Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review

Jennifer N Stinson; Jill A Hayden; Sara Ahola Kohut; Charlene Soobiah; Jenny Cartwright; Shelly K Weiss; Manisha B Witmans

doi:10.1186/1546-0096-12-19

Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review

Pediatr Rheumatol Online J. 2014 Jun 2:12:19. doi: 10.1186/1546-0096-12-19. eCollection 2014.

Authors

Jennifer N Stinson¹, Jill A Hayden², Sara Ahola Kohut³, Charlene Soobiah⁴, Jenny Cartwright², Shelly K Weiss⁵, Manisha B Witmans⁶

Affiliations

¹ Departments of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada ; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada ; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
² Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova scotia, Canada.
³ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada ; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
⁴ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada ; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background: Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (or JIA). However, little is known about the frequency and severity of sleep disturbance(s) and the factors that are associated with sleep problems in children with JIA. The mechanism(s) of the relationships characterizing the development or exacerbation of sleep problems in children with JIA are still unknown, however studies have reported an association. The purpose of this study was to synthesize existing research related to sleep problems in children with JIA.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. An experienced librarian conducted searches in MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to January 2012, to identify potentially relevant citations. Two members independently selected, rated methodological quality using the QUIPS tool, and extracted data from included studies.

Results: Ten studies were included and findings varied across studies; studies were mostly cross-sectional, or case-controlled designs, with only one cohort study available. Four studies found that children and adolescents diagnosed with JIA had significantly more sleep disturbances when compared to healthy controls. Pain was most often associated with sleep disturbances. The heterogeneous findings highlight the complex relationships between JIA and sleep, and low methodological quality of studies in the field.

Conclusions: This review supports an association between poor sleep and increased symptoms related to JIA, specifically the experience of pain. However, results need to be interpreted cautiously given the inconsistent findings regarding factors associated with sleep problems in JIA, the limited evidence available, and its low quality. Furthermore it is not yet determined if the poor sleep patterns predate the symptoms reported with JIA. More research is vital to understanding the factors that predict or perpetuate poor sleep in children and adolescents diagnosed with JIA.

Keywords: Juvenile idiopathic arthritis; Prognostic factor; Sleep problems; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adolescent
Arthritis, Juvenile / complications*
Child
Humans
Quality of Life*
Severity of Illness Index
Sleep Wake Disorders* / etiology
Sleep Wake Disorders* / physiopathology
Sleep Wake Disorders* / psychology