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Sleep disturbance in pediatric patients on automated peritoneal dialysis
Cláudia Gomes1, Lia Oliveira1, Rosário Ferreira2
1Department of Pediatrics, Hospital de Santa Maria, CHLN - Academic Medical Centre of Lisbon, Lisbon, Portugal.
Insights
Sleep disturbance is common in children on automated peritoneal dialysis (APD), affecting over half of patients. Polysomnography (PSG) revealed decreased sleep efficiency and increased awake time, highlighting the need for screening in pediatric chronic kidney disease (CKD).
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Clinical Research
Background:
- Limited research exists on sleep disturbance (SD) in children undergoing automated peritoneal dialysis (APD).
- Previous studies primarily relied on questionnaires, with few utilizing polysomnography (PSG), the diagnostic gold standard.
- This study represents the first assessment of SD in children with chronic kidney disease (CKD) on APD within the country.
Purpose of the Study:
- To investigate the prevalence and characteristics of sleep disturbance in children with CKD treated with APD.
- To compare objective PSG findings with subjective reports from a sleep questionnaire.
Main Methods:
- An observational, descriptive study involving children under 18 on APD for at least three months.
- Exclusion criteria included diabetes, neurological disorders, and sedative/hypnotic use.
- Polysomnography (PSG) was conducted during nocturnal dialysis, followed by a sleep questionnaire on the same day.
Main Results:
- Eight children (median age 10 years) on APD were studied.
- Sleep disturbance was identified in 62.5% of patients via PSG.
- PSG revealed reduced sleep efficiency, prolonged sleep latency, increased awake time, and elevated apnea/hypopnea and desaturation indices.
Conclusions:
- Over half of the studied children on APD experienced sleep disturbance.
- Subjective questionnaire data underestimated the objective findings from PSG.
- Systematic screening for sleep problems is recommended for children with CKD on APD, with a low threshold for formal PSG.
Objective:
There are few reports describing sleep disturbance (SD) in children on automated peritoneal dialysis (APD), and they are mostly based on the application of questionnaires. As far as we know, only two studies used polysomnography (PSG), the gold standard for the diagnosis of SD. This is the first study assessing SD in children with chronic kidney disease (CKD) on APD in our country.
Methods:
This was an observational and descriptive study. Children up to 18 years of age who had undergone APD for a minimum of three months were considered eligible. Exclusion criteria were diabetes, neurologic disorders and sedative/hypnotic therapy. PSG was performed while the children were on their usual cycler nocturnal dialysis regimen. A questionnaire was completed on the same day. Informed, written consent was provided by all participants.
Results:
Eight children on APD were studied. The median age was 10 years (range, 1-18 years) and the mean body mass index z-score was -0.35 (±0.71). The average duration on dialysis was 8.4 months. SD was noted in five (62.5%) patients. The results of PSG showed decreased sleep efficiency (81.05 ± 0.09%) and latency (13.6 ± 11.6 min), increased awake time (23.08% of total sleep time (TST) ± 14.3), apnea/hypopnea index (1.8/h ± 1.9) and desaturation index (4.5 ± 3.7). Periodic leg movements index average was normal (0.78/h ± 0.77). Subjective data obtained by the sleep questionnaire underestimated PSG findings.
Conclusion:
Our study shows that SD was present in more than half of children on PD. This result, in a small sample of patients, alerts to the need for systematic screening for sleep problems in children with CKD with a low threshold for a formal PSG.