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Sleep disturbances in pediatric dialysis patients

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Abstract

Sleep disorders are common in adult dialysis patients, with a prevalence of 60%–80%. To date, sleep disturbances have not been assessed in the pediatric dialysis population. Therefore, the objective of this study is to describe the prevalence of sleep disturbance symptoms in a pediatric dialysis population. We conducted a telephone- or clinic-based interview of 21 children (aged 6–20 years) and their parents in our academic tertiary pediatric dialysis center with questionnaires that assessed four symptom domains of sleep disorders: (1) sleep-disordered breathing, (2) restless leg syndrome or period limb movements (RLS/PLMs), (3) excessive daytime sleepiness, and (4) inadequate sleep time. The presence of a “sleep disturbance” was defined by positive responses in any of the four symptom domains. Overall, 18 (86%) of the children undergoing dialysis [mean age (SD) 14.2 years (1.1), gender (M/F) 11/10] endorsed sleep disturbance symptoms: sleep-disordered breathing (46%), RLS/PLMs (29%), and excessive daytime sleepiness (60%). We conclude that sleep disturbances are very common in pediatric dialysis patients, but may be underrecognized. Given the adverse neurocognitive and physiological outcomes associated with poor sleep, it is important for practitioners caring for children on dialysis to anticipate and screen for treatable sleep conditions.

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Acknowledgement

The authors wish to thank Ellis D. Avner, MD for his critical review of this manuscript and Melanie Klein, CNP, Lisa Metz, RN, and Patricia Minshall, RN for their hard work and dedication in the care of these children and their assistance in the data collection for this report.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Rainbow Babies and Children’s Hospital/University Hospitals of Cleveland, Case University School of Medicine, Cleveland, Ohio, USA

    Ira D. Davis, Mary Ann O’Riordan & Carol L. Rosen

  2. Department of Pediatric Neurology, Tufts-New England Medical Center, 750 Washington Street, Boston, Massachusetts, USA

    Joshua Baron

  3. Rainbow Babies and Children’s Hospital, MS 6003, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA

    Ira D. Davis

Authors
  1. Ira D. Davis
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  2. Joshua Baron
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  3. Mary Ann O’Riordan
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  4. Carol L. Rosen
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Corresponding author

Correspondence to Ira D. Davis.

Appendices

Appendix A

Questionnaire used to assess sleep habits, symptoms of RLS/PLMs, and presence of snoring

The following questions used to assess sleep habits were given to patients and parents:

1:

What time do you/your child go to bed on school nights and weekend nights?

2:

What time do you/your child usually fall asleep on school nights or weekend nights?

3:

What time do you/your child awaken on school nights or weekend nights?

4:

Do you/your child take naps during the day (not including HD days)? If yes, how many hours?

The following are questions given to parents only:

1:

In the past month, have you ever watched your child sleeping?

2:

It can be normal to have a jerk or sudden body movement just as you fall off to sleep, but have you ever seen his/her legs jerk or move “periodically”, every 20–40 s while asleep? If yes: how many nights a week have you seen these kinds of jerks or movements (5 or more times, 2–4 times, 0–1 times)? If no: would you be willing to watch your child after he or she falls asleep at night for 15–20 min and see if these leg jerks or movements are present? If yes: patients and parents were notified that they would be contacted the next day to record their observations.

3:

In the past month, has your child complained of creeping, crawling, or uncomfortable, funny feelings in his/her legs or arms? If yes: how many times does this occur in a week (5 or more times, 2–4 times, 0–1 times)? Has he/she ever asked you to rub or massage his/her legs because of these feelings (yes, no, not sure)? Does he/she move around to make these feelings go away (yes, no, not sure)? Do these feelings seem to make it hard for your son/daughter to get to sleep (yes, no, not sure)? Does your child complain that these feelings ever wake him/her up at night (yes, no, not sure)? Does your child ever complain that these feelings make it hard for him/her to get back to sleep when he/she wakes up (yes, no, not sure)?

4:

Does your child have difficulty breathing when asleep (0=never, 1=not often, 1 night/week, 2=sometimes, 1–2 nights/week, 3=often, 3–5 nights/week, 4=always, 6–7 nights/week)?

5:

Does your child stop breathing during sleep (0=never, 1=not often, 1 night/week, 2=sometimes, 1–2 nights/week, 3=often, 3–5 nights/week, 4=always, 6–7 nights/week)?

6:

Does your child snore (0=never, 1=not often, 1 night/week, 2=sometimes, 1–2 nights/week, 3=often, 3–5 nights/week, 4=always, 6–7 nights/week)?

The following questions regarding symptoms of RLS were answered only by the patient:

1:

In the past month, especially in the evening or right before bedtime, do you ever have creeping, crawling, or uncomfortable, funny feelings in your legs or arms?

2:

If yes: are these feelings made better by moving (yes, no, not sure)?

3:

Are these feelings made better by rubbing your legs (yes, no, not sure)?

4:

Are these feelings made better by rubbing your legs (yes, no, not sure)?

5:

Do these feelings make it hard for you to get to sleep? (yes, no, not sure)?

6:

Do these feelings ever wake you up? (yes, no, not sure)?

7:

Do these feelings make it hard for you to get back to sleep when you wake up (yes, no, not sure)?

8:

Do these feelings get worse when you are lying down or sitting still (yes, no, not sure)?

9:

Do these feelings get worse late in the day and at night (yes, no, not sure)?

Appendix B

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.:

Sitting and reading

2.:

Watching television

3.:

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

4.:

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

5.:

Lying down to rest in the afternoon when circumstances permit

6.:

Sitting and talking to someone

7.:

Sitting quietly after lunch

8.:

Doing homework or taking a test

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Davis, I.D., Baron, J., O’Riordan, M.A. et al. Sleep disturbances in pediatric dialysis patients. Pediatr Nephrol 20, 69–75 (2005). https://doi.org/10.1007/s00467-004-1700-0

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