Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis

Tan, Lek-Hong; Chen, Pei-Shan; Chiang, Hsiu‐Yin; King, Emily J.; Yeh, Hung‐Chieh; Hsiao, Ya-Luan; Chang, David Ray; Chen, Sheng-Hsuan; Wu, Min-Yen; Kuo, Chin‐Chi

doi:10.1016/j.xkme.2022.100458

Cited by 22 publications

(18 citation statements)

References 70 publications

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“…This leads to loss of opportunity for intervention, which may improve their overall outcomes. Presently, there are limited data on sleep quality among patients with CKD in Africa including Nigeria 18…”

Section: Introductionmentioning

confidence: 99%

Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

Adejumo,

Edeki,

Mamven

et al. 2023

BMJ Open

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ObjectivePoor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD.DesignThis was a cross-sectional study that involved patients with CKD .SettingsThe study was carried out in the outpatient clinic of nine hospitals in Nigeria.MethodsSleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant.ResultsThe mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003).ConclusionPoor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.

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Section: Introductionmentioning

confidence: 99%

Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

Adejumo,

Edeki,

Mamven

et al. 2023

BMJ Open

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“…The prevalence of sleep problems in patients with CKD has been shown to be significant, with roughly 50% of patients suffering from poor sleep quality or insomnia [4], and 44% of patients with ESRD experiencing sleep disturbance [5]. Several studies indicated that sleep was one of the potential risk factors for the development and progression of CKD [6,7].…”

Section: Introductionmentioning

confidence: 99%

Sleep traits and risk of end-stage renal disease: a mendelian randomization study

Zhao

Yang

et al. 2023

BMC Med Genomics

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Background Epidemiological evidence relating sleep disorders to end-stage renal disease (ESRD) has been obscure. The present study is sought to examine the association between sleep traits and ESRD. Methods For this analysis, we selected genetic instruments for sleep traits from published genome-wide association studies (GWAS). As instrumental variables, independent genetic variations linked with seven sleep-related features (sleep duration, getting up in the morning, daytime napping, chronotype of morning/evening person, sleeplessness/insomnia, non-snoring, and daytime dozing) were chosen. A two-sample Mendelian randomization (TSMR) study was conducted to assess the causal relationship between sleep traits and ESRD (N = 33,061). The reverse MR analysis subsequently determined the causal relationship between ESRD and sleep traits. The causal effects were estimated using inverse variance weighted, MR-Egger, weighted median. To conduct sensitivity studies, Cochran’s Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plot were used. To study the potential mediators, multivariable mendelian randomization analyses were undertaken further. Results Genetically predicted sleeplessness/ insomnia (OR = 6.11, 95%CI 1.00-37.3, P = 0.049, FDR = 0.105), getting up in the morning easily(OR = 0.23, 95%CI 0.063–0.85; P = 0.0278, FDR = 0.105), non-snoring (OR = 4.76E-02, 95%CI 2.29E-03-0.985, P = 0.0488, FDR = 0.105) was suggestively associated with the risk of ESRD. However, we found no evidence favoring a causal association between other sleep traits and ESRD through the IVW method. Conclusion The present TSMR found no strong evidence of a bidirectional causal association between genetically predicted sleep traits and ESRD.

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“…One study on elderly patients with type 2 diabetes indicated that a longer DM duration, lower eGFR, and presence of nephropathy were all related to increased use of hypnotics ( 39 ). Increased insomnia in PDR with CKD may be due to exposure to a chronic inflammatory status and the heavy psychological burden of comorbid conditions ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Diabetic Retinopathy and Insomnia Risk: A Nationwide Population-Based Study

Kim

Jeong

et al. 2022

Front. Endocrinol.

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BackgroundPrevious studies have suggested a close link between sleep disturbances and diabetic retinopathy (DR). However, to date, no confirmatory findings have been reported. We aimed to explore the risk of insomnia in DR by considering demographic factors and diabetes mellitus (DM)-related variables.MethodsA nationwide population-based cohort of 2,206,619 patients with type 2 diabetes from the Korean National Insurance Service Database was followed up for insomnia incidence. DR, non-proliferative DR (NPDR), and proliferative DR (PDR) were defined according to ICD-10 codes. The interactive effects of sex, age, and DM-related variables were analyzed to evaluate their impact on insomnia risk in DR.ResultsCompared with the non-DR group, insomnia risk was increased in the DR [(adjusted hazard ratio (aHR): 1.125, 95% confidence interval (CI):1.108-1.142), NPDR (aHR:1.117, 95% CI:1.099-1.134), and PDR (aHR:1.205, 95% CI: 1.156-1.256), even after controlling for comorbidities, lifestyle factors, and DM-related variables. The men and youngest age groups (<40 years) were most vulnerable to insomnia risk. Sex, age, DM duration, and chronic kidney disease (CKD) status exerted interactive effects with DR status in increasing the insomnia risk. In the PDR group, sex, age, DM duration, insulin therapy status, and CKD status exerted interactive effects that increased the risk of insomnia.ConclusionInsomnia risk is significantly higher in patients with DR, and clinical attention is warranted.

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Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis

Cited by 22 publications

References 70 publications

Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

Sleep traits and risk of end-stage renal disease: a mendelian randomization study

Association Between Diabetic Retinopathy and Insomnia Risk: A Nationwide Population-Based Study

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