Sleep and quality of life in children

Sleep disorders are known to have a dramatic effect on the quality of life of children. They may present very differently from infancy through adolescence, which makes diagnosis and treatment of these conditions both challenging and complex. Pediatric sleep disorders constitute a variety of conditions including central apnea, acute life-threatening events (ALTEs), sudden infant death syndrome (SIDS), and narcolepsy. However, the most common diagnosis is sleep-disordered breathing (SDB). SDB is associated with adenotonsillar hypertrophy and usually resolves after adenotonsillectomy. Children with SDB have scores on a global quality of life measure that are worse than those of children with asthma or juvenile rheumatoid arthritis. Fortunately, dramatic improvements in quality of life scores for SDB have been shown in a number of studies after adenotonsillectomy. The improvements are comprehensive and include all domains of quality of life. Caregivers report improvements in sleep disturbance, physical suffering, emotional distress, and daytime problems in their children. These improvements in quality of life are maintained up to 18 months after surgery and are dramatic regardless of the severity of SDB. The prevalence of SDB in children with obesity, neuromuscular or craniofacial disorders, Down syndrome or mucopolysaccharidoses is higher than in the general pediatric population and is widely underestimated. Unfortunately, few studies on quality of life have included these "high-risk" children or children with sleep disorders other than SDB. In future studies of quality of life and sleep disorders in children there is a need to quantify the diagnosis of the sleep disorder on the basis of data from polysomnography so that selection criteria might be standardized, to include appropriate control groups in the study design, and to assess the impact of co-morbidities.