Background: epidemiological studies reported an increased incidence of central precocious puberty (CPP) during the last year compared to previous year. Confinement measures and consequent daily routine modifications applied to contain coronavirus infectious disease-19 (COVID-19) contagion have been proposed as a cause of this phenomenon. Our study aims in investigating changes in CPP rates in a tertiary paediatric endocrinology outpatient clinic of South Italy, where school closure and lockdown measures were particularly severe, compared to past year. Moreover, we evaluated sleep patterns and disturbances differences between girls with CPP and healthy controls paying attention to changes before and during lockdown.
Methods: CPP cases were retrospectively evaluated in the period from April 2020 to April 2021. Clinical and biochemical characteristics of lockdown cases were compared to those before lockdown from April 2019 to April 2020. Parents of girls diagnosed with CPP during lockdown and of matched healthy controls filled out a questionnaire about sleep disturbances (SDSC questionnaire) and sleep schedules.
Results: thirty-five girls were diagnosed with CPP during lockdown, whereas the previous year only 14 cases were registered. Clinical and biochemical characteristics did not differ between the two groups. A total of 72 parents-girls pairs (35 CPP and 37 controls) completed the survey. Sleep disturbance rates did not differ between CPP and controls before lockdown (all P > 0.05). Conversely, during lockdown, parents of girls with CPP reported higher rates of sleep disturbs compared to controls: global score 31.4% versus 5.3% (P = 0.005), excessive somnolence (DES) 17.1% versus 2.6% (P = 0.049), sleep breathing disorders (SBD) 17.1% versus 2.6% (P = 0.049), and sleep-wake transition disorders (SWTD) 25.7% versus 2.63 (P = 0.005). No differences were found for disorders in initiating and maintaining sleep (DIMS), disorders of arousal (DOA), and sleep hyperidrosis (SH). Moreover, CPP group showed significant higher rates in shifting toward later bedtime (40.3% vs 17.7%, respectively, P = 0.03) during lockdown compared to controls. Conversely, total hours of sleep and smartphone exposure around bedtime did not differ significantly between the two groups.
Conclusions: our study confirms the observation of increased incidence of CPP after lockdown measures. Additionally, in our population, girls with CPP showed higher rates of sleep disturbances and later bedtime compared to controls. Puberty timing is a complex phenomenon and sleep hormones play a role in hypothalamus-pituitary-gonadal axis maturation. The causality link between sleep disturbances and CPP should be further investigated to gain knowledge in this association.
22 Sep 2021 - 26 Sep 2021