failure, and death3-5). Sleep Commercial License (http://creativecommons.org/
apnea and other sleep disorders can lead to depression, attention deficit and hyperactivity licenses/by-nc/4.0/) which permits unrestricted non-
commercial use, distribution, and reproduction in any
disorder, cognitive disorders, learning disabilities, and emotional instability6-8). medium, provided the original work is properly cited.

158 https://doi.org/10.3345/kjp.2017.60.5.158
 Korean J Pediatr 2017;60(5):158-165

According to a recent study, the prevalence of sleep-related dis­ 2) Diagnosis

eases in children and adolescents was determined to be approxi­ If a patient answered with yes to more than eight of questions
mately 43%, the rate of insomnia was determined to be 5%–20%, 1–23, then they were classified as SDB. Similarly, an answer of
the rate of obstructive sleep apnea was determined to be 1%–3%, “yes” to questions 24, 25, 26, or 2 of questions 27–31 were
the frequency of snoring was determined to be 5%–27%, and the indicative of sleepwalking, night terrors, bruxism, or insomnia,
rate of parasomnias was determined to be 14%–37%9). In Korea, respectively. Snoring for more than 3 days a week (2 que­stions)
snoring, bruxism, and enuresis have been reported to occur in was classified as habitual snoring2).
16.5%–26.7%, 13.2%, and 8.7%, respectively10-12). In the PSQ, SDB has been validated in children older than 2
Despite the high incidence and considerable impact of sleep years old. Therefore, in this study, SDB was diagnosed in children
problems in the lives of children and adolescents, sleep problems older than 2 years of age, as defined in the study by Chervin et
are not of major concern among parents and doctors. Further­ al.13).
more, there are only a few studies regarding the prevalence of Furthermore, enuresis was analyzed only in ages over 5 years,
sleep disorders in Korea10-12). depending on the definition.
In this study, we used the Pediatric Sleep Questionnaire (PSQ)
to examine the prevalence of sleep disorders in Korean children 3) Prevalence and risk factors
and adolescents (Appendix). The PSQ focused on snoring and Based on the information given in response to the question­
sleep disor­dered breathing (SDB). This questionnaire was naire, the incidence of night terrors, bruxism, SDB, and insomnia
employed to overcome the practical difficulties in asking patients were examined. Due to the difference in sleep patterns of children
about sleep problems in an outpatient setting2,13,14). and adults and the variations by age, sleep patterns that were
studied were divided into 4 age groups: 0–1, 2–5, 6–12, and 13–
18 years of age.
Materials and methods In adults, there is a clear difference between the sexes in the
incidence of snoring. We studied whether this is also the case in
1. Study participant children and whether sex differences are present in the prevalence
The PSQ was explained to and completed by 936 patients and of other sleep problems, such as sleepwalking, night terrors,
caregivers who visited a pediatric outpatient clinic of a secondary bruxism, SDB, and insomnia.
hospital or one of 5 private pediatric clinics around the Seoul and Obesity, a known risk factor of SDB, was also closely examined
Gyeonggi areas from July to October of 2009. in this study. Lastly, we analyzed the interconnections of each
disease.
2. Method
1) Questionnaire 4) Statistics
The PSQ, which contains 31 questions, was translated and used. Statistical analysis was performed using IBM SPSS Statistics
Questions 1–23 are composed of items related to snoring, SDB, ver. 19.0 (IBM Co., Armonk, NY, USA). Associations were analyz­
daytime sleepiness, and daytime behavior problems. These ed using a chi-square test and logistic regression analysis. P
questions consisted of items that were proven to be valid by values less than 0.05 were considered significant.
conducting surveys on patients with sleep breathing disorders
with an apnea-hypopnea index (Apnea Hypopnea Index) of 5 or
greater in polysomnography studies. With the appropriate SDB Results
value being 0.33, SDB can be diagnosed in cases where at least 8
of the 23 questions were answered “yes.” The sensitivity was 0.81 1. Characteristics of participants
and the specificity was 0.87 when diagnosing SDB using the Of the 936 survey participants, 901 were analyzed. The mean
questionnaire. Among those in the validation study, 85% of age (standard deviation, SD) was 4.35±3.02, and the ratio of male
patients diagnosed using polysomnography were diagnosed with to female participants was 1:0.93 (466 male, 435 female). The 35
SDB2,13). Notably, the Korean version of the PSQ used in this study excluded surveys included questionnaires without responses or a
was not validated. lack of basic information, such as sex or age.
Other questions related to sleepwalking (question 24), night Among 901 survey participants were 201 infants (0–1 year old),
terrors (question 25), bruxism (question 26), and insomnia 477 preschool children (2–5 years old), 206 school-age children
(questions 27-31). (6–12 years old) and 17 adolescents (13–18 years old). Six
hundred two surveys were completed by children and guar­dians
who used primary hospitals and 299 surveys were com­pleted by

https://doi.org/10.3345/kjp.2017.60.5.158 159
Kim DS, et al. • Sleep problems in children and adolescents at pediatric clinics

Table 1. Demographic variables according to age group

Variable 0–1 yr (n=201) 2–5 yr (n=477) 6–12 yr (n=206) 13–18 yr (n=17) Total (n=901)
Sex
Male 106 (52) 236 (49) 112 (54) 12 (64) 466 (52)
Female 95 (48) 241 (51) 94 (46) 5 (36) 435 (48)
Health care system
Primary 137 (69) 332 (70) 132 (64) 1 (6) 602 (67)
Secondary 64 (31) 145 (30) 74 (36) 16 (94) 299 (33)
Values are presented as number (%).

children and guardians who used secondary hospital. There were Table 2. Prevalence of sleep disorders by Korean version of Pediatric
younger subjects in the primary hospitals; however, there were no Sleep Questionnaire survey
sex differences (Table 1). Diagnosis No. (%) Total
Snoring 285 (31.6) 901
2. Prevalence Habitual snoring 152 (16.9) 901
Among study subjects, the rate of SDB and insomnia was 15.1 Sleep disordered breathing 106 (15.1) 700 (≥2 yr)
% (106 patients) and 13.2% (119 patients), respectively (Table 2). Enuresis 55 (18.0) 297 (≥5 yr)
The rate of snoring, habitual snoring (snoring more than 3 days Sleepwalking 14 (1.6) 901
a week), sleepwalking, night terrors, bruxism, and enuresis among Night terror 171 (19.0) 901
children was 31.6% (285 patients), 16.9% (152 patients), 1.6% (14 Bruxism 190 (21.1) 901
patients), 19% (171 patients), 21.1% (190 patients), and 18% (55 Insomnia 119 (1.23) 901
patients), respectively.

3. Risk factors Table 3. Prevalence of sleep problems according to age

1) Age Sleep problem
0–1 yr 2–5 yr 6–12 yr 13–18 yr
P value
There were statistically significant differences of age in the (n=201) (n=477) (n=206) (n=17)
Snoring 48 (24) 163 (34) 69 (33) 5 (29) 0.07
incidence of insomnia, habitual snoring, night terrors, and bru­
Habitual snoring 18 (9) 89 (18) 43 (21) 2 (12) 0.00
xism (Table 3). The incidence of insomnia was higher in younger
Night terror 54 (27) 92 (19) 25 (12) 0 (0) 0.00
children.
Bruxism 19 (10) 112 (24) 54 (26) 5 (29) 0.00
SDB* - 73 (15) 31 (15) 2 (12) 0.92
2) Sex
Insomnia 43 (21) 60 (13) 15 (7) 1 (6) 0.00
SDB and insomnia had no correlations with sex (P=0.44 and
Values are presented as number (%).
P=0.88, respectively). In addition, there was no significant differ­ SDB, sleep disordered breathing.
ence in the relationship between sleepwalking, night terrors, and *SDB was diagnosed in children more than 2 years.
bruxism (Table 4). The frequency of snoring was higher in boys
(P=0.01); however, there was no difference due to sex in habitual
snoring. Table 4. Rates of sleep problems according to sex
Sleep problem Boys (n=467) Girls (n=434) P value
3) Health care system Snoring 165 (35) 120 (27) 0.01
There was no difference in the incidence of snoring, SDB, and Habitual snoring 86 (18) 66 (15) 0.19
insomnia between the primary and secondary hospitals (Table 5). SDB* 59 (16) 47 (14) 0.34
Sleepwalking 10 (2) 4 (0.1) 0.13
4) Obesity Night terror 99 (21) 72 (17) 0.78
Among children, 12.0% (108 patients) were obese. Among Bruxism 106 (22) 84 (19) 0.20
these obese patients, 42.6% (46 of 108 patients) snored, which Enuresis† 29 (6) 26 (6) 0.88
was greater than the rate of snoring among nonobese patients Insomnia 58 (12) 61 (14) 0.27
(30.4% [239 of 785 patients], P=0.01). Likewise, obese patients Values are presented as number (%).
showed a significantly higher incidence of SDB (26.9%, 21 of 78 SDB, sleep disordered breathing.
*There were 360 boys and 340 girls (age≥2 yr). †There were 163 boys and
patients) than did those patients who were not obese (17.0%, 106 141 girls (age≥ 5 yr).

160 https://doi.org/10.3345/kjp.2017.60.5.158
 Korean J Pediatr 2017;60(5):158-165

of 621 patients) (P=0.00). insomnia than did those without SDB (P=0.00) (Table 7).

5) Correlations of snoring and other sleep problems

There was a significant difference in the rate of bruxism, night Discussion
terror, and SDB between the 3 groups of snoring (habitual snoring,
snoring occasionally, and nonsnoring). However, there were no This research investigated the frequency of sleep-related pro­
significant differences in the frequency of enuresis and insomnia blems by surveying 936 patients under the age of 18, who had
(Table 6). visited 1 of 6 different pediatric hospitals in the Seoul and
Logistic regression analysis showed a high incidence of SDB in Gyeonggi area. Results indicated that, among the patients, 13.2%
snoring patients (Table 7). had insomnia, 15.1% had sleep-related breathing disorders and
31.6% snored, of which 16.9% snored regularly (i.e., more than 3
6) SDB and insomnia times a week). In addition, other sleep related disorders, such as
Children diagnosed with SDB had a higher probability of sleep walking, sleep terror, bruxism and enuresis, were also fre­
quent, occurring in 1.6%, 19%, 21.1%, and 18% of subjects, res­
Table 5. Prevalence of sleep problems between the primary and pectively. Of the 5 relevant survey questions about insomnia,
secondary health care system
13.2% replied "yes" to more than 2 questions, and a high rate
Primary healthcare Secondary health care
Sleep problem P value (29.2%) replied "yes" to more than 1 question.
system (n=602) system (n=299)
Snoring 185 (31) 90 (30) 0.44 Archbold et al.2) reported that 18% replied "yes" to more than
Habitual snoring 99 (16) 53(18) 0.64 two questions and 41.4% said "yes" to more than one question in
SDB* 73 (16) 33(14) 0.56 a similar survey. Furthermore, Lozoff et al.15) stated that the fre­
Insomnia 85 (14) 34(11) 0.25 quency of sleeping disorders in children was 31%. These studies,
Values are presented as number (%).
like this study, choose the study subjects and used surveys
SDB, sleep disordered breathing. completed by children and parents who visited hospitals but did
*The number of children with SDB in general hospital and clinics was 235 and not have chronic illnesses.
465, respectively.
The frequency of behavioral insomnia in children, including
insomnia and night walking, was between 20% and 30% in early
Table 6. The coexistence of sleep problems according to snoring childhood, 15% in school-age children16,17) and the prevalence of
frequency insomnia in adolescents between 16 and 18 years old was
No snoring Snoring Habitual snoring approximately 11%18). As in previous studies, we can see that the
Sleep problem P value
(n=600) (n=156) (n=140)
prevalence of behavioral insomnia is high in infants.
Night terror 97 (16) 35 (22) 38 (27) 0.001
Childhood insomnia can be classified as either behavioral
Bruxism 106 (18) 46 (29) 36 (26) 0.001
insomnia or psychological-physiological insomnia. Behavioral
Enuresis 33/191* (17) 8/52* (15) 14/60* (23) 0.37
insomnia is usually more frequent in younger children, and
SDB 22/449* (5) 22/126* (17) 61/122* (50) 0.001
psychological-physiological insomnia is more common among
Insomnia 78 (13) 22 (14) 19 (14) 0.78
older children and adolescents14,19). Since the survey used in this
Values are presented as number (%).
SDB, sleep disordered breathing. study investigates the presence of behavioral insomnia, it is
*Total number. presumed that the prevalence of insomnia was higher in younger
patients. Furthermore, younger children often sleep together with
Table 7. Regression analysis of risk factors of sleep disordered breathing their parents so their parents would have more easily observed
and insomnia symptoms related to insomnia.
Predictor variable Estimate±SE OR (95% CI) P value Sleep-related breathing disorders are conditions that present
The risk factors of sleep disordered problems in breathing during sleep and are caused by increased
breathing* resistance in the upper respiratory tract. This includes snoring,
Snoring 1.55±0.30 4.75 (2.62–8.60) 0.001 upper airway resistance syndrome and obstructive sleep apnea.
Habitual snoring 1.42±0.28l 4.14 (2.38–7.18) 0.001 Adenotonsillar hypertrophy is the most common cause of SDB
The risk factor of Insomnia† in children and tends to occur in nasal obstruction (e.g., rhinitis,
Age -0.17±0.43 0.83 (0.76–0.91) 0.001 sinusitis, nasal septum deviation). Other risk factors include
SE, standard error; OR, odds ratio; CI, confidence interval. obesity, gastroesophageal reflux disorder, laryngomalacia, central
*Logistic regression analysis revealed higher rates of sleep disordered
breathing among snoring and habitual snoring group. †Logistic regression facial hypoplasia syndrome (e.g., Pierre Robin sequence, Treacher
analysis revealed higher rates of sleep disordered breathing. Collins, Crouzon syndrome), lingual hypertrophy (e.g., 21 trisomy,

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Kim DS, et al. • Sleep problems in children and adolescents at pediatric clinics

Beckwith Wiedeman syndrome), and neuromuscular diseases20,21). snoring between the sexes. However, this study showed a signi­
There are a few major differences in SDB between children and ficantly higher incidence of snoring in boys. This was also the
adults. In children, the symptoms are more diverse and difficult to case in the two other studies10,11) that were conducted in Korea.
diagnose individually. In addition, excessive daytime sleepiness is More research should be conducted to see if it this is due to
common in adults while it is only seen in approximately 7% of unique characteristics of children in Korea.
children22). Conversely, hyperactivity is commonly seen among Snoring children showed a significantly higher incidence of
children. Lastly, symptoms of SDB vary in children depending on SDB, night terrors, and bruxism (Table 6). Logistic regression
their age. In young cases, snoring, apnea, frequent arousal, sweat­ analysis showed the risk of SDB to be 4 times higher in children
ing, dry mouth, and stunted growth are frequently seen. In con­ with habitual snoring (Table 7). Snoring is one aspect of SDB and
trast, cases in older patients frequently included symptoms of the correlations between SDB and night terrors or bruxism has
night terrors, sleep-talking, sleep-walking, enuresis, hyperactivity, been demonstrated in previous studies28,29). Parasomnia is regard­ed
and depression23). SDB can be diagnosed on the basis of patient as a symptom of SDB in children, which is supported by the
history, physical examination, and polysomnography24). observation that treating SDB also relieves parasomnia and by its
In this study, the prevalence of snoring was 31.6%, of which higher incidence in children who have a family history of SDB29).
habitual snoring (more than 3 days per week) was 16.9%. Pre­ Therefore, in children with night terror or bruxism, it is recom­
school children (39%) and school age children (34%) showed a mend­ed to primarily determine whether SDB is present and to
higher rate of snoring than did the other age groups. A previous treat it first.
study done in Korea by Cho et al.11) indicated that 15.5% of In general, the prevalence of enuresis is higher in cases of
children snore at least once a week and 4.3% of children snore snoring. The relationship between enuresis and snoring is
almost every day. In another study which investigated elementary believed to be due to an increase in plasma brain natriuretic pep­
school children10), 26.7% children were observed to snore and tide and a decrease in antidiuretic hormone concentration during
7.1% of children snored more than 3 days a week. These 2 sleep in SDB, thereby causing increased urine production, which
studies10,11), which showed lower resulting numbers than does the is then aggravated by increased abdominal pressure due to the
current study, differed from this study in the recruitment of strong respiratory effort exerted by patients with SDB. Together,
research subjects. The 2 studies gathered research subjects from these events lead to urination.
elementary schools, whereas this study recruited outpatients. The However, in this study of the frequency of enuresis in ages
diseases that the outpatients may have had at the time (e.g., upper greater than 5, there was no significant difference in its incidence
respiratory infection, sinusitis, rhinitis, tonsillitis, etc.) could have across the 23% (14 of 60) of patients with habitual snoring, the
had an influence on snoring, thereby increasing the frequencies 15% (8 of 52) of patients with occasional snoring, and the 17%
shown in the study. In addition, since the subjects were children (33 of 191) of patients who do not snore. Even when compared to
who visited hospitals, results might have shown higher snoring habitual snoring and otherwise, the prevalence of enuresis show­
rates than an average child of similar age. ed no significant difference. The different results from existing
Particularly notable in this study was the frequency of habitual studies is thought to be due to the simplistic classification of
snoring in children younger than 24 months (9%) and in children patients by their "yes" answer to the Korean version of question
between ages 2–5 (18%). Furthermore, this study is the first in our "Does your child wet the bed?" This level of detail is not sufficient
country to document the frequency of snoring in young children. to indicate enuresis, which requires that patients wet the bed at
Recently, it was shown that 60% of facial bones develop in child­ least twice a week for at least 3 months in children ages 5 or more
ren during the first 4 years of life25). Animal studies have shown and many parents misunderstood the questionnaire.
changes in facial structure after induced nasal congestion26), and The risk factors of habitual snoring are similar to those of SDB.
persistency of SDB with long-term follow-up27) suggest that per­ In a study targeting elementary school children in China30), risk
sistent oral breathing caused by factors such as nasal congestion factors, such as low family income, lack of higher education in
may structurally cause chronic development of SDB. This in turn the father, breastfeeding for less than 6 months, smoking during
highlights the necessity for early treatment during infancy and pregnancy, obesity, overweight, respiratory problems (rhinitis,
early childhood. Early detection and treatment of snoring and asthma, adenoids hypertrophy, chronic otitis media), and a family
oral breathing may prevent the development of sleep apnea. history of habitual snoring were investigated. In this study,
However, the nature of this period has not yet been explored in however, such risks were not examined.
our country. It can be said that the high incidence of 9%–18% The prevalence of night terrors was 19% and showed a signifi­
shown in this study expresses the need for a more active diag­ cant difference by age. Night terrors occurred in 27% of infants
nosis and treatment by pediatricians. aged 0–1 years old and in 19% of preschool children. In a study
Research outside of Korea has demonstrated no difference in of twins, similar results to this study were obtained. A higher

162 https://doi.org/10.3345/kjp.2017.60.5.158
 Korean J Pediatr 2017;60(5):158-165

incidence of night terrors was observed in younger children, with outpatients, and not by members of the public, the prevalence
a prevalence of 36.9% in children 18 months old and 19.7% in shown in the results may be higher than that of the community.
children 30 months old31). However, night terrors usually occur in Further research related to sleep problems using a representative
ages 2–4 years and are known to appear in 6% of children, re­ sample group would be necessary.
gardless of sex. The reason this study resulted in a high preval­ Moreover, because the participants conducted the survey after
ence of night terrors is because all patients that answered "yes" to having visited the hospital because of an illness, there is a possi­
the question asking "awake in a panic or frightened" were classi­ bility that the disease was affecting sleep and thus the answer was
fied as having night terrors, even though this question includes affected. Additionally, while socio-economic status which we did
children who have either awaken while crying and those ex­ not asked in this study may have affected the sleep in children.
periencing nightmares. This is a limitation of the survey since the Finally, the age of the subject may affect survey responses. Young
patients may not have fully understood the meaning of night children are mostly observed by the parents while sleeping,
terrors. whereas older children who sleep alone may have had difficulties
Although there are many sleep-related problems in children recognizing their sleep problems, which may have affected their
and adolescents, parents and medical staff do not provide suffi­ answers to the survey.
cient attention to this problem. Despite these limitations, this study is meaningful given the
Meltzer et al.9) reported that the prevalence of sleep problems prevalence of SDB, insomnia, and snoring among Korean child­
according to the ICD-9 (International Classification of Diseases, ren and adolescents. Pediatric clinics of primary medical care
9th revision) is 3.7%, which was lower than the results of previ­ centers report a relatively high prevalence of these conditions.
ous studies. Low prevalence is thought to be a result of the study Furthermore, our results show a higher incidence of snoring in
having been conducted retrospectively based on medical records. infants with a higher frequency in boys. These snoring children
Given the lack of interest in sleep problems, most issues relevant had a four times higher risk of SDB.
to our study were not recorded.
The lack of interest in addressing sleep problems has been
studied in previous research32) that indicated that while 24.6% of Conflict of interest
patients suffer from sleep problems, only 4.1% of parents discuss­
ed the problems and only 7.9% of parents consulted a doctor. No potential conflicts of interest relevant to this article was
Other causes of sleep problems that were not covered in this reported.
study, include family suffering from illness or accidents, sleeping
with a parent, the absence of the mother during the day, depres­
sion of the mother, and maternal ambivalence toward their child­ Acknowledgments
ren. Nevertheless, a previous study had shown that sex, age, birth
order, family size, breastfeeding, parental education, occupation, This research received support from Dr. Hyeung Chae Kang of
paternal presence15). LeeKang Pediatric Clinic, Dr. Ki Tae Kim of Seoul Pediatric Clinic,
Furthermore, children waking up in a panic were shown to Dr. Seung Nam Park of Park Seung Nam Pediatric Clinic, and Dr.
have more stress in the family and the mothers exhibited more Ki Dong Hwang of Hanmaeum Teunteun Pediatric Clinic.
psychiatric disorders33).
In another study, the prevalence of sleep problems was higher
in children of low income families and in infants younger than 1 References
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164 https://doi.org/10.3345/kjp.2017.60.5.158
 Korean J Pediatr 2017;60(5):158-165

<Appendix >

Pediatric Sleep Questionnaire

While sleeping does your child...
1. Snore more than half the time?
2. Snore over three days per a week?
3. Snore loudly?
4. Have loud breathing?
5. Have trouble or struggle with breathing?
Have you ever...
6. Seen your child stop breathing during the night?
Does your child...
7. Have restless sleep?
8. Tend to breathe through the mouth during sleep?
9. Tend to breathe through the mouth during the day?
10. Have a dry mouth upon waking up in the morning?
11. Occasionally wet the bed?
12. Wake up feeling un-refreshed in the morning?
13. Have a problem with sleepiness during the day?
14. Has a teacher or other supervisor comment that your child appears sleepy during the day?
15. Does your child wake up with headaches in the morning?
16. Did your child stop growing at a normal rate at any time since birth?
17. Is your child over weight?
This child often...
18. Does not seem to listen when spoken to directly.
19. Has difficulty organizing tasks.
20. Is easily distracted by extraneous stimuli.
21. Fidgets with hands or feet and squirms in their seat.
22. Is “on the go” or often acts as if “driven by a motor”.
23. Interrupts or intrudes on others (e.g., butts into conversations or games).
Does your child...
24. Walk in their sleep?
25. Awake in a panic or fright?
26. Grinds teeth during sleep?
27. Has difficulty in falling asleep during the night?
28. Wakes over two times during the night?
29. Has difficulty falling back to sleep after nighttime awakening?
30. Awake early in the morning and has difficulty falling back to sleep?
31. Resists going to bed?

https://doi.org/10.3345/kjp.2017.60.5.158 165