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Sleep-Disordered Breathing in Children with Cerebral Palsy Compared to Non-Neurological Controls: A Prospective Study
Montaha Al-Iede1,2, Abdallah Al-Ani3, Amal Abu Libdeh2,4
1Division of Respiratory and Sleep Medicine, Department of Pediatrics, Jordan University Hospital, Amman 11942, Jordan.
Insights
Children with neurological conditions, including cerebral palsy (CP), experience increased sleep disturbances. Polysomnography (PSG) is the most reliable method for evaluating these sleep issues in pediatric patients.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Clinical Research
Background:
- Neurological conditions can significantly impact a child's sleep quality.
- Cerebral palsy (CP) is a common neurological disorder in children.
- Understanding sleep disturbances in these children is crucial for their overall health.
Purpose of the Study:
- To evaluate sleep quality and the prevalence of obstructive sleep apnea (OSA) in children with CP and other neurological conditions.
- To compare sleep parameters between children with neurological conditions and a matched control group.
- To assess the utility of polysomnography (PSG) and sleep questionnaires in diagnosing sleep disturbances.
Main Methods:
- A cohort of 296 children was recruited, including those with neurological disorders and matched non-neurological controls (asthmatic children).
- Sleep quality was assessed using polysomnography (PSG).
- Guardians completed the pediatric sleep questionnaire (PSQ) and sleep disturbance scale for children (SDSC).
Main Results:
- Children with CP (46.3% of neurological cases) exhibited lower sleep efficacy and reduced total sleep time compared to controls.
- While CP patients had comparable apnea-hypopnea index (AHI) to controls, other syndromic patients showed higher AHI.
- The Sleep Disturbance Scale for Children (SDSC) indicated a significantly higher risk of sleep disturbances in children with neurological conditions (OR: 2.015; p=0.043).
Conclusions:
- Children with neurological diseases face a higher risk of sleep disturbances, particularly those without CP.
- Polysomnography (PSG) remains the gold standard for objective and reliable evaluation of sleep disturbances in this population.
- Sleep questionnaires can provide valuable insights but should be complemented by objective measures.
Background/Objectives:
Our aim was to evaluate sleep quality and the prevalence of OSA among children with CP and other neurological conditions using both polysomnography (PSG) and validated sleep questionnaires.
Methods:
This study was conducted at the sleep laboratory of the Jordan University Hospital (JUH) between October 2023 and April 2025. Patients were consecutively recruited from pediatric neurology clinics. Patients completed a PSG session, while guardians/caregivers completed the pediatric sleep questionnaire (PSQ) and sleep disturbance scale for children (SDSC) tools on the behalf of the included patients. The cohort was matched with a control group composed of asthmatic children referred for sleep disturbances.
Results:
We recruited 296 patients, of whom 41.6% had neurological disorders and 58.4% were matched non-neurological controls. Among those with neurological diseases (n = 123), 46.3% were diagnosed with CP. Patients with CP showed significantly lower sleep efficacy than controls (p < 0.001). They also had reduced total sleep time compared to non-neurological controls but, notably, longer sleep time than children with Down Syndrome (all p < 0.05). Patients with CP had arousal index and apnea-hypopnea index values comparable to controls, but both measures were significantly lower than those observed in children with Down Syndrome and other syndromic patients (all p < 0.05). The risk of OSA according to the PSQ was insignificant for both controls and patients with neurological conditions (OR: 0.898; p = 0.720). According to the SDSC questionnaire, patients with neurological conditions had a significantly higher risk of sleep disturbances compared to controls (OR: 2.015; p = 0.043).
Conclusion:
Patients with neurological diseases are at a higher risk of sleep disturbances compared to controls. This was significantly more apparent in non-CP patients than in those with CP. At present, PSG remains the most objective and reliable tool to evaluate these disturbances.
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