Insomnia symptoms in children with sleep-disordered breathing: A scoping review

This scoping review examined the intersection between insomnia symptoms and sleep-disordered breathing (SDB) in the paediatric population, aiming to map current evidence on definitions, comorbid prevalence, assessment methods, interventions, and identify knowledge gaps to inform future research.

A comprehensive search was conducted across seven electronic databases and reported in accordance with the PRISMA-ScR guidelines. Eligible studies included empirical research involving children aged 0-18 years with SDB and insomnia symptoms or any form of insomnia. Data extraction included the study design, population characteristics, definitions and measures of SDB and insomnia symptoms, major outcomes, interventions and the proposed mechanisms underlying their comorbidity.

Of 4801 records identified, nine studies were included in the final review. Reported prevalence of insomnia symptoms among children with SDB ranged from 8.7% to 39.5% in clinical samples and 0.9% to 4.4% in the general population. Comorbidity appeared more common in younger children, those with milder obstructive sleep apnoea (OSA), and those with coexisting anxiety symptoms. Most studies employed retrospective cross-sectional designs, cohort studies were rare, and no intervention trials were identified. Research primarily focused on OSA and snoring, with considerable heterogeneity in the definitions and assessment of insomnia symptoms.

This review synthesises current evidence on paediatric insomnia symptoms in the context of SDB, highlighting frequent co-occurrence and a possible bidirectional relationship. Findings underscore the need for standardised definitions, integrated diagnostic approaches, and multidisciplinary management strategies. Future longitudinal research is warranted to explore the nature of this association, clarify potential causal pathways, and examine the underlying mechanisms.