ESPE Abstracts

Introduction: Cortisol secretion is circadian-driven and plays a significant role in sleep quality. In children with congenital adrenal hyperplasia (CAH) hydrocortisone is the preferred treatment. Hydrocortisone has a short half-life producing alternating hyper- and hypocortisolemia, a non-physiologic cortisol profile, likely disrupting sleep. However, minimal literature exists on sleep health in children with CAH.

Objective: A pilot study evaluating sleep health in children with CAH.

Methods: Children ages 3-15 with CAH were recruited from a multidisciplinary CAH center and wore an Actigraph Link accelerometer watch for one week; objective sleep measures (duration, latency, night wakings, and sleep efficiency) were estimated. Children 8-18 years completed the Children’s Report of Sleep Patterns (CRSP) questionnaire; parents of children 3-10 years completed the Children’s Sleep Habits Questionnaire (CSHQ). This data was compared to published community and clinical samples of same-aged children using linear regression and T-tests.

Results: The sample included 44 children (23 males, mean-age 8.45 years) diagnosed with CAH (25 salt-wasting) on circadian hydrocortisone dosing. Average actigraphy-estimated total sleep time per night was 7.45 hours. None of the children met clinical guidelines for age-specific minimum sleep hours. The average number of night awakenings was highest (average 6 per/hr) between 5-8 hours post hydrocortisone dose, corresponding to elimination of cortisol. Children with CAH had 40.9% more wake time after sleep onset, 38.6% had lower sleep efficiency, and 6.8% had longer sleep latency compared to published healthy controls. Parents of children with CAH (n=30) reported significantly worse CSHQ scores for bedtime resistance, sleep onset delay, and sleep duration versus children with sleep disorders (n=154; P-values<0.05), and for every subscale versus healthy controls (n=469; P-values<0.05) except disordered breathing. There were significant differences (P-values<0.008) in the self-reported CRSP sleep subscales of bedtime worries and restless legs in the 13-18 years age group compared to both community and clinical samples but no differences in the 8-12 age group. However, the 8-12 age group reported increased nighttime awakenings compared to the combined community/clinical sample and worse in the insomnia subscale compared to the community sample, but the differences were not significant.

Conclusion: The objective data showed that children with CAH did not meet recommendations for total sleep time and had more nighttime awakenings compared to peers. With the peak number of awakenings corresponding to when cortisol concentration from the evening hydrocortisone dose was mostly eliminated suggests that impaired circadian secretion of cortisol detrimentally impacts sleep quality.