Health-related quality of life in Canadian children with cerebral palsy: what role does sleep play?

Objective: To evaluate, in Canadian children with cerebral palsy (CP): (1) health-related quality of life (HRQoL) as well as (2) associations between HRQoL and (a) sleep problems, (b) nighttime pain, and (c) child characteristics (eg, age, CP phenotype, comorbidities).

Methods: Children aged 3-12 years were recruited from neurology clinics and a provincial CP registry. Caregivers completed the Pediatric Quality of Life Inventory (PedsQL) Generic Core and CP Modules as well as the Sleep Disturbance Scale for Children (SDSC) to assess HRQoL and sleep, respectively. Child characteristics were extracted from hospital records and registry data.

Results: A total of 146 children with CP (mean age ± standard deviation: 6.9 ± 2.9 years) completed the study. Impaired HRQoL (scores more than 2 SDs below the normative population mean) on the PedsQL Total, Physical and Psychosocial Health scales was found in 33.6%, 38.4% and 17.6% of children, respectively. Non-ambulatory status, sleep problems and significant comorbidity were the strongest predictors of impaired Total HRQoL, with odds ratios (95% confidence intervals) of 30.1 (8.2-110.4), 3.8 (1.1-12.5) and 3.3 (1.2-9.2), respectively, adjusted for young age (5-7 years) and nighttime pain. Non-ambulatory status and sleep problems exclusively increased the risk of impaired physical and psychological health, respectively, with adjusted ORs (95% CIs) of 58.3 (11.9-284.5) and 7.5 (2.5-22.5). More severe sleep problems were associated with worse pain-related HRQoL.

Conclusions: Sleep, non-ambulatory status and presence of comorbidities are important determinants of HRQoL in children with CP. Monitoring sleep, psychosocial functioning and pain is important in this population, as their management should improve HRQoL.