Sleep-disordered breathing in children with chronic kidney disease: a pilot study

Background: Several works have reported a close association between chronic kidney disease (CKD) and sleep-disordered breathing (SDB), showing the prevalence of SDB up to 60-80% in CKD patients with a consequent increase in morbidity and mortality. These studies mainly concern adult populations and data are often collected subjectively through questionnaires. Aims and Objectives: This pilot study aims at evaluating the prevalence and the characteristics of SDB, by performing a home sleep apnea testing in children with CKD stage III-IV, CKD on hemodialysis (HD) and kidney transplanted patients. Methods: From February to September 2019, 27 patients aged between 6 and 17 years, followed by Pediatric Nephrology, Dialysis and Transplant Unit of Fondazione IRCCS Ca9 Granda Ospedale Maggiore Policlinico-Milan-Italy, were enrolled: 9 patients on HD, 9 on CKD (stage III-IV) and 9 transplanted patients. They completed a questionnaire about the sleep history, a quality of life questionnaire (PedsQl) and performed a home sleep apnea testing. Results: Apnea-hypopnea index (AHI) resulted ≥1 in 15/27 children (55.6%): in 4 patients on HD (44.6%), in 5 on III-IV stage CKD (55.6%) and in 6 with kidney transplant (66.7%). The study didn’t show correlations with the sleep questionnaire and PedsQl, neither documented significant differences among the groups in terms of AHI. Conclusions: In this study, the prevalence of SDBs among children with CKD was 10 times higher than the general pediatric population. Considering the impact of the problem, larger studies are desirable to better define the problem and create diagnostic protocols that foresee the study of sleep in these patients.