title: Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review.
abstract: BACKGROUND
  Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (or JIA). However, little is known about the frequency and severity of sleep disturbance(s) and the factors that are associated with sleep problems in children with JIA. The mechanism(s) of the relationships characterizing the development or exacerbation of sleep problems in children with JIA are still unknown, however studies have reported an association. The purpose of this study was to synthesize existing research related to sleep problems in children with JIA.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. An experienced librarian conducted searches in MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to January 2012, to identify potentially relevant citations. Two members independently selected, rated methodological quality using the QUIPS tool, and extracted data from included studies.
  
  
  RESULTS
  Ten studies were included and findings varied across studies; studies were mostly cross-sectional, or case-controlled designs, with only one cohort study available. Four studies found that children and adolescents diagnosed with JIA had significantly more sleep disturbances when compared to healthy controls. Pain was most often associated with sleep disturbances. The heterogeneous findings highlight the complex relationships between JIA and sleep, and low methodological quality of studies in the field.
  
  
  CONCLUSIONS
  This review supports an association between poor sleep and increased symptoms related to JIA, specifically the experience of pain. However, results need to be interpreted cautiously given the inconsistent findings regarding factors associated with sleep problems in JIA, the limited evidence available, and its low quality. Furthermore it is not yet determined if the poor sleep patterns predate the symptoms reported with JIA. More research is vital to understanding the factors that predict or perpetuate poor sleep in children and adolescents diagnosed with JIA.
authors.affiliation: Departments of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada ; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada ; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Stinson
authors.affiliation: Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova scotia, Canada.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hayden
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada ; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Ahola Kohut
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada ; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Charlene
authors.initials: C
authors.lastname: Soobiah
authors.affiliation: Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova scotia, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Cartwright
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shelly K
authors.initials: SK
authors.lastname: Weiss
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Manisha B
authors.initials: MB
authors.lastname: Witmans
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications*; D002648:Child; D006801:Humans; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology / Q000523:psychology
keywords: Juvenile idiopathic arthritis; Prognostic factor; Sleep problems; Systematic review