A Systematic Review of Sleep Hygiene Strategy in CKD

Sleep hygiene strategies are often encouraged in people with chronic kidney disease (CKD). We aimed to summarize the existing evidence on sleep hygiene strategies in this population.

We searched 4 electronic databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) up to July 2024. Studies of any design were eligible if they reported sleep hygiene strategies and sleep outcomes for adults with CKD. We extracted data using standardized tools and synthesized the results into each component of the sleep hygiene strategy. The effectiveness of each sleep hygiene strategy was summarized using meta-analysis and in a narrative manner.

Thirty-eight articles were included. Most studies (45%) focused on bedtime activity, with exercise (standardized mean difference [SMD]: -1.05, 95% confidence interval [CI]: -2.03 to -0.07) and relaxation techniques (SMD: -1.54, 95% CI: -2.34 to -0.73) showing promising effects on sleep quality. However, the timing of these strategies varied, limiting the ability to generalize these strategies in relation to bedtime activity. Few studies (18%) demonstrated positive effects of sleep hygiene education (SMD: -0.82, 95% CI: -1.57 to -0.63), particularly when delivered as part of cognitive behavior therapy (CBT). Mixed results were found regarding the impact of alcohol, caffeine, and cigarettes on sleep disturbances and sleep disorders. Limited studies have been conducted on bedroom environment, sleep patterns, and daytime napping in patients with CKD.

This review showed that sleep hygiene education can be a useful strategy for improving sleep in people with CKD. Exercise and relaxation techniques may reduce sleep disturbances; however, further research is necessary to determine the optimal timing for these activities.