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Sleep disorders in children and adolescents on regular hemodialysis

Abstract

Sleep disorders in children with chronic kidney disease have been assessed in a limited number of studies. Our aim was to characterize the types of sleep disorders in children on regular hemodialysis and to detect the predictors of sleep efficiency in those children. Forty children and adolescents on regular hemodialysis and another 40 age- and gender-matched control groups were interviewed to answer a questionnaire-based survey, a modified Epworth Sleepiness Scale, to assess excess daytime sleepiness. Also, they underwent an overnight in-laboratory polysomnography to assess total sleep time, sleep efficiency, sleep staging, apnea/hypopnea index, and periodic limb movement index. We found poor sleep efficiency in 20% of cases, and periodic limb movement index higher than 5 in 45%, and apnea/hypopnea index higher than 5 in 40%. There was significant negative correlation between sleep efficiency on one hand, and serum potassium, serum creatinine, and sleep onset on other hand (p < 0.001, p < 0.001, and p < 0.001, respectively). There was significant decrease in hemoglobin, serum iron, and transferrin saturation in patients with excess daytime sleepiness (p < 0.001, p = 0.003, and p = 0.010, respectively). By using multivariate linear regression analysis, we found that serum creatinine was the single independent predictor of sleep efficiency.

Conclusion: Poor sleep quality is not uncommon in hemodialysis children. Our results show a lower frequency of sleep disorders in comparison with previous studies. There is a strong association between kidney dysfunction and poor sleep quality in HD children.

What is known:
Sleep disturbances can adversely affect a child’s daytime performance.
• Sleep disorders in children with chronic kidney disease have been assessed in only a limited number of studies.
What is new:
Poor sleep quality is not uncommon in hemodialysis children.
• There is a strong association between kidney dysfunction and poor sleep quality in hemodialysis children.

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Abbreviations

AHI:

apnea/hypopnea index

BP:

blood pressure

CAKUT:

congenital anomalies of kidney and urinary tract

CKD:

chronic kidney disease

EDS:

excess daytime sleepiness

ESRD:

end stage renal disease

ESS:

Epworth Sleepiness Scale

Hb:

hemoglobin

HD:

hemodialysis

HRQOL:

health-related quality of life

PLMI:

periodic limb movement index

PSG:

polysomnography

RLS:

restless leg syndrome

SDB:

sleep disordered breathing

TSAT:

transferrin saturation

TST:

total sleep time

References

  1. 1.

    Beebe DW (2011) Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin N Am 58:649–665

  2. 2.

    O'Brien LM, Gozal D (2004) Neurocognitive dysfunction and sleep in children: from human to rodent. Pediatr Clin N Am 51:187–202

  3. 3.

    Parker KP, Kutner NG, Bliwise DL, Bailey JL, Rye DB (2003) Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis. Health Qual Life Outcomes 1:68

  4. 4.

    Davis ID, Baron J, O'Riordan MA, Rosen CL (2005) Sleep disturbances in pediatric dialysis patients. Pediatr Nephrol 20:69–75

  5. 5.

    Janssen KC, Phillipson S, O'Connor J, Johns MW (2017) Validation of the Epworth sleepiness scale for children and adolescents using Rasch analysis. Sleep Med 33:30–35

  6. 6.

    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

  7. 7.

    Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, Vaughn BV (2017) AASM scoring manual updates for 2017 (version 2.4). J Clin Sleep Med 13:665–666

  8. 8.

    Reed DL, Sacco WP (2016) Measuring sleep efficiency: what should the denominator be? J Clin Sleep Med 12:263–266

  9. 9.

    Witmans MB, Keens TG, Davidson Ward SL, Marcus CL (2003) Obstructive hypopneas in children and adolescents: normal values. Am J Respir Crit Care Med 168:1540

  10. 10.

    Dehlink E, Tan HL (2016) Update on paediatric obstructive sleep apnoea. J Thorac Dis 8:224–235

  11. 11.

    Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, Katz L, Mason TB, Tapia IE (2014) Prevalence of periodic limb movements during sleep in normal children. Sleep 37:1349–1352

  12. 12.

    Weisbord SD, Fried LF, Mor MK, Resnick AL, Unruh ML, Palevsky PM, Levenson DJ, Cooksey SH, Fine MJ, Kimmel PL, Arnold RM (2007) Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol 2:960–967

  13. 13.

    Ito E, Inoue Y (2015) The international classification of sleep disorders, third edition. American Academy of sleep medicine. Includes bibliographies and index. Nihon Rinsho 73:916–923

  14. 14.

    Sabbatini M, Minale B, Crispo A, Pisani A, Ragosta A, Esposito R, Cesaro A, Cianciaruso B, Andreucci VE (2002) Insomnia in maintenance haemodialysis patients. Nephrol Dial Transplant 17:852–856

  15. 15.

    Mucsi I, Molnar MZ, Rethelyi J, Vamos E, Csepanyi G, Tompa G, Barotfi S, Marton A, Novak M (2004) Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 19:1815–1822

  16. 16.

    Darwish AH, Abdel-Nabi H (2016) Sleep disorders in children with chronic kidney disease. Int J Pediatr Adolesc Med 3:112–118

  17. 17.

    El-Refaey AM, Elsayed RM, Sarhan A, Bakr A, Hammad A, Elmougy A, Aboelyazeed AY (2013) Sleep quality assessment using polysomnography in children on regular hemodialysis. Saudi J Kidney Dis Transpl 24:714–718

  18. 18.

    Stabouli S, Papadimitriou E, Printza N, Dotis J, Papachristou F (2016) Sleep disorders in pediatric chronic kidney disease patients. Pediatr Nephrol 31:1221–1229

  19. 19.

    Hanly PJ, Gabor JY, Chan C, Pierratos A (2003) Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis 41:403–410

  20. 20.

    Beecroft J, Duffin J, Pierratos A, Chan CT, McFarlane P, Hanly PJ (2006) Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease. Eur Respir J 28:151–158

  21. 21.

    Davis ID, Greenbaum LA, Gipson D, Wu LL, Sinha R, Matsuda-Abedini M, Emancipator JL, Lane JC, Hodgkins K, Nailescu C, Barletta GM, Arora S, Mahan JD, Rosen CL (2012) Prevalence of sleep disturbances in children and adolescents with chronic kidney disease. Pediatr Nephrol 27:451–459

  22. 22.

    Kawauchi A, Inoue Y, Hashimoto T, Tachibana N, Shirakawa S, Mizutani Y, Ono T, Miki T (2006) Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis. Clin Nephrol 66:440–446

  23. 23.

    Barmar B, Dang Q, Isquith D, Buysse D, Unruh M (2009) Comparison of sleep/wake behavior in CKD stages 4 to 5 and hemodialysis populations using wrist actigraphy. Am J Kidney Dis 53:665–672

  24. 24.

    Iliescu EA, Yeates KE, Holland DC (2004) Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant 19:95–99

  25. 25.

    Ogna A, Forni Ogna V, Haba Rubio J, Tobback N, Andries D, Preisig M, Tafti M, Vollenweider P, Waeber G, Marques-Vidal P, Heinzer R (2016) Sleep characteristics in early stages of chronic kidney disease in the HypnoLaus cohort. Sleep 39:945–953

  26. 26.

    Data from: Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL and Vaughn BV for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.3. www.aasmnet.org. Darien, Illinois: American Academy of Sleep Medicine, 2016

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Author information

Nevine El-baroudy: the principle investigator- revising the manuscript. Mona El Falaki: the coordinator of the team work – revising the manuscript. Amal Hagras: Handling the renal patients as regard to investigations and time plan. Rasha Galal: sharing the nephrology team in handling and managing renal patients – revising the manuscript. Radwa Azmy: managing the Sleep lab and sharing in writing the manuscript. Basma El-sayed: managing the sleep lab. Marian Walaan: handling the logistics and handling patients between nephrology unit and sleep lab. Happy Sawires: handling statistics – writing the manuscript – submitting the manuscript (the corresponding author).

Correspondence to Happy Sawires.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

An informed consent was obtained from patients’ caregivers.

Human and animal rights

The research does not include animals and there were no clinical trials on human subjects.

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Communicated by Mario Bianchetti

Appendix

Appendix

Epworth Sleepiness Scale—Children

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, think about how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = would never doze or sleep, 1 = slight chance of dozing or sleeping, 2 = moderate chance of dozing or sleeping, and 3 = high chance of dozing or sleeping.

  1. 1.

    Sitting and reading

  2. 2.

    Watching television

  3. 3.

    Sitting inactive in a public place (for example, a movie theater or classroom)

  4. 4.

    As a passenger in a car for an hour without a break

  5. 5.

    Lying down to rest in the afternoon when circumstances permit

  6. 6.

    Sitting and talking to someone

  7. 7.

    Sitting quietly after lunch

  8. 8.

    In a car, while stopped for a few minutes in traffic

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Cite this article

El-baroudy, N., El Falaki, M., Hagras, A. et al. Sleep disorders in children and adolescents on regular hemodialysis. Eur J Pediatr (2020). https://doi.org/10.1007/s00431-020-03611-w

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Keywords

  • Sleep quality
  • AHI
  • PLMI
  • Sleep efficiency
  • Hemodialysis