Poor sleep, fatigue tied to cognitive, behavioural problems in children with CKD

Children with chronic kidney disease (CKD) who experienced sleep difficulty and fatigue were more likely than those without such issuesto have a poorer executive functioning and increased emotional-behavioural symptoms, according to a study presented at ASN Kidney Week 2019.

“Children with CKD are at risk for deficits in neurocognitive function. It is not known how sleep problems/fatigue within the context of CKD may contribute to these deficits,” according to Dr Rebecca Johnson from Children’s Mercy Hospital in Kansas City, Missouri, US.

Using data from the CKiD* study, the researchers conducted a study involving 1,030 children with mild-to-moderate CKD (median disease duration 6 years, 63 percent male) to examine the relationship between sleep problems or fatigue and emotional-behavioural and neurocognitive outcomes. Fatigue, sleep disturbance, low energy, and trouble sleeping measures were assessed.[ASN Kidney Week 2019, abstract TH-OR127]

In the overall population, the prevalence of having low energy, trouble sleeping, sleep disturbance, and fatigue were 52 percent, 39 percent, 30 percent, and 26 percent, respectively.

After adjusting for sociodemographic and disease-related covariates, trouble sleeping (β=1.87, 95 percent confidence interval [CI], 0.87–2.87; p=0.0003), sleep disturbance (β=1.28, 95 percent CI, 0.25–2.32; p=0.02), and low energy (β=1.85, 95 percent CI, 0.79–2.9; p=0.0006) were significantly associated with worse parent-reported overall executive functions.

Children who reported having low energy also had a significantly poorer working memory (β=-0.37, 95 percent CI, 0.72 to -0.01; p=0.05 [for digit span forward] and β=-0.48, 95 percent CI, -0.87 to -0.09; p=0.02 [for digit span backward]).

In addition, low energy was significantly associated with lower inhibition (β=-0.92, 95 percent CI, 1.57–0.28; p=0.0006) and worse problem-solving ability (β=-0.67, 95 percent CI, -1.25 to -0.09; p=0.02).

“Each of the four sleep measures was significantly related to more internalizing symptoms on a measure of emotional-behavioural functioning, and sleep disturbance, low energy, and trouble sleeping were associated with more externalizing symptoms,” Johnson and her team noted.

“[Our results showed that] fatigue and sleep problems are prevalent among children with CKD and may affect neurocognitive and emotional-behavioural functioning,” said Johnson, who suggested that “assessment of sleep problems and fatigue, interventions to improve sleep, and treating medical comorbidities may promote more positive emotional-behavioural and neurocognitive outcomes for children with CKD.”