Association of Sleep Duration, Symptoms, and Disorders With Mortality in Adults With Chronic Kidney Disease

Abstract

IntroductionIn general populations, short and long sleep duration, poor sleep quality, and sleep disorders have been associated with increased risk of death. We evaluated these associations in individuals with CKD.MethodsThis was a prospective cohort study of 1452 NHANES 2005 to 2008 participants with CKD. CKD was defined by estimated glomerular filtration rate <60 ml/min per 1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Sleep duration, sleep symptoms (difficulty falling asleep, difficulty staying asleep, daytime sleepiness, and nonrestorative sleep), and sleep disorders (restless legs syndrome and sleep apnea) were self-reported. Vital status was determined using NHANES mortality linkage through December 31, 2011.ResultsIn this cohort, the mean age was 61 years, 58% were women, and 75% non-Hispanic white. During 4.4 years of median follow-up, we observed 234 deaths, of which 75 were due to cardiovascular causes. In multivariable analyses, compared with individuals who reported 7 to 8 hours of sleep, HR (95% CI) for all-cause mortality for sleep duration <7 hours and >8 hours were 1.50 (1.08–2.10) and 1.36 (0.89–2.08), respectively. The corresponding HR (95% CI) for cardiovascular mortality were 1.56 (0.72–3.37) and 1.56 (0.66–3.65). Nonrestorative sleep and restless legs syndrome were associated with increased risk for all-cause mortality (HR, 1.63 [95% CI, 1.13–2.35], and HR, 1.69 [95% CI, 1.04–275], respectively).DiscussionIn adults with CKD, short sleep duration, nonrestorative sleep, and restless legs syndrome are associated with increased risk of death. These findings underscore the importance of promoting adequate sleep in patients with CKD, and the need for future studies evaluating the impact of sleep interventions in this population.

Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Extrapolation into the glomerular disease population seems relevant as this is a modifiable factor and can be applied broadly to all patients. 30 Weight reduction in obese patients may benefit glomerular diseases. [31][32][33] Small studies, focusing on diet and bypass surgery, have shown at least short-term benefits.…”

“…Established and emerging risk factors for progression of kidney diseaseRisk factors for progressive loss of GFR Emerging risk factors for progressive loss of GFR Prematurity (low birth weight) and other reasons for low nephron number29 Low-sleep duration and other related disorders (e.g., restless legs syndrome, sleep apnea)30 Obesity[31][32][33] Gender?34 GFR, glomerular filtration rate.…”

Is Restless Legs Syndrome Associated with an Increased Risk of Mortality? A Meta-Analysis of Cohort Studies

“… 31 – 35 In nine studies (64.3%), the diagnosis of RLS was based on self-administered questionnaires, 4 , 36 – 38 ICD-9 codes, 5 , 39 and other sleep quesionnaires. 40 , 41 The results of 11 studies (78.6%) 4 , 5 , 31 – 34 , 36 , 37 , 40 , 41 supported RLS as a risk factor for increased mortality. The opposite conclusion was found in only three studies (21.4%).…”

Management of Insomnia in Hemodialysis Patients: A Literature Review

“…Gangguan tidur terutama insomnia banyak dikeluhkan pasien hemodialisa dan membuat kualitas tidur yang buruk. Kualitas tidur yang buruk bisa membahayakan pasien karena akan meningkatkan risiko kematian dan kerusakan kardiovaskular pada pasien dengan penyakit ginjal kronis (CKD) (Ricardo et al, 2017).…”