Sleep in children and adolescents with juvenile idiopathic arthritis: A systematic review and meta-analysis of case-control studies

Abstract

Study Objectives: Juvenile idiopathic arthritis (JIA) is one of the most common pediatric rheumatic disease. However, sleep alteration associated with this autoimmune disease remain unclear. We aimed in this systematic review and meta-analysis to compare sleep duration, quality, and architecture in JIA subjects with those in their healthy peers. Methods: Systematic search performed in PubMed, EMBase, Cochrane, and PsycINFO databases included 19 studies in the qualitative synthesis of which 10 met the inclusion criteria for the meta-analysis. Results: Pooled results from subjective methods indicated pronounced sleep disturbances and complaints in youth with JIA compared with their healthy counterparts. This was further confirmed by increased difficulty maintaining sleep (wake after sleep onset [WASO]; standardized mean differences [SMD]: -0.69; CI: -1.29 to -0.09, p =. 02) and a tendency to increased difficulty initiating sleep (sleep onset latency [SOL]; SMD: -0.29; CI: -0.60 to 0.03, p =. 07). There were no remarkable differences in sleep duration or sleep architecture between JIA patients and healthy controls. High heterogeneity was found for several outcomes. This could be explained by the different methods used as well as associated sleep disorders, medication, and comorbidities. Conclusions: Although included studies were methodologically diverse, the summarized results of our review and meta-analysis bring evidence that children with JIA present more fragmented sleep compared to healthy peers. Thereby, the implementation of strategies to manage and improve sleep in this population are needed and might have a beneficial effect on the symptoms and functions of JIA. Statement of Significance: We observed that youth with Juvenile idiopathic arthritis (JIA) present pronounced sleep disturbances compared to their healthy counterparts: Meta-analysis found more difficulty maintaining sleep and a tendency to increased sleep latency in youth with JIA. However, results show discrepancies due to the different materials and methods used. Larger sample and further disentanglement of sample composition, considering associated sleep disorders, medication and comorbidities should be addressed in future studies.