US Trends in Prevalence of Sleep Problems and Associations with Chronic Kidney Disease and Mortality

Abstract

BackgroundTo better understand the relation between sleep problems and CKD, we examined temporal trends in the prevalence of self-reported sleep problems in adults in the United States and their associations with CKD and all-cause mortality.MethodsUsing data from 27,365 adult participants in five biannual National Health and Examination Surveys (2005–2006 through 2013–2014), we studied five self-reported sleep problems—trouble sleeping, sleep disorder, nocturia (urinating ≥2 times/night), inadequate sleep (<7 hours/night), and excessive sleep (>9 hours/night)—plus a composite index. We conducted three types of analysis: temporal trends in the prevalence of each sleep measure by CKD status, using model-based standardization; cross-sectional analysis of associations between four CKD measures and each sleep measure, using logistic regression; and survival analysis of the association between each sleep measure and mortality, using Cox regression.ResultsThe prevalence of trouble sleeping and sleep disorder increased over the five surveys by 4% and 3%, respectively, whereas the other sleep problems remained relatively stable. All sleep problems, except inadequate sleep, were more common during the study period among adults with CKD than without CKD (40% versus 21% for nocturia; 5% versus 2% for excessive sleep; 30% versus 25% for trouble sleeping; 12% versus 8% for sleep disorder). Both eGFR <30 ml/min per 1.73 m2 and albuminuria were positively associated with nocturia and excessive sleep. Excessive sleep and nocturia were also associated with higher mortality (adjusted hazard ratio for >9 versus 7–9 hours/night=1.7; 95% CI, 1.3 to 2.1; and for nocturia=1.2; 95% CI, 1.1 to 1.4).ConclusionsThe high prevalence of sleep problems among persons with CKD and their associations with mortality suggest their potential importance to clinical practice. Future work could examine the health effects of identifying and treating sleep problems in patients with CKD.

Wafer‐Scale 2D Hafnium Diselenide Based Memristor Crossbar Array for Energy‐Efficient Neural Network Hardware

“…A positive voltage sweep is required for SET (transition from HRS to LRS), whereas a negative voltage sweep is needed for RESET (transition from LRS to HRS), indicating a typical bipolar characteristic similar to other conductive‐bridge memristors. [ 15,48,49 ] During the SET process, a small set voltage ( V set ) is extracted at around 0.6 V, showing a low operation voltage than other 2D material‐based memristors. [ 15,18,19,23,50,51 ] Moreover, a low power consumption of only 0.82 pJ is needed to set the device (Figure S8, Supporting Information), manifesting its suitability for energy‐efficient applications.…”

“…Memristors based on 2D materials have emerged as a promising option over TMO‐based memristors [ 10,11 ] due to their unique properties and superior device performance, including large RS ratio, [ 12 ] low switching voltage, [ 12,13 ] small device variation, [ 14 ] as well as, capability of transition between the threshold and bipolar RS. [ 12,15 ] However, conventional 2D material‐based memristive devices are fabricated using mechanical exfoliation, which lacks a good control of flake thickness and poor spatial variation. [ 16–19 ] Moreover, due to the single crystallinity of the exfoliated flake, post‐treatments are required to decorate defects for creating switching pathways, such as, ion and electron beam irradiation, which hinder the implementation of circuits and computing hardware.…”

“…[ 16–19 ] Moreover, due to the single crystallinity of the exfoliated flake, post‐treatments are required to decorate defects for creating switching pathways, such as, ion and electron beam irradiation, which hinder the implementation of circuits and computing hardware. [ 15,20–22 ] To address these inherent limitations caused by mechanical exfoliation, considerable efforts have been dedicated to develop scalable fabrication processes. One such approach is liquid‐phase exfoliation and spin‐coating, which can produce large quantities of materials, but at the expense of crosspoint area scaling and nanoflake orientation control, resulting in poor endurance and low array density.…”

A Narrative Review of Management Strategies for Common Symptoms in Advanced CKD

“…99 Unfortunately the prevalence of sleep disorders continues to rise among persons with CKD and has almost doubled over the past 10 years. 100 Several factors, including fluid overload, 101 contribute to sleep disorders in patients with CKD/ESKD, such as disruption in evening melatonin levels, presence of inflammatory factors, malnutrition, anemia and iron deficiency known to predispose to RLS, pruritus, pain, dyspnea, and co-occurring conditions such as congestive heart failure and mood disorders. 102,103 Sleep disorders, in turn, are associated with increased morbidity and mortality, fatigue, lower cognitive scores, depression, impaired immune system and poor QOL.…”

“… 99 Unfortunately, the prevalence of sleep disorders continues to rise among persons with CKD and has almost doubled over the past 10 years. 100 …”