Sleep Quality and Depressive Symptoms in Clinically Stable Pediatric Familial Mediterranean Fever: Associations with...

Background: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disease that may adversely affect sleep quality, emotional well-being, and other patient-reported outcomes during childhood and adolescence. However, previous pediatric studies have frequently included heterogeneous patient populations with varying disease activity, limiting understanding of the relationship between disease severity and psychosocial functioning. Objective: To evaluate sleep quality and depressive symptoms in clinically stable children and adolescents with FMF during attack-free periods and to investigate their relationships with disease severity assessed using the International Severity Scoring System for Familial Mediterranean Fever (ISSF) and developmental factors. Methods: This cross-sectional case-control study included 72 children and adolescents with FMF and 88 age- and sex-comparable healthy controls. All patients with FMF were evaluated during clinically stable attack-free periods while receiving maintenance colchicine therapy. Depressive symptoms and sleep quality were assessed using the Children's Depression Inventory (CDI) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Disease severity was evaluated using the ISSF. Multivariable logistic regression analysis was performed to identify factors independently associated with poor sleep quality. Results: Healthy controls demonstrated significantly higher mean CDI and PSQI scores than patients with FMF (CDI: 10.3 ± 6.8 vs. 8.2 ± 5.3, p = 0.048; PSQI: 4.7 ± 2.7 vs. 3.0 ± 2.3, p < 0.001). Poor sleep quality (PSQI ≥ 5) was more frequent among controls (46.6% vs. 25.0%, p = 0.006). Within the FMF cohort, adolescents (13-18 years) had significantly poorer sleep quality than younger children (p = 0.005). Increasing age was independently associated with poor sleep quality (OR 1.24, 95% CI 1.07-1.43; p = 0.003), whereas FMF diagnosis was not independently associated with poor sleep quality after adjustment for age and sex. No significant association was identified between ISSF-defined disease severity and psychosocial outcomes. Sleep quality showed a modest positive correlation with depressive symptom severity (Spearman's ρ = 0.313, p = 0.007). Conclusions: Children and adolescents with FMF receiving maintenance colchicine therapy during clinically stable attack-free periods did not demonstrate poorer sleep quality or greater depressive symptom severity than age- and sex-comparable healthy controls. Increasing age appeared to be more closely associated with poor sleep quality than clinically assessed disease severity, whereas sleep quality showed a modest association with depressive symptom severity. These findings suggest that incorporating routine assessment of sleep quality and psychological well-being into multidisciplinary follow-up may facilitate a more comprehensive evaluation of children and adolescents with FMF.