The Impact of Sleep on Neurologic and Neurocognitive Complications in Children With Sickle Cell Disease: A Scoping Review.

Sleep-disordered breathing (SDB), characterized by sleep fragmentation and hypoxia, is a prevalent yet underappreciated complication in children with sickle cell disease (SCD). The interplay between SDB and neurologic outcomes in SCD, including stroke and cognitive impairment, is an area of emerging clinical concern. The aim of this review is to provide an overview and synthesis of available data to improve understanding of the impact sleep disruption and SDB have on neurologic and neurocognitive complications in children with SCD. We conducted a comprehensive literature search across databases including Medline, PubMed, and Cochrane from inception to March 2023. Studies assessing neurologic outcomes (e.g., stroke, silent cerebral infarcts) or cognitive function in children with SCD in relation to SDB were included. A total of 542 studies were screened, with 21 meeting inclusion criteria. SDB was associated with adverse neurologic outcomes, including increased stroke risk, higher transcranial Doppler velocities, and cerebral vasculopathy. Neurocognitive deficits, including reduced IQ, verbal comprehension, and executive function, were linked to nocturnal hypoxemia and fragmented sleep. Treatment interventions such as adenotonsillectomy and positive airway pressure improved sleep quality and mitigated neurocognitive deficits. SDB exacerbates the neurologic burden in children with SCD through pathways involving hypoxia, oxidative stress, and inflammation. Screening and timely intervention for sleep disorders in this population are crucial to improving neurologic and cognitive outcomes.