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Sleep Disturbances and Neurobehavioral Performance in Juvenile Idiopathic Arthritis

Teresa M Ward1,2, Dean W Beebe3,4, Maida Lynn Chen3,4

  • 1From the School of Nursing, University of Washington; Seattle Children's Hospital, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine; Seattle Children's Hospital, Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine, Seattle, Washington; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. teward@uw.edu.

The Journal of Rheumatology
|January 17, 2017
PubMed

Insights

Children with juvenile idiopathic arthritis (JIA) and obstructive sleep apnea (OSA) experience more sleep disturbances and slower neurobehavioral performance. Elevated obstructive apnea hypopnea index (OAHI) may contribute to these issues in JIA patients.

Area of Science:

  • Pediatric Rheumatology
  • Sleep Medicine
  • Neuroscience

Background:

  • Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition affecting children.
  • Obstructive sleep apnea (OSA) is increasingly recognized as a potential comorbidity in JIA.
  • Sleep disturbances can significantly impact a child's overall health and neurodevelopment.

Purpose of the Study:

  • To investigate polysomnographic (PSG) sleep disturbances in children with JIA, specifically comparing those with and without OSA.
  • To evaluate the effect of the obstructive apnea hypopnea index (OAHI) on neurobehavioral performance in JIA patients.
  • To adjust for confounding factors such as IQ, pain, medication, and daytime sleepiness.

Main Methods:

  • A cohort of 6-11 year old children, including 68 with JIA and 67 controls, underwent overnight PSG.
  • Participants completed daytime sleepiness surveys, multiple sleep latency tests, and neurobehavioral performance tests.
  • Statistical analyses were performed to compare sleep parameters and neurobehavioral outcomes between groups.

Main Results:

  • Children with JIA and OSA exhibited significantly higher mean OAHI and arousal indices compared to JIA without OSA and controls.
  • Neurobehavioral tests revealed significantly slower simple reaction time and impaired sustained attention in JIA with OSA, even after adjusting for covariates.
  • Elevated OAHI was strongly associated with increased sleep disturbances and poorer neurobehavioral function.

Conclusions:

  • Obstructive sleep apnea is a significant comorbidity in juvenile idiopathic arthritis.
  • Elevated OAHI in JIA patients is linked to increased sleep disturbances and impaired neurobehavioral performance.
  • These findings suggest that OSA may predispose children with JIA to daytime sleepiness and cognitive deficits.
Abstract

Keywords:
CANTABDAYTIME SLEEPINESSJUVENILE IDIOPATHIC ARTHRITISNEUROBEHAVIORAL PERFORMANCEOBSTRUCTIVE SLEEP APNEAPOLYSOMNOGRAPHY

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