SLEEP IN CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS

描述（由申请人提供）：大约285,000名美国儿童被诊断患有关节炎，青少年类风湿性关节炎（JRA）是最常见的形式。JRA患儿，无论疾病严重程度如何，均报告睡眠质量差、白天嗜睡、焦虑和情绪改变。充足的睡眠对儿童的健康和正常生长发育至关重要。健康儿童睡眠不足与多动症、注意力持续时间缩短、注意力不集中、冲动、白天过度嗜睡、神经行为表现差、学习成绩下降和旷课率增加有关。JRA患儿的睡眠紊乱可能会对儿童的行为、情绪、学习成绩、进行日常身体和社会活动的能力以及疾病症状（疼痛、僵硬、疲劳）的严重程度产生类似的负面影响。睡眠质量可能是症状严重程度、学习表现以及JRA儿童适应这种慢性疾病的程度的重要预测指标。在我们的初步研究中，我们已经开始在一小部分患有JRA的儿童样本中通过自我报告、行为和生理指标来记录睡眠紊乱的程度。这些数据首次表明，在炎症和关节肿胀最严重的时期，睡眠最受干扰，然而，即使在疾病缓解期间，儿童也抱怨睡眠质量差，白天嗜睡过多。在JRA患儿中，睡眠中断的程度及其对日间功能的影响尚未得到研究。拟议的研究建立在我们的试点研究结果的基础上，其独特之处在于它将使用受试者内部重复测量设计来确定夜间睡眠不良的程度，并评估在关节炎发作和疾病缓解期间睡眠不良对白天嗜睡、神经行为表现、学习成绩和情绪/情感指标的影响。这项研究的结果将为JRA儿童的睡眠质量和白天功能提供关键信息；因此，为临床治疗的发展设定方向，以提高关节炎发作和疾病缓解期间的睡眠质量，因为可能需要不同的治疗策略。

DESCRIPTION (provided by applicant): Approximately 285,000 of America's children have been diagnosed with arthritis, and juvenile rheumatoid arthritis (JRA) is the most prevalent form. Children with JRA, regardless of disease severity, report poor sleep quality, excessive daytime sleepiness, anxiety, and altered mood. Adequate sleep is essential for health and normal growth and development in children. Insufficient sleep in healthy children has been associated with hyperactivity, decreased attention span, distractibility, impulsivity, excessive daytime sleepiness, poor neurobehavioral performance, decrements in school performance, and increased school absenteeism. Disturbed sleep in children with JRA is likely to have similar negative impact on the child's behavior, mood, school performance, ability to carry out daily physical and social activities, as well as disease symptom (pain, stiffness, fatigue) severity. Sleep quality may be an important predictor of symptom severity, school performance, and how well children with JRA adjust to living with this chronic illness. In our preliminary studies, we have begun to document the extent of disturbed sleep by self-report and behavioral and physiological indicators in a small sample of children with JRA. These data show for the first time that sleep is most disrupted during periods when inflammation and joint swelling are most acute, yet children complain of poor sleep quality and excessive daytime sleepiness even during periods of disease remission. The extent of disrupted sleep and its impact on daytime functioning has not been studied in children with JRA. The proposed study builds on our pilot studies findings and is unique in that it will use a within-subject, repeated-measures design to determine the extent of poor nighttime sleep and evaluate the impact of poor sleep on daytime sleepiness, neurobehavioral performance, academic performance, and emotional/affective indicators during both periods of arthritic flare and disease remission. The results of this study will provide key information about sleep quality and daytime functioning in children with JRA; thus setting directions for the development of clinical therapies to enhance sleep quality during periods of arthritic flare as well as disease remission as different treatment strategies likely will be required.