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Sleep Characteristics in Early Stages of Chronic Kidney Disease in the HypnoLaus Cohort

Ogna, Adam ; Ogna, Valentina Forni ; Rubio, José Haba ; Tobback, Nadia ; Andries, Dana ; Preisig, Martin ; Tafti, Mehdi ; Vollenweider, Peter ; Waeber, Gerard ; Marques-Vidal, Pedro ; Heinzer, Raphaël

In: Sleep, 2016, vol. 39, no. 4, p. 945-953

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    Titel
    • Sleep Characteristics in Early Stages of Chronic Kidney Disease in the HypnoLaus Cohort
    Autor
    • Ogna, Adam. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Ogna, Valentina Forni. Service of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Rubio, José Haba. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Tobback, Nadia. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Andries, Dana. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Preisig, Martin. Department of Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Tafti, Mehdi. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Vollenweider, Peter. Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Waeber, Gerard. Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Marques-Vidal, Pedro. Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    • Heinzer, Raphaël. Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Sleep, 2016, vol. 39, no. 4, p. 945-953. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:331537
    Summary
    Abstract Study Objectives To evaluate the association between early stages of chronic kidney disease (CKD) and sleep disordered breathing (SDB), restless legs syndrome (RLS), and subjective and objective sleep quality (SQ). Methods Cross-sectional analysis of a general population-based cohort (HypnoLaus). 1,760 adults (862 men, 898 women; age 59.3 (± 11.4) y) underwent complete polysomnography at home. Results 8.2% of participants had mild CKD (stage 1-2, estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m2 with albuminuria) and 7.8% moderate CKD (stage 3, eGFR 30-60 mL/min/1.73 m2). 37.3% of our sample had moderate-to-severe SDB (apnea-hypopnea index [AHI] ≥ 15/h) and 15.3% had severe SDB (AHI ≥ 30/h). SDB prevalence was positively associated with CKD stages and negatively with eGFR. In multivariate analysis, age, male sex, and body mass index were independently associated with SDB (all P < 0.001), but kidney function was not. The prevalence of RLS was 17.5%, without difference between CKD stages. Periodic leg movements index (PLMI) was independently associated with CKD stages. Subjective and objective SQ decreased and the use of sleep medication was more frequent with declining kidney function. Older age, female sex, and the severity of SDB were the strongest predictors of poor SQ in multivariate regression analysis but CKD stage was also independently associated with reduced objective SQ. Conclusions Patients with early stages of CKD have impaired SQ, use more hypnotic drugs, and have an increased prevalence of SDB and PLM. After controlling for confounders, objective SQ and PLMI were still independently associated with declining kidney function. Significance Analyzing a large population-based cohort by polysomnography, we observed an independent association between declining kidney function, objective sleep quality and periodic leg movements. Conversely, the increased prevalence of sleep disordered breathing in early stages of chronic kidney disease seems to be explained by classic risk factors, such as age, sex, and obesity. These observations provide new information to the current understanding of sleep disturbances in chronic kidney disease patients, suggesting that specific mechanisms appearing late in the course of kidney function decline, such as uremic toxins accumulation and fluid overload, may explain the increased prevalence of sleep disordered breathing in end stage renal disease patients. The causal significance of the described relationships warrants prospective investigation.