Abstract
Objective: The aims of the current study were to (1) explore the features of overall poor sleep and specific sleep disorders in Chinese middle age and older adult hemodialysis patients; (2) examine the association between sleep disorders and cognitive impairment (CI) in middle age and older patients undergoing hemodialysis in China.Methods: Data of patients undergoing maintenance hemodialysis were collected from the prospective cohort study of CI in Chinese patients undergoing hemodialysis (Registered in Clinical Trials.gov, ID: NCT03251573). We included 613 patients (mean age = 63.7; SD = 7.8) in this study. We assessed sleep conditions using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and cognitive function by the Chinese Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) scale. Then the association between sleep disorders and CI was evaluated using multivariate logistic regression analysis.Results: The prevalence of sleep disorders in this group of 613 hemodialysis patients was 77.0%. Patients with CI were more inclined to have sleep disorders in specific aspects of sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction (p < 0.05). In multivariate logistic regression analyses, every 1-point increase in global PSQI score was associated with a 1.2-fold increased risk of CI (adjusted OR = 1.201; 95%CI = 1.123–1.284, p < 0.001). For each specific PSQI, every 1-point increase in sleep disturbances score was associated with a 2.6-fold increased risk of CI (adjusted OR = 2.624; 95%CI = 1.891–3.640, p < 0.001), and every 1-point increase in daytime dysfunction score was associated with a 3.7-fold increased risk of CI (adjusted OR = 3.709; 95%CI = 2.653–5.184, p < 0.001), whereas every 1-point increase in sleep duration score was associated with a decreased risk of CI (adjusted OR = 0.600; 95%CI = 0.434–0.830, p = 0.002).Conclusion: Poor sleep quality especially sleep disturbances, daytime dysfunction, and long sleep duration are associated with CI in middle age and older adult hemodialysis patients. Thus, the early detection of sleep disorders may help identify patients with cognitive impairment among hemodialysis individuals.Clinical Trial Registration: [Clinical Trials.gov], identifier [NCT03251573]
Highlights
Cognitive impairment (CI) is common in individuals with chronic kidney disease (CKD), especially in hemodialysis patients with end-stage renal disease (ESRD) (Murray et al, 2006)
We investigated whether each specific sleep disorder was associated with CI, for these seven components, only sleep disturbances, daytime dysfunction, and sleep duration were associated with CI
Patients with CI were more inclined to have sleep disorders in specific aspects of sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction. These results remained almost consistent in following multivariate adjustment, suggesting that poor sleep quality especially sleep disturbances, daytime dysfunction, and long sleep duration were associated with CI in middle age and older adult hemodialysis patients
Summary
Cognitive impairment (CI) is common in individuals with chronic kidney disease (CKD), especially in hemodialysis patients with end-stage renal disease (ESRD) (Murray et al, 2006). Facing such a great challenge, it seems critically important to make further exploration about the detection and prevention of CI among hemodialysis patients Sleep quality, another common public health issue, has been proved to be related to poor cognitive function in the general population (Ratcliff and Van Dongen, 2009). A recent study in peritoneal dialysis patients noted that possible narcolepsy was associated with general cognitive dysfunction (Zhao et al, 2019), and another study concluded that sleep-disordered breathing was associated with CI, in patients with advanced CKD (Kang et al, 2012) In contrast with those studies, Rodriguez et al (2013) reported no association between sleep disturbances and cognitive function in hemodialysis patients. Further exploration about the relationship between them is in great need in hemodialysis patients
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