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Sleep disorders in children and adolescents on regular hemodialysis


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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Fig. 1
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Fig. 3



apnea/hypopnea index


blood pressure


congenital anomalies of kidney and urinary tract


chronic kidney disease


excess daytime sleepiness


end stage renal disease


Epworth Sleepiness Scale






health-related quality of life


periodic limb movement index




restless leg syndrome


sleep disordered breathing


transferrin saturation


total sleep time


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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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The authors declare that they have no conflict of interest.

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An informed consent was obtained from patients’ caregivers.

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

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Communicated by Mario Bianchetti



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