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. 2025 May 9:17:839-849.
doi: 10.2147/NSS.S501926. eCollection 2025.

Autonomic Nervous Regulation was Associated with Sleep Quality Among Peritoneal Dialysis Patients

Baodi Huang #  1 , Yujun Qian #  1 , Ying Gao  2 , Zhenye Chen  3 , Li Zhang  1 , Huijuan Mao  1 , Changying Xing  1 , Haibin Ren #  1 , Jing Wang #  1
Affiliations

Autonomic Nervous Regulation was Associated with Sleep Quality Among Peritoneal Dialysis Patients

Baodi Huang et al. Nat Sci Sleep. .

Abstract

Background: The issue of compromised sleep quality among patients with end-stage kidney disease (ESKD), particularly those undergoing peritoneal dialysis (PD), is notably pronounced. Dialysis patients exhibit significant alterations in cardiac autonomic nerve activity. However, the relationship between autonomic nervous system activity and sleep remains inadequately elucidated.

Methods: This cross-sectional study enrolled adult maintenance PD patients in our center. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Heart rate variability (HRV) and Skin sympathetic nerve activity (SKNA) parameters were recorded to reflect autonerve activity responses or regulation capacity.

Results: A total of 73 PD patients participated in this study, with a prevalence of poor sleep quality at 38.4%. Serum creatinine (1157.0±294.3 vs 969.6±353.4 mmHg, p = 0.022) and phosphorus levels (2.1±0.5 vs 1.7±0.5 mmHg, p = 0.002) were higher in the poor sleep quality group compared to the good group. Linear regression analyses indicated that PSQI scores were associated with SKNA (β, -2.54; 95% CI, -4.90 to -0.19; P=0.035), standard deviation of all sinus RR intervals (SDNN) (β, -0.05; 95% CI, -0.09 to -0.01; P=0.015), and SD2 (β, -0.04; 95% CI, -0.07 to -0.01; P=0.018).

Conclusion: Poor sleep quality in PD patients may be associated with longer dialysis vintage, higher BMI, higher diastolic blood pressure, and higher level of serum uremic toxin, and affected by cardiac autonomic nerve function disorder.

Keywords: autonomic nervous system; end-stage kidney disease; heart rate variability; peritoneal dialysis; skin sympathetic nerve activity; sleep quality.

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Conflict of interest statement

All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow Chart of Patient Enrollment.
Figure 2
Figure 2
The percentage of PD patients with global and subdomain sleep quality impairment.
Figure 3
Figure 3
The correlation of SKNA with PSQI and SDNN. (A) The correlation of SKNA with PSQI. (B) The correlation of SKNA with SDNN.
Figure 4
Figure 4
The correlation of various HRV parameters with PSQI. (A) The correlation of SDNN with PSQI. (B) The correlation of RMSSD with PSQI. (C) The correlation of |AC| with PSQI. (D) The correlation of DC with PSQI. (E) The correlation of TP with PSQI. (F) The correlation of LF with PSQI. (G) The correlation of HF with PSQI. (H) The correlation of LF/HF with PSQI. (I) The correlation of SD1 with PSQI. (J) The correlation of SD2 with PSQI. (K) The correlation of SD1/SD2 with PSQI. (L) The correlation of SampEn with PSQI.
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