Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients

Abstract

Rationale Among adult liver transplant recipients, sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower HRQoL. The aim of this cross-sectional study was to determine the impact of sleep problems on child HRQoL in pediatric liver transplant recipients using validated measures of sleep and quality of life. Methods Participants included 47 liver transplant recipients (LTR). The mean age of patients was 10.9 years ± 4.6, and the mean time since transplant was 6.2± 3.9 years. The primary indication for transplantation was biliary atresia (51%). Results Based on parent report, pediatric transplant recipients had symptoms of sleep disordered breathing, excessive daytime sleepiness, daytime behavior problems, and restless legs. 40.4% of parents and 43.8% of children reported significantly lower child Total HRQoL. Age, time since transplantation and health status variables were not significantly related to quality of life. Hierarchical regression analyses revealed that the sleep-disordered breathing subscale of the Pediatric Sleep Questionnaire accounted for significant variance in parent-proxy reports on the PedsQL summary scales measuring child Psychosocial Health (R2=0.38, p < 0.001), Physical Health (R2=0.19, p=0.004), and Total HRQoL (R2 =0.35, p < 0.0001). Across the subscales of the PedsQL, sleep-disordered breathing accounted for significant variance on the child self-reported school functioning scale (R2 = 0.18, p=0.033). Clinically significant sleep problems were more common among children with low Total HRQoL. There were no significant group differences based on child self-report. Conclusions Sleep problems were common in this cohort of pediatric liver transplant recipients and predicted significant variance in parent-proxy reports of HRQoL. Prospective larger scale studies are needed to assess factors that may lead to sleep difficulties and low HRQoL in this population. Appropriate detection of significant sleep problems may lead to interventions that could benefit the quality of life of pediatric LTR.

Short- and long-term health consequences of sleep disruption

“…The presence of a sleep disturbance was most frequent in the dialysis group compared to the other groups,34 while sleep disturbance was associated with a significant decrease in the overall total QoL score on the Pediatric Quality of Life Inventory (PedsQL) Version 4.0 Generic Core Scales for pre-dialysis and transplant subjects ( P = 0.002 and P = 0.001, respectively). A study of 47 pediatric liver transplant recipients investigated the impact of sleep problems (as assessed by the Pediatric Sleep Questionnaire) on HRQoL, as measured using the PedsQL 74. Sleep-related breathing disorders and excessive daytime sleepiness were prevalent, affectinĝ23% and 40% of children in the study, respectively 74.…”

“…A study of 47 pediatric liver transplant recipients investigated the impact of sleep problems (as assessed by the Pediatric Sleep Questionnaire) on HRQoL, as measured using the PedsQL 74. Sleep-related breathing disorders and excessive daytime sleepiness were prevalent, affectinĝ23% and 40% of children in the study, respectively 74. According to the parent proxy and child self-report, ~40% of participants had a substandard HRQoL.…”

“…According to the parent proxy and child self-report, ~40% of participants had a substandard HRQoL. The physical manifestations of chronic diseases, such as chemical imbalances in dialysis patients, along with medications that may adversely affect sleep, play a role in sleep disruption and require comprehensive management to allow for effective sleep 34,74…”

Psychologic Evaluation in Liver Transplantation: Assessment of Psychologic Profile of End-Stage Liver Disease Patients Before and After Transplant

“…17,18 Sleepiness and fatigue are also common events in patients with chronic liver disease, which can reduce their daily function and their health-related quality of life. [19][20][21][22][23] In addition, impaired neuropsychologic and cognitive functions, such as memory, have been common in liver disease patients and transplant recipients. [24][25][26][27][28] Such deficits may lead to nonadherence to medication and its debilitating consequences, including transplant rejection, infection, and even increased mortality.…”

A preliminary investigation of sleep quality and patient‐reported outcomes in pediatric solid organ transplant candidates

“…Poor sleep quality has also been associated with cognitive problems in other pediatric groups . Despite the significant lack of literature on sleep functioning during the pretransplant phase, research conducted with patients post‐transplantation has shown that sleep accounts for more variance than age, time since transplantation or health status in children's HRQOL . Thus, while empirical evidence reveals that disruptions in sleep are both present post‐transplantation and also associated with a wide variety of negative psychosocial outcomes, further research is needed to investigate whether similar problems exist pretransplantation, an important gap in the transplant literature.…”