Impact of psychosocial status on sleep quality in adolescents with childhood-onset systemic lupus erythematosus

BACKGROUND: Adequate sleep is essential for neurodevelopment and immune regulation, yet adolescents with childhood-onset systemic lupus erythematosus (cSLE) are at high risk for sleep disturbances. While these associations are well-documented in adults, data on the pediatric population remains limited. This study evaluated sleep quality in Indonesian adolescents with cSLE and examined its association with psychosocial distress. METHODS: This cross-sectional study enrolled 60 adolescents (aged 10-18 years) diagnosed with cSLE at a tertiary hospital in Bandung, Indonesia. Psychosocial status was screened using the Pediatric Symptom Checklist-17 (PSC-17), and sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI). Disease activity was measured using the MEX-SLEDAI. The data were analyzed using Chi-squared or Fisher's exact tests as appropriate and Spearman correlations. A p-value less than or equal to 0.05 was deemed significant. RESULTS: The prevalence of poor sleep quality (PSQI ≥ 5) was 41.7%, while 18.3% of participants exhibited psychosocial distress, predominantly in the internalizing domain (16.7%). A significant association was found between psychosocial distress and poor sleep quality (p = 0.039). Adolescents with psychosocial distress had a 2.10 times higher risk of poor sleep (95% CI: 1.24-3.55). Notably, inpatient status was significantly associated with worse sleep compared to outpatients (p = 0.030). PSC-17 scores showed a positive correlation with total PSQI scores (r = 0.301, p = 0.019) and were specifically linked to the daytime dysfunction dimension (r = 0.365, p = 0.004). CONCLUSION: Poor sleep quality is common among adolescents with cSLE and is significantly associated with psychosocial distress, particularly reflected in daytime dysfunction. These findings support integrating routine screening of sleep quality and psychosocial distress into comprehensive cSLE care and highlight the need for larger longitudinal studies to clarify causal pathways and identify modifiable drivers of sleep disturbance.