Risk factors for sleep disorders in patients undergoing peritoneal dialysis

Gui-Ling Liu,You-Lu Zhao,Ye-Ping Ren,Li Hao,Jin-Lan Liao,Jie Dong,Qin Wang,Li-Ping Duan,Zu-Ying Xiong,Qiu-Nan Zhan,Zhao-Xia Zheng

doi:10.1007/s41105-021-00311-2

Abstract

Sleep disorders in patients with end-stage renal disease are common but have rarely been reported in previous studies. Therefore, we examined the prevalence of sleep disorders and the risk factors for declining sleep quality in patients undergoing peritoneal dialysis (PD). A multicenter prospective cohort study was conducted at five PD centers across different provinces in China. A total of 449 patients who underwent PD between March to November 2013 were enrolled. Demographic data, laboratory indicators, presence of depression, and sleep assessment data were collected. Sleep questionnaires reflecting five categories of sleep disorders, namely, insomnia, restless legs syndrome, excessive daytime sleepiness, possible narcolepsy, and sleepwalking and nightmares, were administered at baseline and at 24 months postoperatively. Sleep disorders were diagnosed when a patient had at least one sleep problem. At baseline, 335 (74.6%) patients had at least one type of sleep disorder. Depression, diabetes mellitus (DM), and male were found to be associated with the presence of a sleep disorder. At follow-up, the prevalence of insomnia, restless legs syndrome, and excessive daytime sleepiness had significantly increased in 285 patients. Furthermore, cardiovascular disease (CVD) was found to be associated with the presence of sleep disorders in patients with one or more disorders at baseline, whereas a low serum albumin level was found to be associated with sleep disorders in patients without any sleep disorders at baseline. The prevalence of sleep disorders was relatively high among PD patients at baseline and increased afterthe2-year follow-up. Depression, DM, and male were associated with all sleep disorders at baseline. CVD was associated with the presence of a sleep disorder at baseline and worse sleep quality at the 2-year follow-up; whereas a low serum albumin level was associated with the risk of acquiring a sleep disorder at the 2-year follow-up among patients with normal sleep status at baseline.

Highlights

Given the increasing prevalence of end-stage renal disease (ESRD) and its associated burden on health, it is urgent to improve the clinical outcomes and quality of life of patients with ESRD [1]
There were no differences in sex, peritoneal dialysis (PD) duration, level of education, body mass index, mean arterial pressure, hemoglobin, serum albumin, triglycerides, total cholesterol, serum sodium, or calcium (Table 1)
By the end of the study, patients had switched to hemodialysis and patients died, 26 of whom died of cardiac disease

Summary

Introduction

Given the increasing prevalence of end-stage renal disease (ESRD) and its associated burden on health, it is urgent to improve the clinical outcomes and quality of life of patients with ESRD [1]. Patients with ESRD, especially those undergoing dialysis, have significantly higher rates of sleep disorders than the general population [2]. The prevalence of sleep disorders varies between 50% and ≥ 80% in patients with ESRD, depending on the methodology used [2,3,4,5]. A Hong Kong study reported a high prevalence of sleep symptoms among patients undergoing continuous ambulatory peritoneal dialysis [6], including sleep maintenance insomnia (60%), sleep onset insomnia (73%), restless legs syndrome (62%), pruritus (71%), daytime sleepiness (77%), and frequent awakening (69%). Previous studies have reported that advanced age, hyperphosphatemia, and depression are risk factors for sleep disorders in patients on dialysis [4, 8]. Recent reviews have shown sex-based differences in the two most common sleep disorders, insomnia and restless legs syndrome. Studies on sex-based differences in sleep disorders are limited [9]

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Conclusion