Chapter 36 - Sleep Disorders in Chronic Kidney Disease

Abstract

Sleep is an essential function of life. Sleep clearly serves a crucial role in the promotion of health and performance. Poor sleep quality and sleep disorders have been a recurrent finding in patients with chronic kidney disease (CKD). Sleep disorders such as obstructive sleep apnea (OSA) can contribute to hypertension, diabetes (type 2 diabetes mellitus [T2DM]), cardiovascular disease (CVD), and worsen obesity, all of which are implicated in the etiology of CKD. CKD itself may lead to OSA. Mechanisms specific to OSA could hasten decline in renal function in and of themselves. OSA, in spite of its high prevalence, remains underdiagnosed and undertreated in CKD patients. Optimal sleep duration and quality play a significant role in improving control of T2DM. Insufficient sleep has been shown to increase the risk of obesity. Restless legs syndrome (RLS) and insomnia worsen health-related quality of life in CKD patients. RLS and depression are associated with increased mortality in CKD patients. There is emerging evidence linking insomnia and RLS to an increased risk of CVD, which is an important cause of mortality in CKD patients, and insomnia is increasingly recognized as having a causal link to dementia and white matter disease. Addressing sleep disorders could help to prevent not only the development but also the progression of CKD.