# Sleep Disturbances and Non-REM Phase Alterations in Children with Celiac Disease: A Combined Questionnaire and EEG Study

## TL;DR

Children with celiac disease often experience sleep problems, especially if they don't follow a gluten-free diet, and these issues are linked to changes in brain activity during sleep.

## Contribution

This study is the first to examine sleep microstructure in children with celiac disease and links sleep spindle changes to sleep disturbance severity.

## Key findings

- Sleep disturbances are more common in children with celiac disease compared to controls.
- Poor adherence to a gluten-free diet is associated with more severe sleep problems.
- Reduced sleep spindle amplitude and density correlate with higher sleep disturbance scores.

## Abstract

What are the main findings?
Sleep disturbances are frequently reported in children with celiac disease and appear to be more pronounced in those with poor adherence to a gluten-free diet.Lower sleep spindle amplitude and density are observed in children with higher sleep disturbance scores, suggesting an association between subjective symptoms and N2 sleep microarchitecture.

Sleep disturbances are frequently reported in children with celiac disease and appear to be more pronounced in those with poor adherence to a gluten-free diet.

Lower sleep spindle amplitude and density are observed in children with higher sleep disturbance scores, suggesting an association between subjective symptoms and N2 sleep microarchitecture.

What are the implications of the main findings?
These findings underscore the potential relevance of dietary adherence when interpreting sleep-related complaints in pediatric celiac disease.Sleep spindle metrics may represent promising objective correlates of symptom burden, warranting further validation in longitudinal and larger-scale studies.

These findings underscore the potential relevance of dietary adherence when interpreting sleep-related complaints in pediatric celiac disease.

Sleep spindle metrics may represent promising objective correlates of symptom burden, warranting further validation in longitudinal and larger-scale studies.

Background: Celiac disease (CD) is a multisystem immune-mediated disorder increasingly recognized to affect sleep and neurobehavioral functioning. Pediatric data remain limited, and no prior study has examined especially for sleep microstructure in this population. This study evaluates the prevalence and patterns of sleep disturbances in children with CD using the Sleep Disturbance Scale for Children (SDSC) and explores potential electrophysiological correlates through N2 sleep spindle analysis. Methods: Children with biopsy-confirmed CD (n = 31) and age-matched controls (n = 25) completed the SDSC. A subgroup of CD patients with SDSC ≥ 35 and healthy controls underwent quantitative sleep spindle analysis (C3, C4, O1, O2) using automated and visual verification methods combined. Results: Clinically significant sleep disturbances were substantially more prevalent in CD than in controls (77.4% vs. 12%). Excessive somnolence, sleep–wake transition disorders, and sleep hyperhidrosis were the most affected domains. Moreover, among children with CD, those noncompliant with a gluten-free diet exhibited higher rates of excessive somnolence and sleep–wake transition disorders. While spindle parameters did not differ between groups, higher SDSC scores (≥35)—particularly in the somnolence and sleep–wake transition disorder domains—are associated with reduced spindle amplitude and density, suggesting that spindle alterations are linked to sleep disturbance severity rather than disease status per se. Conclusions: Sleep disturbances are common in pediatric CD and worsen with poor dietary adherence. Although sleep microarchitecture is largely preserved, reduced spindle activity is evident in children with higher subjective sleep burden, suggesting that spindle metrics may serve as potential objective markers for sleep disturbance. Longitudinal studies are required for validation.