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Sleep Disturbances and Non-REM Phase Alterations in Children with Celiac Disease: A Combined Questionnaire and EEG
Mehpare Sarı Yanartaş1, Nurel İnan Aydemir2, Furkan Donbaloğlu1
1Department of Pediatric Neurology, Faculty of Medicine, Akdeniz University, 07100 Antalya, Türkiye.
Insights
Sleep disturbances are common in children with celiac disease (CD) and worsen with poor gluten-free diet adherence. Reduced sleep spindle activity correlates with increased sleep disturbance severity in pediatric CD patients.
Area of Science:
- Pediatric Gastroenterology
- Sleep Medicine
- Neuroimmunology
Background:
- Celiac disease (CD) is an immune-mediated disorder impacting multiple systems, with growing recognition of its effects on sleep and neurobehavior.
- Limited pediatric data exists on sleep disturbances, particularly sleep microstructure, in children with CD.
- This study investigates sleep patterns and potential electrophysiological correlates in pediatric CD.
Purpose of the Study:
- To evaluate the prevalence and patterns of sleep disturbances in children with celiac disease (CD) using the Sleep Disturbance Scale for Children (SDSC).
- To explore potential electrophysiological correlates of sleep disturbances in pediatric CD through N2 sleep spindle analysis.
- To examine the association between dietary adherence and sleep disturbances in children with CD.
Main Methods:
- Children with biopsy-confirmed CD (n=31) and age-matched controls (n=25) completed the SDSC.
- A subgroup of CD patients (SDSC ≥ 35) and healthy controls underwent quantitative sleep spindle analysis.
- Automated and visual verification methods were combined for sleep spindle analysis.
Main Results:
- Clinically significant sleep disturbances were significantly more prevalent in children with CD (77.4%) compared to controls (12%).
- Excessive somnolence, sleep-wake transition disorders, and sleep hyperhidrosis were the most affected domains in pediatric CD.
- Children with CD noncompliant with a gluten-free diet showed higher rates of excessive somnolence and sleep-wake transition disorders.
- Reduced spindle amplitude and density were associated with higher SDSC scores, particularly in somnolence and sleep-wake transition disorder domains, indicating a link to sleep disturbance severity.
Conclusions:
- Sleep disturbances are highly prevalent in pediatric celiac disease and are exacerbated by poor dietary adherence.
- While sleep microarchitecture is generally preserved, reduced sleep spindle activity is observed in children with a higher subjective sleep burden.
- Sleep spindle metrics may offer potential objective markers for assessing sleep disturbances in pediatric CD, warranting further longitudinal validation.
Abstract:
Background: Celiac disease (CD) is a multisystem immune-mediated disorder increasingly recognized to affect sleep and neurobehavioral functioning. Pediatric data remain limited, and no prior study has examined especially for sleep microstructure in this population. This study evaluates the prevalence and patterns of sleep disturbances in children with CD using the Sleep Disturbance Scale for Children (SDSC) and explores potential electrophysiological correlates through N2 sleep spindle analysis. Methods: Children with biopsy-confirmed CD (n = 31) and age-matched controls (n = 25) completed the SDSC. A subgroup of CD patients with SDSC ≥ 35 and healthy controls underwent quantitative sleep spindle analysis (C3, C4, O1, O2) using automated and visual verification methods combined. Results: Clinically significant sleep disturbances were substantially more prevalent in CD than in controls (77.4% vs. 12%). Excessive somnolence, sleep-wake transition disorders, and sleep hyperhidrosis were the most affected domains. Moreover, among children with CD, those noncompliant with a gluten-free diet exhibited higher rates of excessive somnolence and sleep-wake transition disorders. While spindle parameters did not differ between groups, higher SDSC scores (≥35)-particularly in the somnolence and sleep-wake transition disorder domains-are associated with reduced spindle amplitude and density, suggesting that spindle alterations are linked to sleep disturbance severity rather than disease status per se. Conclusions: Sleep disturbances are common in pediatric CD and worsen with poor dietary adherence. Although sleep microarchitecture is largely preserved, reduced spindle activity is evident in children with higher subjective sleep burden, suggesting that spindle metrics may serve as potential objective markers for sleep disturbance. Longitudinal studies are required for validation.
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