Association between sleep disorders and child violence assessed in Southern Brazil Associação entre distúrbios do sono e violência infantil avaliada no Sul do Brasil

Results: among the children evaluated, 66.7% had SDs. The sample profile was predominantly female (59.3%) and aged between 4 and 7 years old (48.8%). Physical violence was found in 40.7% of the children, in addition to sexual (35.8%), psychological (24.4%), negligence (14.6%) and other types of violence (OTV) (4.5%). SDs are significantly associated with sexual, psychological and OTV (p=0.016). Regarding the subscales, there was a significant difference between the age groups in the bedtime resistance (BR) factor score (p=0.033). The BR characteristic typifies sexual, psychological and OTV. Sleep anxiety (SA) typifies more psychological, sexual and OTV. Night awakenings (NAs) typify psychological, sexual and physical violence. According to the type of violence, significant differences were found in SA (p=0.039), NAs (p=0.026) and BR (p=0.004).


Introduction
The World Health Organization defines violence as "the intentional use of force or physical power against another person that results (or is highly likely to result) in injury, death, psychological damage or inadequate development" (1). Violence is a complex phenomenon, associated with specific sociocultural and political contexts and dynamics (2).
In its report (1), the World Health Organization classifies violence against children into physical abuse, sexual abuse, psychological abuse and neglect. Among them, neglect is prevalent (50%), followed by physical abuse (33.3%), psychological abuse (8.3%) and sexual abuse (8.3%) (3,4). One example of the manifestation of the latter is a study that assessed the profile of children and adolescents who have suffered sexual abuse in Rio Grande do Sul which has shown that 39.35% of them were between 10 and 14 years old, followed by 30.64% who were between 5 and 9, with a predominance of girls (5).
Furthermore, mistreatment at an early age has a greater negative impact: increased anxiety, depressive disorders, aggressiveness and withdrawn behavior, suicidal thinking and/or intention, eating disorders, sleep disorders (SDs) and behavioral problems such as bullying and rule-breaking habits (4,(6)(7)(8)(9). It is important to highlight that the violence must also be identified according to emotional or nutritional deprivation as well as reports of developmental failures, weight changes and schooling problems (3).
More specifically, disruptive nocturnal behaviors are considered a class of SDs that includes nightmares, night terror and dream-enacting behaviors. According to the study carried out by Cecil et al., with an age range between 16 to 24 years old, disruptive nocturnal behaviors have been associated with females and older age (10). Also, emotional, and sexual abuse has been associated with disruptive nocturnal behaviors, with a greater association with the emotional effect (8,10

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consumption, personality disorders, attention deficit and hyperactivity disorder (and several other reasons). They also show a correlation with obesity, chronic respiratory disease, stroke, heart disease, cancer and diabetes (13,14). Child abuse has already been linked to smaller total brain size, leading to synaptic changes and reduced brain activity on electroencephalograms (15). Hence the importance of an early assessment of SDs among children.
Thus, the present study aimed to identify SDs and their characteristics in children who have been victims of child violence. Therefore, its goal is to assist in the prevention and the onset and aggravation of diseases (13).

Methods
The study protocol has been approved by

Results
The research population comprised 129 children, victims of child violence or exposed to domestic violence, who were treated at the reference center.  Table 1).  (Figure 1).   Based on the data from this study, it is possible to conclude that there is a significant occurrence of SDs associated with situations of child violence.

Funding
This study was financially supported by the corresponding author.

Conflicts of interest disclosure
The authors declare no competing interests relevant to the content of this study.

Authors' contributions
All the authors declare to have made substantial contributions to the conception, or design, or acquisition, or analysis, or interpretation of data; to have drafted the work or revising it critically for important intellectual content; to have approved the version to be published.

Availability of data and responsibility for the results
All the authors declare to have had full access to the available data and they assume full responsibility for the integrity of these results.