Pediatric sleep and pain: etiologies, consequences, and clinical considerations

Abstract

Study objectives: To examine current evidence of the relationship between sleep and pain from the neonatal period through adolescence. This review serves as a critical review of the literature and of the needs for future research on pediatric sleep and pain.

Methods: The PubMed online database was queried from January 1, 1960, to March 1, 2020, producing 149 articles applicable to pain and sleep in the pediatric population. Of those, 97 articles were cited in this review with the key articles including over 3800 participants.

Results: The pediatric literature supports the relationship between poor sleep (both sleep efficiency and nighttime awakenings) and subsequent risk for pain, especially among children with chronic disease. The reverse effect of pain on sleep is not yet well delineated. The key moderating factors explored in the literature are pharmacologic and nonpharmacologic therapies, psychologic health, and the etiology of pain. There is evidence that both altered sleep and pain early in life impact neurodevelopment, as seen by changes in sleep structure in clinical studies and alterations in brain development in animal models.

Conclusions: The complicated relationship between sleep and pain is critically important during pediatric development when alterations to a normal sleep structure can have a lifelong impact. It is becoming clear that sleep deprivation and poor sleep quality exacerbate pain. Further research is needed into the complex alterations of sleep in chronic pain conditions as well as treatments to improve sleep in pediatric care.

Citation: Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med. 2022;18(9):2281-2289.

Keywords: neonatal; neurodevelopment; pain; pediatric; sleep.

Figure 1. Flow diagram of studies reviewed for inclusion.

NICU = neonatal intensive care unit, PICU = pediatric intensive care unit.

Figure 2. Relationship between pediatric sleep, pain, and neurodevelopment.

Demonstrates moderating factors as well as the way in which sleep restriction and sleep disorders exacerbate pain through the activation of inflammatory mediators, decreased lower endogenous opioids and the downregulation of opioid receptors, and limbic changes resulting in cingulate cortical changes that correlate with adverse emotional responses to pain, and by promoting a chronic wind-up of the pain system at the level of the thalamus lowering the threshold for pain signals to be transmitted.