Evaluation of Sleep Health in Children With Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency

TL;DR

Children with congenital adrenal hyperplasia (CAH) experience impaired sleep health, including reduced sleep duration and increased nighttime awakenings.

Contribution

This study is the first to use actigraphy and validated questionnaires to evaluate sleep health in children with CAH.

Findings

Sleep duration in children with CAH was below recommended guidelines with worse sleep efficiency and increased awakenings.

Parents reported significant sleep onset delays and more night awakenings compared to community and clinical samples.

Awakenings increased after the evening hydrocortisone dose's washout, suggesting a link to medication timing.

Abstract

Literature on sleep health in children with congenital adrenal hyperplasia (CAH) is sparse despite the important role the hypothalamic-pituitary-adrenal axis plays in sleep onset, duration, and awakenings after sleep onset.

To evaluate sleep health in children and adolescents with CAH as measured by wrist actigraphy and validated sleep questionnaires.

Cross-sectional study at our multidisciplinary CAH clinic. Participants aged 3 to 18 years with classic CAH wore an ActiGraph GT3X+ accelerometer for 1 week. Children and parents completed sleep questionnaires, and the results were compared to published samples from the community and children with sleep disorders (clinical). Actigraphy sleep health measures were compared to consensus sleep duration recommendations and normative data in healthy children.

Forty-four participants (23 male) with CAH completed the study. Actigraphy found sleep duration in children with CAH was less than recommended guidelines with significantly worse sleep efficiency and increased wake after sleep onset (P < .05) compared to healthy children. After sleep onset, the average number of awakenings increased from 1.67 per hour during the first 2 hours after the evening hydrocortisone dose to 3.12 per hour 4 to 7 hours after the dose, corresponding with washout of the evening hydrocortisone dose. Parents of 3- to 10-year-olds reported significantly worse sleep onset delay and decreased sleep duration than both the community and clinical samples, and significantly more night awakenings than the community sample.

Our findings suggest that sleep health is impaired in children with CAH and is an important consideration for both clinical practice and future research.

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