Sleep and fatigue symptoms in children and adolescents with CKD: a cross-sectional analysis from the chronic kidney disease in children (CKiD) study

Abstract

Background: Although symptoms of sleepiness and fatigue are common in adults with chronic kidney disease (CKD), little is known about the prevalence of these symptoms in children with CKD.

Study design: Cross-sectional analysis within a cohort study.

Setting & participants: We describe the frequency and severity of sleep problems and fatigue and assess the extent of their association with measured glomerular filtration rate (mGFR) and health-related quality of life (HRQOL) in 301 participants of the Chronic Kidney Disease in Children cohort.

Outcomes & measurements: Sleep and fatigue-related items from the Pediatric Quality of Life Inventory 4.0 Generic Scales and the CKD-related Symptoms List were used.

Results: Median mGFR was 42.0 mL/min/1.73 m(2) (25th-75th percentiles, 31.2-53.2), and median age was 13.9 years (25th-75th percentiles, 10.8-16.2). Children with mGFR of 40-<50, 30-<40, or <30 mL/min/1.73 m(2) had 2.07 (95% CI, 1.05-4.09), 2.35 (95% CI, 1.17-4.72), and 2.59 (95% CI, 1.15-5.85) higher odds of having more severe parent reports of low energy than children with mGFR > or = 50 mL/min/1.73 m(2). Compared with participants with mGFR > or = 50 mL/min/1.73 m(2), those with mGFR < 30 mL/min/1.73 m(2) had 3.92 (95% CI, 1.37-11.17) higher odds of reporting more severe weakness, and those with mGFR of 40-<50 mL/min/1.73 m(2) had 2.95 (95% CI, 1.26-6.88) higher odds of falling asleep during the day. Low energy, trouble sleeping, and weakness were associated with lower HRQOL scores.

Limitations: Symptoms of sleep and fatigue represent the child's or parent's perception of symptom severity, whereas individual items can lead to imprecise measurements of sleep and fatigue.

Conclusions: Lower mGFR was associated with increased weakness, low energy, and daytime sleepiness. Furthermore, a strong association between trouble sleeping, low energy, and weakness with decreases in overall HRQOL was observed. Detection and treatment of poor sleep and fatigue may improve the development and HRQOL of children and adolescents with CKD.

Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Distribution of child report of trouble sleeping (panel A), parent report of trouble sleeping (panel B), child report of low energy (panel C), and parent report of low energy (panel D) PedsQL outcomes overall and by mGFR level.

Figure 2

Distribution of child report of weakness (panel A), waking up early (panel B), falling asleep during the day (panel C), and decreased alertness (panel D) CKD-related symptoms overall and by mGFR level.

Figure 3

Adjusted estimated Quality of Life scores by child report of trouble sleeping (panel A) and parent report of trouble sleeping (panel B), and by child report of low energy (panel C) and parent report of low energy (panel D). Values reported are mean child and parent Quality Of Life scores and 95% confidence intervals after adjusting for age, sex, mGFR stage, income, percentage of life with CKD, BMI percentile, low birth weight, hypertension and anemia. A report of “often” or “almost always” having trouble sleeping was associated with lower PedsQL scores (mean of 57.2 compared to means of 78.5 [P

Figure 4

Adjusted estimated child Quality Of Life scores by parent and/or child report of symptom severity for weakness (panel A), waking up too early (panel B), falling asleep during the day (panel C) and decreased alertness (panel D). Values reported are mean child Quality of Life scores and 95% confidence intervals after adjusting for age, sex, mGFR stage, income, percentage of life with CKD, BMI percentile, hypertension and anemia. A report of “moderate” or “severe” weakness was associated with lower quality of life (mean of 63.0 vs. 74.8 [P