JPP Student Journal Club Commentary: Sleep in Youth With Chronic Health Conditions: Expanding Models to Understand Complexity in Youth With Comorbid Conditions.

Reynolds and colleagues (2018) highlight the role that comorbid medical conditions play in exacerbating negative quality of life outcomes for pediatric populations. They demonstrated that in minority youth with persistent asthma, those with more comorbid conditions also experienced, on average, poorer sleep and academic outcomes. More specifically, higher cumulative risk index (CRI) scores (i.e., more comorbidities) were significantly related to decreased sleep duration and increased school absences. CRI scores were also assessed as a moderator between asthma-related lung function and sleep and academic functioning. They found that better lung function was associated with better sleep efficiency for individuals with one comorbid condition; CRI scores did not moderate the relationships among the remaining models. Multiple comorbidities may create a more complex picture for understanding the relationship between lung function and sleep quality. Additionally, higher sleep-disordered breathing (SDB) risk was associated with more school absences in the full sample and in the Latino group, but not for the African-American group. However, African-American children had higher rates of SDB risk than Latino children. This work contributes to the literature on sleep problems in youth and underscores the compounding impact of chronic medical conditions on functional outcomes. However, certain familyand cultural-level components were not fully explored, and further research is needed to better understand the complex relationships between comorbidities of chronic health conditions and sleep quality. Factors that potentially impact children’s sleep are critical to investigate, particularly in pediatric populations, given that sleep problems contribute to negative cognitive, academic, and socioemotional outcomes and approximately 50–70% of children with chronic medical and/or neurodevelopmental conditions experience sleep problems (Evans, Djilas, Seidman, Zeltzer, & Tsao, 2017; Köse, Yilmaz, Ocako glu, & € Ozbaran, 2017). While the current study demonstrated a strong relationship between comorbid conditions and sleep quality, other unexplored areas may provide additional explanation for these findings, including socioeconomic status (SES), cultural differences in sleep practices and beliefs, and parent knowledge of healthy child sleep. This commentary will discuss the possible contribution of these three variables to the results found by Reynolds and colleagues and provide suggestions for future directions. Obtaining a more comprehensive view of the factors that impact sleep and other quality of life outcomes is especially important for youth with chronic medical conditions. Ethnicity and SES appear to impact the amount and quality of children’s sleep. While the current study investigated group differences in sleep by ethnicity, the authors did not thoroughly explore the potential impact of SES. Consistent with prior research demonstrating that SES plays a role in sleep quality (Buckhalt, 2011; Buckhalt, El-Sheikh, & Keller, 2007; El-Sheikh, Kelly, Buckhalt, & Benjamin Hinnant, 2010), Reynolds and colleagues (2018) found that the relationship between poverty status and sleep duration in the overall sample approached significance.