Herbie Murray
Sleep disorders are prevalent in patients with chronic kidney disease (CKD), especially those with end-stage renal disease (ESRD). The reasons for the increased rates of sleep-related issues in this population are likely multifactorial. Sleep issues are not only related to decreased quality of life but are also associated with increased health risks and mortality in CKD.
Sleep apnea, restless leg syndrome, excessive sleepiness, and insomnia are the most common sleep disorders in CKD patients. These sleep disorders have been discovered to be highly common in CKD patients and have a major influence on their quality of life and morbidity.
| Characteristics | Values |
|---|---|
| --- | --- |
| Prevalence | 45% to 80% in adults with end-stage kidney disease (ESKD) and affects approximately half of patients with earlier stages of CKD |
| Risk factors | Older age, male gender, obesity, smoking, increased neck circumference, and diabetes |
| Treatment | Relaxation techniques, exercise, acupressure, medication, cognitive-behavioral therapy, educational interventions, benzodiazepine treatment, dopaminergic agonists, telephone support, melatonin, reflexology, light therapy, different forms of peritoneal dialysis, music, aromatherapy, and massage |
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What You'll Learn
- Sleep apnea: A sleep disorder that causes breathing to be interrupted or stopped for more than 10 seconds while in a deep sleep
- Restless leg syndrome: An uncomfortable sensation in the legs that is relieved by movement
- Dialysis treatment: A build-up of waste in the blood can cause discomfort and make sleeping difficult
- Anxiety and depression: Mental health issues can keep people awake at night
- Changes in sleep patterns: CKD patients may feel more tired than usual and fall asleep earlier or nap during the day
Sleep apnea: A sleep disorder that causes breathing to be interrupted or stopped for more than 10 seconds while in a deep sleep
Sleep apnea is a sleep disorder that causes interruptions or cessations in breathing during sleep. It is characterised by repeated episodes of apneas, arousals, and loud snoring. Sleep apnea is a chronic sleep disorder that can cause excessive sleepiness and cognitive impairment, diminishing daytime functioning.
Prevalence
The prevalence of sleep apnea in the general population is approximately 2%-4%, while in end-stage renal disease (ESRD) patients, it is estimated to be between 50%-60% through self-report questionnaires and about 70%-80% of ESRD patients when based on polysomnography.
Types of Sleep Apnea
Sleep apnea is divided into three sub-types: central sleep apnea (CSA), obstructive sleep apnea (OSA), or mixed. While OSA is the most common form of sleep apnea in the ESRD population, CSA may be underreported in patients with ESRD as it can only be diagnosed with polysomnography tests.
Risk Factors
The direct relationship between sleep apnea and ESRD is not clear, but several studies have examined "rostral fluid shift" as a possible mechanism in the pathogenesis of OSA in CKD patients. Due to their reclined position overnight, excess fluid shifts from the legs towards the neck, leading to upper airway restriction and collapse.
Treatment
The first line of treatment for sleep apnea in CKD patients is continuous positive airway pressure (CPAP). Other treatment modalities in the general population include the use of dental appliances, oral surgery, and treating underlying medical conditions (e.g., obesity or hypothyroidism). These modalities have not yet been extensively studied in the CKD population.
Impact
Sleep apnea in the ESRD can cause excessive sleepiness and cognitive impairment, diminishing daytime functioning. It is also commonly linked to depression, hypertension and increased cardiovascular morbidity and mortality.
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Restless leg syndrome: An uncomfortable sensation in the legs that is relieved by movement
Restless leg syndrome (RLS) is a neurological condition that causes an irresistible urge to move the legs. It is a sleep disorder that is triggered by resting and attempting to sleep, and is also a movement condition as people with RLS are forced to move their legs to find relief from symptoms.
People with RLS experience an uncomfortable sensation in their legs that can feel like aching, throbbing, pulling, itching, crawling, or creeping. These sensations are relieved by movement, and leg movement or walking typically provides temporary relief from the discomfort.
RLS is often associated with end-stage renal disease and hemodialysis, and people with chronic kidney disease (CKD) often experience it. It is believed that high levels of parathyroid hormone (PTH) are linked to the prevalence of RLS in patients with CKD.
There is no cure for RLS, but treatment is available. Dopamine agonists are a common treatment option, but only 25% of patients experience long-term effectiveness, and long-term use can lead to a worsening of symptoms, known as augmentation. Iron therapy is also used to treat RLS, as the condition is worsened by iron deficiency.
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Dialysis treatment: A build-up of waste in the blood can cause discomfort and make sleeping difficult
Dialysis is a treatment for people with failing kidneys, and there are two types: hemodialysis and peritoneal dialysis. Both types of dialysis filter waste and excess fluid from the blood, as healthy kidneys would.
A build-up of waste in the blood can cause discomfort and make sleeping difficult. This is a common issue for people with chronic kidney disease (CKD), who often have trouble falling and staying asleep. This can be caused by restless leg syndrome, sleep apnea, or inadequate dialysis clearance.
Inadequate dialysis clearance can cause a build-up of waste in the blood, leading to feelings of illness and discomfort. This can be addressed by peritoneal dialysis, which pulls waste and toxins from the body.
Dialysis treatment can also cause insomnia or difficulty staying asleep. This may be due to the noises made by dialysis machines, which can wake patients up.
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Anxiety and depression: Mental health issues can keep people awake at night
People with chronic kidney disease (CKD) often have trouble falling and staying asleep. Mental health issues such as worry, anxiety, and sadness can keep people awake at night. These mental health issues are highly prevalent in CKD patients and can be detrimental to their overall health and quality of life.
CKD patients undergoing haemodialysis commonly experience depressive and anxiety symptoms due to various physical and psychosocial factors. The prevalence of depressive disorder and anxiety disorder among CKD patients was found to be around 66% and 61%, respectively. Furthermore, depression and anxiety were significantly associated with gender, occupation, income, and duration of haemodialysis in these patients.
CKD patients with depression and anxiety may benefit from holistic treatment using multidisciplinary approaches to improve their overall quality of life.
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Changes in sleep patterns: CKD patients may feel more tired than usual and fall asleep earlier or nap during the day
CKD patients may experience changes in their sleep patterns, such as feeling more tired than usual, falling asleep earlier than their normal bedtime, or napping during the day. These changes can be attributed to various factors, such as physical and mental health issues, restless leg syndrome, sleep apnea, inadequate dialysis clearance, and worry, anxiety, and sadness.
To improve sleep quality, CKD patients are advised to limit their nap time, reduce caffeine intake, exercise during the day, adjust their sleep clock, find ways to relax before bedtime, and create a comfortable sleeping environment.
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