title: Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients.
abstract: Among adult liver transplant recipients (LTRs), sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower health-related quality of life (HRQOL). The aim of this cross-sectional study was to determine the impact of sleep problems on the HRQOL of pediatric LTRs using validated measures. Participants included 47 LTRs. Mean age of the LTRs was 10.9 ± 4.6 years, and mean time since transplantation was 6.2 ± 3.9 years. The primary indication for transplantation was biliary atresia (51%). According to parent reports, 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 total HRQOL for the recipients. Age, time since transplantation, and health status were not significantly related to the 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 Pediatric Quality of Life (PedsQL) summary scales measuring children's psychosocial health (R(2) = 0.36, P < 0.001), physical health (R(2) = 0.19, P = 0.004), and total HRQOL (R(2) = 0.35, P < 0.001). Also, the sleep-disordered breathing subscale accounted for significant variance in the child self-reported school functioning scale (R(2) = 0.18, P = 0.03). Clinically significant sleep problems were more common among children with low total HRQOL. In conclusion, sleep problems were common in this cohort of pediatric LTRs and predicted significant variance in HRQOL. Prospective larger scale studies are needed to assess factors that contribute to sleep difficulties and low HRQOL in this population. The detection and treatment of significant sleep problems may benefit the HRQOL of pediatric LTRs.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5318, USA. emfred@med.umich.edu
authors.forename: Emily M
authors.initials: EM
authors.lastname: Fredericks
authors.forename: Dawn
authors.initials: D
authors.lastname: Dore-Stites
authors.forename: Sheyla Y
authors.initials: SY
authors.lastname: Calderon
authors.forename: Andrew
authors.initials: A
authors.lastname: Well
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Eder
authors.forename: John C
authors.initials: JC
authors.lastname: Magee
authors.forename: M James
authors.initials: MJ
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D002648:Child; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000453:epidemiology / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life; D012044:Regression Analysis; D012148:Restless Legs Syndrome / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D020182:Sleep Apnea, Central / Q000453:epidemiology / Q000523:psychology; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*; D012913:Snoring / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires