Sleep disturbance in pediatric patients on automated peritoneal dialysis

Abstract

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.

Keywords: Children; Peritoneal dialysis; Polysomnography; Sleep disturbance.