title: Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis.
abstract: OBJECTIVE
  To determine and compare the prevalence of disturbed sleep in JIA and JDM and the relationship of sleep disturbance to pain, function, disease activity and medications.
  
  
  METHODS
  One hundred fifty-five patients (115 JIA, 40 JDM) were randomly sampled and were mailed questionnaires. Sleep disturbance was assessed by the sleep self-report (SSR) and the children's sleep habits questionnaire (CSHQ). Fatigue, pain and function were assessed by the paediatric quality of life inventory (PedsQL) and disease activity by visual analogue scales (VASs). Joint counts were self-reported.
  
  
  RESULTS
  Eighty-one per cent responded, of whom 44% reported disturbed sleep (CSHQ > 41); there were no differences between disease groups. Poor reported sleep (SSR) was highly correlated with PedsQL fatigue (r = 0.56, P < 0.0001). Fatigue was highly negatively correlated with quality of life (r = -0.77, P < 0.0001). The worst pain intensity in the last week was correlated to sleep disturbance (r = 0.32, P = 0.0005). Fatigue was associated with prednisone and DMARD use.
  
  
  CONCLUSIONS
  Sleep disturbance and fatigue are prevalent among children with different rheumatic diseases. Sleep disturbance and fatigue are strongly associated with increased pain and decreased quality of life. Strategies aimed at improving sleep and reducing fatigue should be studied as possible ways of improving quality of life for children with rheumatic illness.
authors.affiliation: Department of Pediatrics, Technion Institution, Pediatric Department Rheumatology Unit, Technion Faculty of Medicine, Meyer Children’s Hospital of Haifa, Haifa, Israel.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Butbul Aviel
authors.forename: Robyn
authors.initials: R
authors.lastname: Stremler
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Benseler
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cameron
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Laxer
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ota
authors.forename: Rayfel
authors.initials: R
authors.lastname: Schneider
authors.forename: Lynn
authors.initials: L
authors.lastname: Spiegel
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Stinson
authors.forename: Shirley M L
authors.initials: SM
authors.lastname: Tse
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications / Q000503:physiopathology*; D002648:Child; D003430:Cross-Sectional Studies; D003882:Dermatomyositis / Q000150:complications / Q000503:physiopathology*; D004185:Disability Evaluation; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires