Association of sleep disturbances with cognitive impairment and depression in maintenance hemodialysis patients

Abstract

Background There are few data on the relationship of sleep with measures of cognitive function and symptoms of depression in dialysis patients. Methods We evaluated the relationship of sleep with cognitive function and symptoms of depression in 168 hemodialysis patients, using multivariable linear and logistic regression. Sleep disturbances were assessed using the sleep subscale battery of the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Health Experience Questionnaire. The cognitive battery assessed a broad range of functioning including global ability, verbal intelligence, supraspan learning, auditory retention, visual retention, attention/mental processing speed, visual construction/fluid reasoning and motor speed. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression (CESD) Scale, with depression indicated by a CESD score ≥ 16. Results Mean (SD) age of participants was 62 (17) years, 49% were women, 30% were African American and 33% had diabetes. There was no significant relationship between sleep score and performance on any neurocognitive test (p>0.13, for all multivariable analyses). The prevalence of depression increased from 16% in the highest quartile (best) of sleep score, to 31% in the lowest quartile (worst) of sleep score. In multivariable analyses, each 1 SD increase in sleep score was associated with a 2.18 (95% confidence interval, 1.07–3.29, p<0.001) lower CESD score. Results were consistent when considering individual components of both the CESD and sleep score. Conclusions Disturbances in sleep are associated with symptoms of depression but not measures of cognitive function. Dialysis patients with disturbances in sleep should be screened for depression.

Determinants of quality of life in advanced kidney disease: time to screen?

“…It is an independent risk factor for mortality in CKD,49 50 probably resulting from poor dietary intake and poor adherence to treatment. Depression has also been associated with increased hospitalisation,51 sexual dysfunction,52 increased peritonitis rates in PD patients,53 sleep disturbance,54 progression to ESRD55 and dialysis withdrawal 56…”

Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis

“…It has been long known that older age is an associated factor with poor quality of sleep in the general population . In patients on haemodialysis, some studies found this link but others did not …”

Patient‐reported cognitive functioning and daily functioning in chronic dialysis patients

“…Over the past decades, the number of studies documenting cognitive impairment among dialysis patients has increased. These studies report the prevalence of cognitive impairment, the relationship between neuropsychological functioning and test timing and dialysis modality, and risk factors for cognitive impairment . The clinical implications of cognitive impairment in the dialysis population, such as its association with low‐protein catabolic rate, increased technician time caring for patient after dialysis, and increased hospital days, have also been reported …”