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. 2011;33(5):398-406.
doi: 10.1159/000326343. Epub 2011 Apr 8.

Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study

Mark Unruh  1 , Manjula Kurella Tamura, Brett Larive, Anjay Rastogi, Sam James, Brigitte Schiller, Jennifer Gassman, Christopher Chan, Robert Lockridge, Alan Kliger
Affiliations

Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study

Mark Unruh et al. Am J Nephrol. 2011.

Abstract

Background: Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients.

Methods: Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality.

Results: The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001).

Conclusion: These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.

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Figures

Fig. 1
Fig. 1
Derivation of the analytic cohort.
Fig. 2
Fig. 2
Adjusted relationship between sleep quality quartile and self-reported HRQOL. The test for differences between the highest and lowest quartile was significant in each domain (Physical Health Component (PHC) <0.0001, Mental Health Component (MHC) <0.0001, Bodily Pain (BP) <0.0001, Vitality (VT) <0.0001). The analysis was adjusted for age, sex, race, vintage and diabetes.
Fig. 3
Fig. 3
Relationship between sleep quality and self-reported time to recovery. The test for differences between the highest and lowest quartile was significant (p < 0.0001).
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