Sleep in Pediatric Pulmonary Diseases

Sleep problems are common in pediatric patients with chronic respiratory disorders. Nocturnal awakenings are frequent in children with asthma. Chronobiologic rhythms impact the pathophysiology of nocturnal asthma. Poor sleep quality can lead to impaired school performance, neurocognitive defects and attention problems in children. As lung function worsens sleep disruption becomes more prominent in patients with cystic fibrosis. Bronchopulmonary dyplasia has been associated with hypoxia during sleep. These infants have been reported to have reduced total sleep time, sleep fragmentation and reduced REM sleep. Nocturnal respiratory variations are exaggerated at night in children with sickle cell disease and the nocturnal hypoxia has been associated with painful crisis. Adenotonsillar hypertrophy with attendant obstructive sleep apnea worsen these episodes in sickle cell disease. In children with kyphoscoliosis hypoventilation at night worsens during REM sleep. Nocturnal hypoventilation generally precedes respiratory failure. Sleep-disordered breathing with excessive daytime sleepiness has been well described in pediatric neuromuscular disorders. Abnormal sleep patterns including sleep-disordered breathing occur in infants with apnea of prematurity and sudden infant death syndrome. Further research in this diverse group of sleep disorders in children exploring the pathophysiology and treatment is essential.