Association of Sleep Difficulty with Kidney Disease Quality of Life Cognitive Function Score Reported by Patients Who Recently Started Dialysis

Abstract

Sleep disorders are associated with impaired cognition in the general population, but little attention has been given to the potential association between sleep and cognitive function in the dialysis population. This study investigated reported sleep difficulty and cognitive function scores in a national cohort of patients who initiated maintenance hemodialysis and peritoneal dialysis. The cognitive function scale of the Kidney Disease Quality of Life instrument (KDQOL-CF), which measures aspects of cognitive ability that are important for daily functioning (perceived reaction time, ability to concentrate, and tendency to become confused), was used. The study population included 2286 patients who responded to a questionnaire at baseline in the US Renal Data System Dialysis Morbidity and Mortality Study Wave 2. Reported sleep difficulty was associated in a univariate manner with lower KDQOL-CF score. In a multivariable regression analysis that controlled for age, gender, race, education, diabetic ESRD, cardiovascular comorbidity, smoking, hemoglobin, serum albumin, prescribed sleep medications, dialysis modality, pre-ESRD care, bodily pain, and depressed mood, the association of sleep difficulty with KDQOL-CF score remained significant (P < 0.0001); the association also was significant in a multivariable analysis that was restricted to hemodialysis patients and included adjustment for Kt/V (P ‫؍‬ 0.001). Depressed mood and sleep medication prescription predicted a lower KDQOL-CF score, and higher educational level and less bodily pain predicted a higher KDQOL-CF score. Increased understanding of links among sleep difficulty, management of sleep difficulty, and cognitive function could benefit multiple dimensions of dialysis patients' quality of life and daily functioning.

Sleep Quality in Non Dialysis Chronic Kidney Disease: Associated Factors and Influence on Prognosis

“…Moreover, since hemoglobin values are physiologically lower in women, a gender effect may also bias the comparison of hemoglobin concentration between poor and good sleepers. Previous investigations suggested that sleep disorders are more common in diabetic patients [17]. We did not observe significant differences in sleep quality scores between diabetic and non-diabetic patients.…”

Health-related Quality of Life in CKD Patients

“…This effect was modulated by age, gender, co-morbidities and the use of beta blockers. Sleep disturbances affect other components of HRQOL such as cognitive function (34). It is therefore critical that inquiry into the symptoms of sleep disturbances be performed during a clinical encounter and remedial interventions (such as withdrawal of ␤-blockers if feasible) are undertaken.…”

Prevalence of sleep disturbances in children and adolescents with chronic kidney disease

“…In adults, lower quality of life has been demonstrated in pre-dialysis CKD and dialysis patients with sleep problems, particularly in patients with RLS and daytime sleepiness [2,8,29,[31][32][33]. A decrease in the cognitive function sub-category score of the Kidney Disease Quality of Life instrument was also noted in a group of hemodialysis patients from the US Renal Data System Dialysis Morbidity and Mortality Study Wave 2, where depressed mood and use of sleep medication predicted a lower cognitive function score, while higher educational level and less bodily pain correlated with a higher cognitive function score [31]. In this study of children with pre-dialysis CKD, low energy, trouble sleeping, and weakness were associated with lower HRQOL scores as assessed by the PedsQL 4.0 Generic Scales [14].…”