Self‐perceived quality of sleep and mortality in Norwegian dialysis patients

Abstract

Sleep complaints are prevalent and associated with poor health-related quality of life (HRQoL), depression and possibly mortality in dialysis patients. This study aimed to explore possible associations between sleep quality, daytime sleepiness and mortality in dialysis patients. In this study, 301 dialysis patients were followed up to 4.3 years. HRQoL was evaluated at baseline with the Kidney Disease and Quality of Life--Short Form (KDQoL-SF), depression with Beck Depression Inventory (BDI), sleep quality with Pittsburgh Sleep Quality Index and daytime sleepiness with Epworth Sleepiness Scale. The single item "on a scale from 0-10, how would you evaluate your sleep?" in the sleep subscale in KDQoL-SF was used to identify poor (0-5) and good sleepers (6-10). A total of 160 patients (53.3%) were characterized as poor sleepers. They were younger (r = 0.241, P < 0.001), had more depression (BDI: 8.72 ± 6.79 vs. 13.60 ± 8.04, P < 0.001), a higher consumption of hypnotics and antidepressants and reduced HRQoL (Mental Component Summary score: 45.4 ± 11.0 vs. 50.0 ± 10.4, P < 0.001. Physical Component Summary score: 35.0 ± 9.9 vs. 38.5 ± 10.5, P = 0.004). In multivariate analyses, poor sleepers had nearly a twofold increase in mortality risk (hazard ratio [HR] 1.92, confidence interval [CI] 1.10-3.35, P = 0.022). Daytime sleepiness was not related to mortality (HR 1.01, CI 0.95-1.08, P = 0.751). Sleep complaints predicted increased mortality risk in dialysis patients and should therefore be routinely assessed. Further studies are needed to find suitable treatment options for poor sleep in dialysis patients as it may affect both HRQoL and survival.

Prevalence and Predictors of Poor Sleep Quality in Patients on Maintenance Hemodialysis

“…Poor quality of sleep is an important factor to be considered in this group as this has been found to worsen the quality of life [3,25]. The available literature shows that a variety of factors are associated with poor sleep quality, e.g., young age, older age, depression, reduced appetite, diabetes, body pain, sedentary life, body mass index, waist circumference, dyspnea, and sleep apnea to name a few [3,10,12,23,26,27].…”

“…Poor quality of sleep has been found to increase the mortality among patients on MHD [3,12]. However, one study did not find any correlation between the mortality and poor sleep among these patients [13].…”

“…One of the common complaints that we are expected to address is altered sleep, in such settings. Patients on maintenance hemodialysis (MHD) suffer from poor quality of sleep [1][2][3]. Previous literature suggests that nearly 53-87% of the patients on MHD have poor quality sleep as measured by Pittsburg Sleep Quality Index [2][3][4].…”

“…Patients on maintenance hemodialysis (MHD) suffer from poor quality of sleep [1][2][3]. Previous literature suggests that nearly 53-87% of the patients on MHD have poor quality sleep as measured by Pittsburg Sleep Quality Index [2][3][4]. Poor quality sleep has been correlated with the older age, female gender, poor quality of life, depression, and knowledge about their illness [5,6].…”

“…Some studies have reported that increasing duration of dialysis, physical health, co-morbidities, burden of kidney disease, sexual function, dyspnea, pain, itching, mean corpuscular volume, serum albumin, and diabetes mellitus worsen the quality of sleep [2,3,9,10]. However, contradictory studies are also available that suggest that quality of sleep in MHD patients is not related to age, gender, biochemical parameters, and other factors mentioned above [4,6].…”