SUN-128 SLEEP DISTURBANCES IN CHILDREN AND ADOLESCENTS AFTER KIDNEY TRANSPLANTATION

Abstract

Previous studies suggest that disturbances of sleep are prevalent amongst children with chronic kidney disease including those who have a kidney transplant. However, the aetiology of sleep disorders in this population is not clear. The aims of this study were to ascertain the prevalence, typology and aetiology of sleep disturbances in paediatric kidney transplant recipients. Parents of children who had a kidney transplant at a single centre completed online questionnaires about their child’s sleep. The questionnaires utilised were the Sleep Disturbance Scale for Children (SDSC), the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), questions about sleep hygiene and questions about restless leg syndrome. Demographic and clinical details were collected from medical records. Responses on the SDSC reflect sleep disturbances across 6 domains: disorders of initiating and maintaining sleep; sleep-disordered breathing; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis. Linear regression was used to assess the association between sleep disturbance and clinical variables of age, gender, estimated glomerular filtration rate (eGFR) and body mass index. P-value <0.05 was considered to be significant, however, readjustments were made using sequential Bonferroni to reduce the probability of false statistical significance. Questionnaires were returned by parents of 27 children and adolescents who had a median age of 14 years (IQR 11.0-17.5) and had a mean time since transplant of 6.0 ± 4.4 years. At least one type of sleep disturbance was identified in 21 of 27 (78%) transplant recipients using the SDSC. The most common sleep disturbances were disorders of initiating and maintaining sleep (48%) and disorders of excessive somnolence (30%). Low eGFR, low magnesium and male gender were statically significant predictors of sleep disturbances through univariate analysis. However, male was the only significant factor for sleep-wake transition disorder after performing a Bonferroni correction. All children who screened positive for restless leg syndrome (22%) and for excessive daytime sleepiness using ESS-CHAD (11%) were part of the 78% identified using the SDSC. The majority of children and adolescents who scored positive for disorders of initiating and maintaining sleep reported use of electronic devices in the hour before bed. A high prevalence of sleep disturbances are present in children and adolescents after kidney transplantation which may have an under recognised impact on quality of life. Serum magnesium may be a modifiable risk factor and lifestyle factors may also contribute. We suggest that screening for sleep disturbances should be part of routine post-transplant care to optimise normal growth and development.