Subjective and Objective Sleep Quality in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison With Matched Controls From the Sleep Heart Health Study

Unruh, Mark L.; Sanders, Mark H.; Redline, Susan; Piraino, Beth M.; Umans, Jason G.; Chami, Hassan; Budhiraja, Rohit; Punjabi, Naresh M.; Buysse, Daniel; Newman, Anne B.

doi:10.1053/j.ajkd.2008.04.019

« Previous Next »American Journal of Kidney Diseases
Volume 52, Issue 2 , Pages 305-313, August 2008

Subjective and Objective Sleep Quality in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison With Matched Controls From the Sleep Heart Health Study

Mark L. Unruh, MD, MSc
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA
- Address correspondence to Mark Unruh, MD, MSc, University of Pittsburgh Medical Center, Renal-Electrolyte Division, 3550 Terrace St, A909 Scaife Hall, Pittsburgh, PA 15261.
Mark H. Sanders, MD
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
Susan Redline, MD, MPH
- Center for Clinical Investigation, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
Beth M. Piraino, MD
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA
Jason G. Umans, MD, PhD
- Penn Medical Laboratory, MedStar Research Institute, Washington, DC
- Department of Medicine, Georgetown University, Washington, DC
- Department of Obstetrics and Gynecology, Georgetown University, Washington, DC
Hassan Chami, MD, MSc
- Department of Medicine, Boston University, Boston, MA
- VA Boston Health Care System, Boston, MA
Rohit Budhiraja, MD
- Pulmonary, Sleep, and Critical Care Division, Southern Arizona VA Healthcare System, Tucson, AZ
- University of Arizona, Tucson, AZ
Naresh M. Punjabi, MD
- Johns Hopkins University School of Medicine, Baltimore, MD
Daniel Buysse, MD
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA
Anne B. Newman, MD, MPH
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.

Received 29 November 2007; accepted 11 April 2008. published online 10 July 2008.

Background

Studies examining sleep in the hemodialysis (HD) population have largely lacked an adequate comparison group. It therefore is uncertain whether poor sleep quality in the HD population reflects age, chronic health conditions, or effects of conventional HD therapy.

Study Design

Cross-sectional matched-group study.

Setting & Participants

Forty-six in-center HD patients were compared with 137 community participants participating in the Sleep Heart Health Study matched for age, sex, body mass index, and race.

Predictor

HD patients compared with community-dwelling non-HD participants.

Outcomes & Measurements

Home unattended polysomnography was performed and scored by using similar protocols. Sleep habits and sleepiness were assessed by using the Sleep Habits Questionnaire and Epworth Sleepiness Scale.

Results

Average age of study samples was 63 years, 72% were white, and average body mass index was 28 ± 5 kg/m². HD patients were significantly more likely than community participants to have short sleep (odds ratio, 3.27; 95% confidence interval, 1.16 to 9.25) and decreased sleep efficiency (odds ratio, 5.5; 95% confidence interval, 1.5 to 19.6). HD patients reported more difficulty getting back to sleep (odds ratio, 2.25; 95% confidence interval, 1.11 to 4.60) and waking up too early (odds ratio, 2.39; 95% confidence interval, 1.01 to 5.66). There was no association between polysomnography sleep time and self-reported sleep time (r = 0.09; P = 0.6) or between the Epworth Sleepiness Scale and severity of sleep apnea (r = 0.10; P = 0.5) in the HD population.