Assessment of sleep quality in pediatric patients using hearing aids and cochlear implants: cross sectionalstudy

Abstract Background Hearing loss in children can negatively impact various developmental domains, but its effect on sleep quality is often overlooked. This study aimed to evaluate and compare the sleep quality of school-aged children with hearing loss using different device modalities—specifically bilateral hearing aids, unilateral cochlear implants, bilateral cochlear implants, and bimodal stimulation—with that of their age- and gender-matched normal-hearing peers. Results Children with hearing loss exhibited significantly higher total sleep disturbance scores compared to the control group (median total T-score: 64.0 vs. 51.0, p < 0.001). Specifically, the study group demonstrated significantly higher disturbances in sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, and sleep hyperhidrosis (all p < 0.001). When comparing the study subgroups based on their specific hearing devices (bilateral hearing aids, unilateral cochlear implants, bilateral cochlear implants, and bimodal users), a significant difference was observed uniquely in the domain of disorders of initiating and maintaining sleep ( p = 0.004); post-hoc analysis confirmed that bilateral cochlear implant users experienced clinical-level difficulties (mean T-score: 74.30 ± 11.10) compared to both bilateral hearing aid (55.80 ± 6.65; adjusted p = 0.006) and unilateral cochlear implant users (58.80 ± 5.67; adjusted p = 0.012). Additionally, a delayed age of hearing device fitting was positively correlated with increased sleep breathing disorders ( r = 0.324, p = 0.030). Conclusions The sleep quality of children with hearing loss is significantly more impaired compared to their normal-hearing peers, particularly concerning breathing, arousal, and sleep transitions. These findings support the clinical hypothesis that daytime auditory fatigue and sensory transition contrasts may negatively influence pediatric sleep architecture. Incorporating routine sleep screenings using standardized tools like the SDSC during audiological follow-ups is critical to facilitate timely multidisciplinary referrals to pediatric sleep specialists and ensure optimal holistic development.