Sleep Health and Quality of Life in Children and Adolescents with NF1: A Biopsychosocial Perspective

Background: This study applies Buysse’s sleep health framework to examine sleep in children and adolescents with neurofibromatosis type 1 (NF1). By examining sleep timing, daytime sleepiness, sleep quality, sleep behavior, sleep duration, and sleep efficiency together, this framework captures the multidimensional nature of sleep and its relationship with biopsychosocial factors and health-related quality of life (HR-QoL) in NF1. Methods: This multi-site, prospective, cross-sectional study included 131 children and adolescents with NF1 and 71 typically developing (TD) controls aged 6 to 16 years. A sleep health composite was derived from carer rating scales and 7 days of actigraphy. A biopsychosocial framework was used to examine factors associated with sleep health in NF1, including sociodemographic, cognitive, psychopathology, and biological variables. Independent predictors of QoL were examined to assess the unique contributions of sleep quality, sleep duration, and previously established predictors of HR-QoL in NF1. Results: Poorer sleep health was evident in children with NF1. Compared with TD controls, children with NF1 were five times as likely to have poor sleep quality, with almost 78% demonstrating impaired sleep efficiency and nearly half not obtaining sufficient sleep at night. The strongest risk factors were being male, elevated pain, and having greater levels of ADHD and autism spectrum disorder traits. Conclusions: Findings suggest sleep health in NF1 is interconnected with multiple biopsychosocial factors. A better understanding of these relationships will help identify early risk markers, improve prediction of clinical trajectories, and guide the development of targeted multimodal interventions for sleep disruption in NF1.