Pediatric sleep and pain: etiologies, consequences, and clinical considerations

Erin E Morris; Michael J Howell; Elizabeth Pickup; Conrad Iber; Sonya G Wang

doi:10.5664/jcsm.10008

Pediatric sleep and pain: etiologies, consequences, and clinical considerations

J Clin Sleep Med. 2022 Sep 1;18(9):2281-2289. doi: 10.5664/jcsm.10008.

Authors

Erin E Morris¹, Michael J Howell², Elizabeth Pickup³, Conrad Iber⁴, Sonya G Wang¹

Affiliations

¹ Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota.
² Department of Neurology, University of Minnesota-Twin Cities, Minneapolis, Minnesota.
³ Pediatric Neurology, Children's National Hospital, Washington, DC.
⁴ Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota-Twin Cities, Minneapolis, Minnesota.

Abstract

Study objectives: To examine current evidence of the relationship between sleep and pain from the neonatal period through adolescence. This review serves as a critical review of the literature and of the needs for future research on pediatric sleep and pain.

Methods: The PubMed online database was queried from January 1, 1960, to March 1, 2020, producing 149 articles applicable to pain and sleep in the pediatric population. Of those, 97 articles were cited in this review with the key articles including over 3800 participants.

Results: The pediatric literature supports the relationship between poor sleep (both sleep efficiency and nighttime awakenings) and subsequent risk for pain, especially among children with chronic disease. The reverse effect of pain on sleep is not yet well delineated. The key moderating factors explored in the literature are pharmacologic and nonpharmacologic therapies, psychologic health, and the etiology of pain. There is evidence that both altered sleep and pain early in life impact neurodevelopment, as seen by changes in sleep structure in clinical studies and alterations in brain development in animal models.

Conclusions: The complicated relationship between sleep and pain is critically important during pediatric development when alterations to a normal sleep structure can have a lifelong impact. It is becoming clear that sleep deprivation and poor sleep quality exacerbate pain. Further research is needed into the complex alterations of sleep in chronic pain conditions as well as treatments to improve sleep in pediatric care.

Citation: Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med. 2022;18(9):2281-2289.

Keywords: neonatal; neurodevelopment; pain; pediatric; sleep.

Publication types

Review

MeSH terms

Animals
Child
Chronic Pain* / etiology
Chronic Pain* / psychology
Chronic Pain* / therapy
Humans
Pain Measurement
Sleep
Sleep Initiation and Maintenance Disorders*