Objective: Children and adolescents with chronic fatigue syndrome (CFS) frequently report sleep disturbances. However, little is known about the nature and severity of sleep disturbance and factors associated with sleep problems in pediatric CFS. The purpose of this review was to synthesize and critically appraise existing literature relating to sleep disturbances in pediatric CFS. Methods: Embase, CINAHL, PsychINFO, PubMed. and Medline databases were searched to retrieve all studies that included an assessment of sleep in pediatric CFS. Two reviewers independently assessed eligibility, extracted data, and systematically assessed reporting quality. Results: Six studies were included and these were mostly case-controlled designs. Findings varied across studies; however, most studies found that children and adolescents with CFS had signifi cantly more sleep disturbances when compared to healthy controls. Signifi cant methodological variations and limitations were apparent. Conclusions: This review suggests that children and adolescents with CFS experience sleep disturbances. However, results need to be interpreted cautiously given the limited evidence available and its overall low quality. More research is required to elucidate the nature and extent of sleep disturbance in pediatric CFS and should focus on (1) identifying the specifi c types, causes, and severity of sleep disturbances; (2) the specifi c consequences of sleep disturbances; and (3) Originally thought to occur only in adults, it is becoming increasingly recognized within the pediatric population with estimates of incidence ranging from 0.001% to 2%.2-5 With typical age of onset in mid to late adolescence, the effect of CFS often occurs in the critical stages of higher education where missed schooling due to illness can have a major effect on future academic and social outcomes. Sleep problems are commonly reported by children and adolescents with CFS. 6It is well accepted that adequate amount and quality of sleep is crucial for healthy child development and the functional consequences of poor sleep for children and adolescents are well known.7 Although studies show that most children and adolescents with CFS complain of sleep disturbances, 6 the type and severity of sleep disturbance that these children and adolescents experience has not been well characterized. There has been limited investigation of factors that might contribute to sleep disturbances (physiological, psychological, and social) in this group, as well as little or no evidence supporting the effi cacy of sleep interventions in children and adolescents with CFS. Therefore, there is little guidance for clinicians in how to best manage sleep disturbances in this population, which may potentially exacerbate disease burden in this already vulnerable group.

This study provides objective and subjective evidence of sleep disturbance in adolescents with CFS/ME compared with healthy adolescent controls.