Association between Serum Vitamin D Levels and Sleep Disturbance in Hemodialysis Patients

Abstract

Sleep disturbance is a frequent and serious complication of hemodialysis (HD). Low serum vitamin D levels have been associated with sleep quality in non-HD subjects. Our aim was to examine the possible association between serum vitamin D levels and the presence of sleep disturbance in HD patients. We recruited 141 HD patients at the HD center of the First Affiliated Hospital of Jiaxing University during 2014–2015. Serum levels of 25-hydroxyvitamin D (25(OH)D) were determined by the competitive protein-binding assay. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Demographic, clinical and laboratory data were recorded. Meanwhile, 117 healthy control subjects were also recruited and underwent measurement of 25(OH)D. Eighty-eight patients (62.4%) had sleep disturbance (PSQI scores ≥ 5). Patients with sleep disturbance showed lower levels of 25(OH)D as compared to those without sleep disturbance (85.6 ± 37.4 vs. 39.1 ± 29.1 nmol/L, p < 0.001). In multivariate analyses, serum levels of 25(OH)D (≤48.0 nmol/L) were independently associated with sleep disturbance in HD patients (OR 9.897, 95% CI 3.356–29.187, p < 0.001) after adjustment for possible variables. Our study demonstrates that low serum levels of vitamin D are independently associated with sleep disturbance in HD patients, but the finding needs to be confirmed in future experimental and clinical studies.

Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia

“…Evidences are growing that hyperphosphatemia was associated with poor sleep quality [ 20 , 21 , 92 , 93 ], despite inconsistencies existing [ 24 ]. While the presence of hyperphosphatemia-related pruritus could be the mediating factor for poor sleep quality [ 20 ], to the best of our knowledge, there is no clear mechanism of how poor sleep quality may influence serum phosphate level among the dialysis population.…”

A meta‐analysis: Does vitamin D play a promising role in sleep disorders?

“…Our study evaluated 1563 relevant literatures, but only 25 studies met the inclusion criteria, which contained a total of 3,603 subjects (Balaban et al., 2012; Bozkurt et al., 2012; Celik et al., 2015; Cikrikcioglu et al., 2016; Erden et al., 2014; Ghaderi et al., 2017; Gong et al., 2018; Gunduz et al., 2016; Han, Zhu, Shi, Wu, & Gu, 2017; Huang, Shah, Long, Crankshaw, & Tangpricha, 2013; Huzmeli, 2018; Kerley et al., 2016; Liguori et al., 2015; Majid et al., 2018; Mason et al., 2016; Mete et al., 2013; Neves et al., 2017; Pazarli, Ekiz, & Inonu Koseoglu, 2019; Qiao et al., 2018; Terzi & Yilmaz, 2016; Toujani et al., 2017; Uygur, Baki, Tanriverdi, Ornek, & Atalay, 2016; Wali et al., 2018; Zhao et al., 2017; Zicari et al., 2016). These 25 articles included 21 papers analyzing differences in vitamin D concentrations between sleep disorders and controls (Balaban et al., 2012; Bozkurt et al., 2012; Celik et al., 2015; Cikrikcioglu et al., 2016; Erden et al., 2014; Gong et al., 2018; Gunduz et al., 2016; Han et al., 2017; Huzmeli, 2018; Kerley et al., 2016; Liguori et al., 2015; Mete et al., 2013; Neves et al., 2017; Pazarli et al., 2019; Qiao et al., 2018; Terzi & Yilmaz, 2016; Toujani et al., 2017; Uygur et al., 2016; Wali et al., 2018; Zhao et al., 2017; Zicari et al., 2016) and 4 papers (RCTs) evaluating the change in the PSQI score in response to supplementation with vitamin D (Ghaderi et al., 2017; Huang et al., 2013; Majid et al., 2018; Mason et al., 2016). The detailed outcomes are presente...…”

“…For the 21 papers analyzing differences in vitamin D levels, 11 studies were conducted in Eurasia (Balaban et al., 2012; Bozkurt et al., 2012; Celik et al., 2015; Cikrikcioglu et al., 2016; Erden et al., 2014; Gunduz et al., 2016; Huzmeli, 2018; Mete et al., 2013; Pazarli et al., 2019; Terzi & Yilmaz, 2016; Uygur et al., 2016), 3 studies were performed in Europe (Kerley et al., 2016; Liguori et al., 2015; Zicari et al., 2016), and 5 studies were performed in Asia (Gong et al., 2018; Han et al., 2017; Qiao et al., 2018; Wali et al., 2018; Zhao et al., 2017) (the America group and Africa group were not analyzed because only 1 paper was included, respectively (Neves et al., 2017; Toujani et al., 2017)). Seven studies used EI to analyze the vitamin D levels (Balaban et al., 2012; Celik et al., 2015; Cikrikcioglu et al., 2016; Gong et al., 2018; Mete et al., 2013; Qiao et al., 2018; Zhao et al., 2017), and 6 studies used CI (Erden et al., 2014; Kerley et al., 2016; Neves et al., 2017; Pazarli et al., 2019; Uygur et al., 2016; Zicari et al., 2016), while the remaining studies (Bozkurt et al., 2012; Gunduz et al., 2016; Terzi & Yilmaz, 2016; Toujani et al., 2017) ( n = 4)used other methods (4 studies (Han et al., 2017; Huzmeli, 2018; Liguori et al., 2015; Wali et al., 2018) did not provide an assay method). The type of sleep disorder was OSAS (mild) in 5 studies (Bozkurt et al., 2012; Kerley et al., 2016; Mete et al., 2013; Pazarli et al., 2019; Uygur et al., 2016), OSAS (moderate) in 7 studies (Bozkurt et al., 2012; Erden et al., 2014; Kerley et al.,…”

“…The detailed outcomes are presented in Table 2, Table 3, Table S1, and Table S2. Celik et al, 2015;Cikrikcioglu et al, 2016;Erden et al, 2014;Gunduz et al, 2016;Huzmeli, 2018;Mete et al, 2013;Pazarli et al, 2019;Terzi & Yilmaz, 2016;Uygur et al, 2016), 3 studies were performed in Europe (Kerley et al, 2016;Liguori et al, 2015;Zicari et al, 2016), and 5 studies were performed in Asia (Gong et al, 2018;Han et al, 2017;Qiao et al, 2018;Wali et al, 2018;Zhao et al, 2017) (the America group and Africa group were not analyzed because only 1 paper was included, respectively (Neves et al, 2017;Toujani et al, 2017)). Seven studies used EI to analyze the vitamin D levels (Balaban et al, 2012;Celik et al, 2015;Cikrikcioglu et al, 2016;Gong et al, 2018;Mete et al, 2013;Qiao et al, 2018;Zhao et al, 2017), and 6 studies used CI (Erden et al, 2014;Kerley et al, 2016;Neves et al, 2017;Pazarli et al, 2019;Uygur et al, 2016;Zicari et al, 2016),…”

Effect of Progressive Muscle Relaxation on Sleep Quality Among Patients With Chronic Diseases: A Literature Review

“…In patients with haemodialysis, sleep impairment would decrease the quality of life and increase medication use and mortality rate (Elder et al, 2008). A recent study reported that poor sleep quality is associated with lower vitamin D levels (Han et al, 2017). Disturbed sleep also causes increased mortality rates, exacerbations and use of emergency department for chronic obstructive pulmonary disease (Omachi et al, 2012).…”