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 efect on sleep quality is often overlooked. This study aimed to evaluate and compare the sleep quality of school-aged children with hearing loss using diferent device modalities—specifcally 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 signifcantly higher total sleep disturbance scores compared to the control group (median total T-score: 64.0 vs. 51.0, p<0.001). Specifcally, the study group demonstrated signifcantly 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 specifc hearing devices (bilateral hearing aids, unilateral cochlear implants, bilateral cochlear implants, and bimodal users), a signifcant diference was observed uniquely in the domain of disorders of initiating and maintaining sleep (p=0.004); post-hoc analysis confrmed that bilateral cochlear implant users experienced clinical-level difculties (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 ftting was positively correlated with increased sleep breathing disorders (r=0.324, p=0.030). Conclusions The sleep quality of children with hearing loss is signifcantly more impaired compared to their normalhearing peers, particularly concerning breathing, arousal, and sleep transitions. These fndings support the clinical hypothesis that daytime auditory fatigue and sensory transition contrasts may negatively infuence pediatric sleep architecture. Incorporating routine sleep screenings using standardized tools like the SDSC during audiological followups is critical to facilitate timely multidisciplinary referrals to pediatric sleep specialists and ensure optimal holistic development.