Sleep Issues in Children with Chronic Health Conditions

Children with asthma. Disrupted sleep in children with asthma is also related to negative outcomes, even when asthma is well controlled, said Lisa J. Melzer, PhD, assistant professor of pediatrics at National Jewish Health in Denver, who emphasized that deficient sleep can negatively affect learning, behavior, growth, and weight gain, as well as cause increased inflammation, which can lead to poorer asthma control and quality of life.

She emphasized the need for sleep interventions that address sleep hygiene, sleep duration, and insomnia symptoms, and said sleep issues in these children are treatable if identified. To that end, she encouraged screening in children with asthma for sleep problems that may be due to physiological (e.g., obstructive sleep apnea) and behavioral (e.g., insomnia) reasons, while acknowledging the challenge of screening.

“While screening for insomnia or other behavioral sleep issues would be ideal, it is unlikely to happen due to physician time constraints,” she said. “However, at the very least, otolaryngologists should be asking whether the child snores and following up as recommended by the American Academy of Pediatrics (AAP) clinical guidelines for the evaluation and treatment of sleep apnea in pediatric populations.” The AAP clinical guidelines are available at http://pediatrics.aappublications.org/content/130/3/576.

Children with cancer. Daytime fatigue and excessive daytime sleepiness are the two most important issues related to sleep disturbances in children with cancer, according to Valerie Crabtree, PhD, director of clinical services and training in the department of psychology at St. Jude Children’s Research Hospital in Memphis, Tenn.

This is particularly true for children with craniopharyngioma, who show excessive daytime sleepiness after surgery and before photon therapy, and is significantly related to lower verbal comprehension and processing speed. She emphasized that this excessive daytime sleepiness also extends into the survivorship period.

Children with other types of brain tumors also have high levels of sleepiness, particularly when they reach adolescence, she said.

The importance of recognizing and clinically managing the excessive sleepiness in these children is highlighted by the risk for negative effects of brain tumors and tumor treatment on cognition over time. “Many children who are treated for brain tumors are at risk for cognitive late effects, in which, over time, they may begin to show difficulties with processing speed, working memory, attention, and other aspects of their cognitive abilities,” she said.