Avaliação da Qualidade de Vida e do Sono em crianças e adolescentes com Bexiga Neurogênica Secundária à Espinha Bífida

Abstract

Introduction: Children with myelomeningocele (MMC) have a higher prevalence of sleep disorders than the general pediatric population, particularly sleep-related breathing disorders. However, specific information about children with neurogenic bladder (NB) and MMC in the Brazilian population was previously unknown, as were related factors and their possible impact on the quality of life of these patients. Objectives: The primary objective was to determine the prevalence of sleep disorders in children with NB secondary to MMC and to evaluate its association with quality of life, clinical, and demographic factors. The secondary objective was to conduct a systematic review to analyze the prevalence of sleep disorders in children with MMC. Methods: This cross-sectional study involved children aged 8–17 years followed at a multidisciplinary outpatient clinic in Brazil, a reference center for the follow-up of children with spina bifida, between January 2023 and August 2024. Sleep disorders were assessed using the translated and validated Portuguese version of the Sleep Disturbance Scale for Children (SDSC). Quality of life was assessed using the Brazilian versions of QUALAS-C and QUALAS-T. Clinical and demographic data were also collected. Statistical analysis included the Mann-Whitney test, Fisher’s exact test, and binary logistic regression. Results: The sample included 117 patients, 62 (53%) of whom were girls; the median age was 11.9 [9.3–14] years. Sixty-six percent of our population showed some form of sleep disturbance. The most frequent disturbances were sleep-related breathing disorders (42.24%), sleep hyperhidrosis (10.34%), and daytime sleepiness (1.72%). Comparison of quality of life scores between participants with and without sleep disorders revealed no statistically significant differences. The median bladder/bowel domain scores of the QUALAS were 65 [IQR: 50–90] for those with sleep disorders and 67.5 [IQR: 50–93.75] for those without (p = 0.465). Similarly, the median scores in the family/independence domain of the QUALAS were 65 [IQR: 40–83.75] in cases with sleep disorders vs. 67.5 [IQR: 50–93.75] in those without (p = 0.09). We evaluated a possible association between various variables—including age, sex, BMI, mobility, lesion level, presence of hydrocephalus, use of intermittent catheterization, and urinary and fecal continence—and sleep disorders using a logistic regression model. Only age showed a significant association after adjustments (OR = 5.92; 95% CI: 2.52–12.83). Conclusion: Sleep disorders are highly prevalent among children with MMC, particularly in younger children. Screening for sleep disorders using validated questionnaires should be part of the routine care for these patients. Early recognition and management of such disorders may reduce long-term impacts on the neurodevelopment and well-being of this population.