Sleep Fragmentation and Biomarkers in Juvenile Idiopathic Arthritis

Abstract

Objectives: (1) To compare sleep (nighttime sleep duration and sleep efficiency) and sleep fragmentation (movement and fragmentation index), as measured by actigraphy, and symptoms (pain and fatigue) in 8-to 14-year-old children with polyarticular and extended oligoarticular juvenile idiopathic arthritis (JIA) and (2) to examine the associations between sleep fragmentation (movement and fragmentation index) and the calcium-binding protein biomarkers S100A12 and myeloid-related protein (MRP8/14). Method: Participants included 40 children with extended oligoarticular (n ¼ 15) or polyarticular (n ¼ 25) JIA and their parents. Serum protein samples were obtained during routine rheumatology clinic visits. Children completed the PedsQL Multidimensional Fatigue Scale and daily pain and sleep diaries and wore actigraphy monitors for 9 consecutive days. Parents completed the Children's Sleep Habits Questionnaire (CSHQ). Results: Of the 40 children, 68% scored above the CSHQ clinical cutoff score for sleep disturbances. Mean nighttime sleep duration was 7.5 hr, and mean sleep efficiency was 85.3%. Group differences were not found for nighttime sleep duration, sleep efficiency, movement and fragmentation index, or S100A12 and MRP8/14 protein concentrations. In a stepwise regression, medications, joint count, and movement and fragmentation index explained 21% of the variance in MRP8/14 concentration. Conclusion: Decreased nighttime sleep duration, poor sleep efficiency, and fragmented sleep were observed in our sample, regardless of JIA category. Sleep fragmentation was a significant predictor of MRP8/14 protein concentration. Additional research is needed to understand the interrelations among sleep fragmentation, effects of medication, and S100A12 and MRP8/14 protein biomarkers in JIA.

Sleep and Pain in Pediatric Illness: A Conceptual Review

“…Most children experience arthritis-related pain on more than 60% of days, while 39% experience daily pain [112]. Studies included validated subjective sleep measures (typically parent reports) [38,39,[113][114][115][116][117], daily assessments of pain and sleep [118,119], PSG, multiple sleep latency testing (MSLT), and/or actigraphy [114,117,[120][121][122][123].…”

“…MSLT indicates a shorter mean sleep-onset latency (indicating increased sleepiness) in JIA with active disease compared with controls and those with inactive disease, but the findings are mixed regarding whether daytime sleepiness is clinically significant [122,123]. Actigraphy demonstrated short sleep duration and poor sleep efficiency; however, there was no relation to disease activity, and healthy controls were not utilized [117]. Prospective assessments support a unidirectional relationship between sleep quality and pain, as poor sleep quality predicted next-day pain rather than daily pain predicting nighttime sleep, and mood served as a moderator [119].…”

Instrumentos para avaliação do padrão de sono em crianças com doenças crônicas: revisão integrativa

“…Após leitura exaustiva dos resumos, foram excluídos todos os materiais que se encontravam em duplicidade, bem como os que não pertenciam à temática do estudo. Assim, restaram 16 artigos [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] para serem analisados em maior profundidade. O fluxograma da seleção dos estudos para a revisão integrativa é representado na Figura 1.…”

“…Desta categoria emergiram quatro subcategorias, englobando 12 estudos [16][17][18][19][20][21][22][23][24][25][26][27] . Eles abordam o sono e sintomas como dor, fadiga, problemas de comportamento e os relacionam com o sono de crianças com doenças crônicas.…”

“…O primeiro avalia ao mesmo tempo o sono, a fadiga e a dor em 40 crianças (8-14 anos) com diagnóstico de artrite idiopática juvenil. Concluiu-se que 68% das crianças com artrite idiopática juvenil tem um sono perturbado, as crianças mais novas (8-11 anos) dormiram mais e mais cedo que as crianças mais velhas (12-14 anos) 26 .…”