Sleep Disturbances in Chronic Kidney Disease - The CKD-REIN Cohort Study

Insomnia and excessive daytime sleepiness (EDS) are common in patients with chronic kidney disease (CKD), but their determinants are poorly understood. We analyzed multiple factors likely to affect sleep with the aim of disentangling the contributions of CKD markers and symptoms from those of social factors, lifestyle, comorbid conditions, and drug-induced effects, with the latter 2 highly prevalent in this population.

Prospective cohort study.

In total, 2,765 patients with CKD stages 2-5 not receiving dialysis (mean age, 67 ± 13 years; 66% men) from a representative sample of 40 nephrology clinics in France.

Albuminuria, estimated glomerular filtration rate, CKD symptoms, lifestyle, comorbid conditions, and medications collected annually.

Insomnia and EDS ≥ 3 times/week in the past 3 months assessed with a standardized questionnaire at baseline, 1-, 3-, and 5-year follow-ups, providing 7,264 observations overall.

Adjusted odds ratios of insomnia and EDS associated with time-updated exposures estimated with mixed effects logistic regressions.

Baseline prevalence of reported insomnia was 22% (95% confidence interval, 21%-24%) and that of EDS, 15% (14%-16%). Based on the 7,264 observations, neither prevalence was associated with albuminuria after adjustment for age and gender. The odds ratio of EDS alone increased significantly with decreasing estimated glomerular filtration rate, 1.16 (1.05-1.28 mL/min/1.73 m²) per 10 mL/min/1.73 m², independent of social factors, physical activity, obesity, heart failure, and long half-life benzodiazepine use. It was no longer significant after adjustment for fatigue, which displayed a strong dose-effect relation with EDS, depression, insomnia, and sleep apnea. Insomnia prevalence increased strongly with severity of cramps, itching, and stress, independent of other determinants including female gender, heart failure, thyroid hormone use, depression, and sleep apnea.

Self-reported sleep disturbances and limited longitudinal inference.

This study highlights the multifactorial nature of sleep disturbances in CKD and the potentially modifiable contribution of CKD symptoms and drug-induced effects.