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Prevalence of sleep disordered breathing in children with chronic kidney disease
Naresh Kumar1, Roselin Juliet Joice2, Roshni Julia Rajan3
1Department of Paediatric Nephrology, Christian Medical College, Tamil Nadu, Vellore, India.
Insights
Sleep disordered breathing (SDB) affects nearly half of children with chronic kidney disease (CKD), even in early stages. Severity increases with CKD progression, highlighting the need for SDB screening in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Cardiorespiratory Health
Background:
- Sleep disordered breathing (SDB) is a common comorbidity in children with chronic kidney disease (CKD).
- Previous estimates suggest SDB affects up to 62% of pediatric CKD patients.
- This study investigates SDB prevalence and severity across CKD stages 2-5 using polysomnography (PSG).
Purpose of the Study:
- To determine the prevalence and severity of SDB in children with CKD stages 2-5.
- To compare SDB indices between early (stage 2) and advanced (stages 3-5) CKD.
- To assess the utility of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) in identifying SDB in this population.
Main Methods:
- Observational, cross-sectional study conducted in South India (March-December 2023).
- Enrolled 36 children (aged 5-18) with CKD stage ≥2, including dialysis and post-transplant patients.
- Utilized polysomnography (PSG) and ESS-CHAD for SDB assessment; analyzed apnea-hypopnea index (AHI) for obstructive sleep apnea (OSA) diagnosis.
Main Results:
- Overall OSA prevalence was 47%, despite only 6% reporting symptoms via ESS-CHAD.
- OSA was present in 50% of children with early-stage CKD (stage 2).
- Moderate to severe OSA was predominantly observed in children with advanced CKD (stages 3-5).
Conclusions:
- Sleep disordered breathing is highly prevalent across all stages of pediatric chronic kidney disease.
- SDB severity significantly correlates with advancing stages of CKD.
- Routine PSG screening for SDB is crucial in children with CKD, irrespective of reported symptoms.
Background:
Sleep disordered breathing (SDB) is reported in nearly 62% of children with chronic kidney disease (CKD). We report the prevalence and severity of SDB in children with CKD stages 2-5 using polysomnography (PSG).
Methods:
This observational, cross-sectional study was conducted in the pediatric nephrology outpatient clinic and sleep medicine laboratory at a tertiary care center in south India from March to December 2023. We enrolled children aged 5-18 years, with CKD stage ≥ 2, including dialysis-dependent and 3 months post-kidney transplantation, and performed the Epworth Sleepiness Scale questionnaire for Children and Adolescents (ESS-CHAD) and PSG after obtaining informed consent. Age-specific values of apnea hypopnea index (AHI) were used to diagnose and measure obstructive sleep apnea (OSA). Comparisons between PSG indices were performed between children with early CKD (stage 2) and advanced CKD (stages 3 to 5 T).
Results:
Among the 36 patients (75% males) with CKD enrolled, even though only 2 (6%) clinically reported SDB as per ESS-CHAD, an overall prevalence of 47% of OSA was observed. Though increasing prevalence and severity was found with increasing stages of CKD, a significant proportion of patients with CKD 2 (50%) had OSA. Moderate to severe OSA was noted only in patients with advanced CKD.
Conclusion:
SDB is prevalent in all stages of CKD in children, with greater severity in higher stages of CKD.
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