Untreated sleep disordered breathing (SDB) in children is associated with significant adverse health outcomes, including neurobehavioral performance deficits, excessive daytime sleepiness, poor health-related quality of life, and cardiovascular consequences. From our previous study we know that a large number of children with Juvenile Idiopathic Arthritis (JIA) showed signs of SDB that were associated with impaired neurobehavioral function after controlling for age, intelligence quotient, medication, and pain. SDB may be a comorbidity that is important to address in JIA, but which is often overlooked during clinical care. JIA is one of the most common rheumatologic chronic conditions in children and an estimated 20% experience lifelong pain and significant disability. Complaints of sleep disturbances are common in JIA. Fragmented sleep and pathophysiological consequences of SDB likely contribute to poor health outcomes and disability, but there is a paucity of research both about SDB and neurobehavioral outcomes in JIA. Our recent study was the first report of a laboratory assessment of sleep disturbance and daytime sleepiness in combination with validated tests of neurobehavioral performance in school-aged children with JIA. The purpose of the proposed case control study is to verify and extend our findings of SDB, neurobehavioral performance and daytime sleepiness in JIA compared to a group of peers without JIA.
The specific aims are to compare: 1) indices, risk factors, and types of SDB;2) scores on neurobehavioral tests and daytime sleepiness;and 3) associations between apnea hypopnea indices and respiratory-related arousals on neurobehavioral function and daytime sleepiness in 75 children with JIA and 75 age, sex matched control children. To achieve these aims, we have refined our instrumentation and will use state of the art laboratory technologies sensitive for the assessment of SDB, along with validated tests of neurobehavioral function, and physiological daytime sleepiness Results from this study will (1) provide new knowledge for dissemination to pediatric rheumatologists and primary care clinicians about the need to screen for SDB and daytime sleepiness and (2) lay the ground work for a large multi-site clinical SDB prevalence study in children with JIA. The potential impact of this research on clinical care is substantial;it will (a) help clinicians prioritize screening and treatment for SDB and daytime sleepiness in JIA, (b) alter clinical care in the management of JIA to improve health outcomes;and (c) clarify putative links between JIA, SDB, and daytime sleepiness potentially opening new avenues for treatment.

Public Health Relevance

Sleep disordered breathing (SDB) is a major public health concern in children. SDB in conjunction with JIA may further potentiate neurobehavioral decrements, negative interactions with peers at school and family members at home, lower quality of life, and long term disability. Knowledge about the extent of SDB and daytime sleepiness in JIA will (a) help clinicians prioritize screening and treatment for SDB and daytime sleepiness, (b) alter clinical care in the management of JIA to improve health outcomes;and (c) clarify putative links between JIA, SDB, and daytime sleepiness opening new avenues for treatment and for research.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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Matocha, Martha F
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University of Washington
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Schools of Nursing
United States
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