# Sleep-Disordered Breathing in Children with Cerebral Palsy Compared to Non-Neurological Controls: A Prospective Study from a Tertiary Center in Jordan

## TL;DR

This study found that children with cerebral palsy have worse sleep quality than non-neurological controls, but similar risk of sleep apnea.

## Contribution

First prospective study comparing sleep-disordered breathing in cerebral palsy and non-neurological children using polysomnography.

## Key findings

- Children with cerebral palsy had significantly lower sleep efficacy than controls.
- Cerebral palsy patients had comparable apnea–hypopnea index values to controls but lower than Down Syndrome patients.
- Neurological conditions were associated with higher sleep disturbance risk according to SDSC questionnaires.

## Abstract

Background/Objectives: Our aim was to evaluate sleep quality and the prevalence of OSA among children with CP and other neurological conditions using both polysomnography (PSG) and validated sleep questionnaires. Methods: This study was conducted at the sleep laboratory of the Jordan University Hospital (JUH) between October 2023 and April 2025. Patients were consecutively recruited from pediatric neurology clinics. Patients completed a PSG session, while guardians/caregivers completed the pediatric sleep questionnaire (PSQ) and sleep disturbance scale for children (SDSC) tools on the behalf of the included patients. The cohort was matched with a control group composed of asthmatic children referred for sleep disturbances. Results: We recruited 296 patients, of whom 41.6% had neurological disorders and 58.4% were matched non-neurological controls. Among those with neurological diseases (n = 123), 46.3% were diagnosed with CP. Patients with CP showed significantly lower sleep efficacy than controls (p < 0.001). They also had reduced total sleep time compared to non-neurological controls but, notably, longer sleep time than children with Down Syndrome (all p < 0.05). Patients with CP had arousal index and apnea–hypopnea index values comparable to controls, but both measures were significantly lower than those observed in children with Down Syndrome and other syndromic patients (all p < 0.05). The risk of OSA according to the PSQ was insignificant for both controls and patients with neurological conditions (OR: 0.898; p = 0.720). According to the SDSC questionnaire, patients with neurological conditions had a significantly higher risk of sleep disturbances compared to controls (OR: 2.015; p = 0.043). Conclusion: Patients with neurological diseases are at a higher risk of sleep disturbances compared to controls. This was significantly more apparent in non-CP patients than in those with CP. At present, PSG remains the most objective and reliable tool to evaluate these disturbances.