title: Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis.
abstract: OBJECTIVE
  To determine what sleep abnormalities may exist in children with juvenile rheumatoid arthritis (JRA). and their relationship to pain, dysfunction. and disease activity.
  
  
  METHODS
  Twenty-five children with active JRA (11 pauciarticular, 9 polyarticular, 5 systemic) had their sleep assessed by parallel, validated patient and parent questionnaires (Sleep Self-Report, SSR, and Children's Sleep Habits Questionnaire, CSHQ). Disease activity was assessed by parent and physician global assessments (on a 5 point scale: 0 = no disease activity to 4 = very severe disease), erythrocyte sedimentation rate (ESR), and numbers of swollen and limited joints. Functional assessment was based on parental completion of the Juvenile Arthritis Functional Assessment Report (JAFAR). Pain was assessed by the average pain visual analog scale of the Varni Pediatric Pain Questionnaire. Results were compared to those from 45 healthy age and sex matched controls by Mann-Whitney U tests, and correlated with variables of JRA disease activity, function, and pain using Spearman correlations.
  
  
  RESULTS
  Patients with JRA had higher total score on the CSHQ (p < 0.0001), as well as subscales assessing night wakings, parasomnias. sleep anxiety, sleep-disordered breathing, and morning wakening/daytime sleepiness (p < 0.0001-0.05). There were no correlations between CSHQ scores and JRA disease activity or pain variables, but the total score on the SSR did correlate with pain (r = 0.56, p = 0.005).
  
  
  CONCLUSIONS
  We conclude that sleep abnormalities are common in children with JRA, and are multi-dimensional.
authors.affiliation: Department of Pediatrics, Hasbro Children's Hospital and Brown University School of Medicine, Providence, RI 02903, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Bloom
authors.forename: Judith A
authors.initials: JA
authors.lastname: Owens
authors.forename: Melissa
authors.initials: M
authors.lastname: McGuinn
authors.forename: Chantelle
authors.initials: C
authors.lastname: Nobile
authors.forename: Leah
authors.initials: L
authors.lastname: Schaeffer
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alario
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D001171:Arthritis, Juvenile / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D002648:Child; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D010147:Pain Measurement; D020447:Parasomnias / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires