Abstract / Summary
Background/Objectives: Sleep across the transfusion cycle remains understudied in children with transfusion-dependent β-thalassemia (TDT). We assessed sleep patterns and hematologic correlates before and after transfusion. Methods: This prospective, controlled, repeated-measures study included 27 children with TDT and 30 controls who had been frequency-matched at recruitment on age, sex, and school-attendance category; no fixed one-to-one patient–control pairs were formed. Participants completed 14-day sleep diaries spanning the pre- and post-transfusion weeks and repeated Children’s Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) assessments. The three primary outcome domains were sleep-diary measures (including sleep regularity, daytime nap frequency, sleep-duration variability, and nocturnal awakenings), continuous CSHQ total and subscale scores, and the continuous modified PSQI global score. Threshold classifications, individual questionnaire items, and laboratory/MRI associations were exploratory. Multiplicity was controlled within the diary and questionnaire families using the Benjamini–Hochberg false discovery rate (FDR). Results: Within the primary sleep-diary domain, weekday sleep irregularity was greater in patients pre-transfusion (16.3 vs. 10.2 min; q = 0.014) but not post-transfusion (q = 0.220); sleep-duration variability was greater before and after transfusion (both q = 0.026), and diaries recorded more daytime naps and more and longer nocturnal awakenings across 14 days (q < 0.05). Within the primary questionnaire domains, the continuous modified PSQI global score and CSHQ total, sleep-behavior, and daytime-sleepiness scores were higher in patients pre-transfusion (all q < 0.001). In exploratory, unadjusted analyses, lower pre-transfusion hemoglobin correlated with greater daytime sleepiness (ρ = −0.425; p = 0.027). Conclusions: Multiplicity-adjusted findings across the three primary outcome domains suggest differences in reported sleep timing, regularity, continuity, daytime napping, and questionnaire scores in children with TDT. However, the small sample, the number of component outcomes and contrasts, and the absence of actigraphy require cautious interpretation.