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Language and sleep quality in children with Congenital Zika Syndrome


Zika virus is a recently recognized human teratogen which infection in pregnant women impacted in the increase of children with microcephaly and central nervous system alterations which compose the phenotype denominated Congenital Zika Syndrome (CZS). The complete phenotype of CZS is still in delineation since the first births occurred in late 2015 and clinical consequences caused by the maternal infection can still be presented during the children's development. It is known that among them are severe language impairment and a high frequency of sleep disorders, which have been described by our group as part of the phenotype of children with CZS. Considering that sleep problems may aggravate neurodevelopmental disorders and that early diagnosis may mitigate the consequences of sleep disorders on behavior, cognition, and language acquisition, it is important to investigate possible relationships between language and sleep quality for therapeutic planning in children with CZS.


To correlate language performance and sleep quality in children with CZS.


This study was approved by the Ethics Committee under protocol 1.743.023. Thirteen children of both genders, aged 25 to 30 months, diagnosed with CZS participated in this study. Language performance was analyzed using the Early Language Milestone Scale (ELM Scale) and sleep quality using the Brief Infant Sleep Questionnaire (BISQ). The correlation between language performance and sleep quality was tested using Spearman's correlation test, and the significance level adopted was p < 0.05.


100% of the participants had lower performance than expected for their chronological age in auditory receptive and auditory expressive skills with a mean of -84 ± 9.8 in the delta percentile for auditory expressive and of -74 ± 13 in the delta percentile for auditory receptive skills. Correlation analysis showed a positive correlation (p = 0.01; r = 0.61) between hours of sleep at night and receptive hearing ability; similarly, a positive correlation (p = 0.02; r = 0.58) was observed between waking hours in the morning and receptive hearing ability.


All children diagnosed with CZS in the 25 to 30 month age range had lower auditory skills than expected for their chronological age. The more hours of sleep at night and the later the children woke up, the less severe were the deficits in receptive hearing skills.


Sleep, Congenital Zika Syndrome, Language Development, Speech Language Pathology, ELM Scale


Área Clínica


Universidade Estadual Paulista "Júlio de Mesquita Filho" - São Paulo - Brasil


Nathani Cristina da Silva, Ana Luiza Decanini Miranda de Souza, Kriscia Gobi Rosa, Erlane Marques Ribeiro, Celia Maria Giacheti, Luciana Pinato