Sleep disorders: a systematic review of an emerging major clinical issue in renal patients

Abstract

The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients' perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.

Insomnia severity in chronic kidney disease patients with various therapies

“…In our study, we also found that these habits did not contribute to the insomnia severity score. A few studies have suggested that number and severity of comorbidity in hemodialysis patients can be attributed with the increase in the prevalence of sleep disorders [2,4,30]. In our study, we found that ischemic hearth disease was an independent determinant of the insomnia severity score.…”

“…The prevalence of insomnia is greater in dialysis patients than in general population [2,3]. Studies have been reported to range from 45% to 90% [4][5][6][7][8][9][10][11].…”

Can We Improve Quality of Life of Patients on Dialysis?

“…Problems with sleep are very common in ESRD (up to 40%-80%) and range from insomnia and sleep apnea to restless leg syndrome (31,32). Indeed, poor sleep is itself a predictor of mortality and QOL (33).…”

Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction

“…21 Sleep disorders are closely related to depression both in the general population and HD patients. 9 Disturbed sleep is among the cardinal symptoms of major depression.…”