Poor sleep quality linked to higher mortality for adults on hemodialysis
Key takeaways:
- Patients sleeping less than the median duration of 6 to 7 hours had a higher mortality risk on dialysis days.
- Use of sleeping pills contributed to higher mortality rates.
Poor sleep quality may be linked to higher mortality for adults on hemodialysis, data show.
“Impaired sleep and sleep-related symptoms, including sleep apnea and restless legs syndrome, are among the common unpleasant symptoms experienced by end-stage kidney disease (ESKD) patients,” Yoko Narasaki, PhD, RD, of the division of nephrology in the David Geffen School of Medicine at University of California Los Angeles, wrote with colleagues. “Despite the frequent occurrence of sleep disorders and sleep-related symptoms in dialysis patients, they are oftentimes under-recognized and subsequently under-treated due to lack of routine assessment, limited patient-provider interaction time, conflation with other comorbidities, and reporting biases due to social and cultural factors.”
Researchers ran a prospective, multicenter, cohort analysis using the NIH Malnutrition, Diet and Racial Disparities in Chronic Kidney Disease cohort of 452 adults on in-center hemodialysis. The mean age of patients was 55 years, and 46% were women.
Researchers in the observational study followed patients for a median 3.5 years to gauge the effect of sleep patterns on mortality using protocolized surveys from 2014 to 2019.
Hazard ratios showed patients sleeping less than the median duration of 6 to 7 hours, were at a higher risk for mortality on dialysis days (HR = 1.59; 95% CI, 1.09-2.31) and non-dialysis days (HR = 1.51; 95% CI. 1.04-2.19). In addition, patients with frequent difficulty falling asleep, fatigue and post-dialysis or general exhaustion faced higher mortality risks, with hazard ratios of 1.74, 1.69, 2.42 and 1.73, respectively.
Researchers found that moderate to high use of sleeping pills was associated with higher mortality rates (HR = 2.07; 95% CI, 1.08-3.97) for those using pills sometimes and (HR = 2; 95% CI, 1.22-3.28) for frequent users compared with patients who never or rarely took these medications. Intra-dialytic sleeping or napping outside of the primary sleep period did not correlate with worse survival outcomes, though patients with conditions such as sleep apnea or restless legs syndrome had an increased mortality risk.
More research may identify the “efficacy and safety of sleeping interventions, particularly non-pharmacologic strategies, in advanced CKD and ESKD populations,” the researchers wrote.
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