Abstract
Background: Hospitalization and acute illness expose children to multiple risk factors for sleep disturbances, which may negatively affect recovery and long term cognitive and executive functioning. Sleep problems are highly prevalent in childhood and may be particularly important in children with congenital heart disease (CHD), who already face increased cardiovascular risk. However, evidence on post discharge sleep disturbances in this population is limited.
Methods: In this cross sectional study, children with CHD admitted to the pediatric cardiology ward of Shahid Rajaee Educational and Therapeutic Hospital were enrolled after obtaining institutional approval and parental informed consent. Sleep habits and disturbances after discharge were assessed using the Children’s Sleep Habits Questionnaire (CSHQ). Demographic and clinical data were collected. Data were analyzed using descriptive statistics, appropriate inferential tests, and multivariable regression to examine associations between demographic variables and total CSHQ score.
Results: A total of 100 children were included (45% girls, 55% boys; 40% aged 4–6 years and 60% aged 7–10 years). Most mothers had a high school diploma (50%), and 35% had university education; 45% of fathers had a diploma and 45% had university education. The mean CSHQ total score was 62.4 (SD 10.2; range 38–85), indicating overall moderate sleep quality. Subscale scores showed moderate problems in bedtime resistance, sleep duration, sleep anxiety, night wakings, and daytime sleepiness, good status in sleep onset delay and sleep disordered breathing, and poor status in parasomnias. Total sleep score was significantly associated with sex, age, maternal and paternal education, and number of previous hospitalizations (all P < 0.05). In regression analysis, sex (β = 0.28), age (β = 0.35), maternal education (β = 0.42), and number of hospitalizations (β = 0.50) remained significant predictors of sleep quality (all P < 0.05).
Conclusions: Sleep disturbances after discharge are common in children with CHD and include bedtime resistance, night wakings, sleep anxiety, and daytime sleepiness. Given their potential effects on physical and psychological health and family stress, targeted, family centered interventions and structured post discharge education on sleep should be integrated into routine care. Improving sleep may contribute to better overall outcomes in children with CHD.

Key words: Congenital heart disease (CHD), Sleep disturbances, Post-discharge sleep, Children's Sleep Habits Questionnaire (CSHQ), Pediatric sleep quality