Sleep Disturbances and Chronic Kidney Disease

Medical research on this topic can be found cross-discipline to include articles in dialysis and transplant journals, but also within sleep science publications and molecular science research.  Sleep disturbances for children with chronic kidney disease (CKD) or on hemodialysis (HD) or peritoneal dialysis (PD) have been reported in the literature, with other research centered on adult or transplant patients.   We found a wide and diverse intersection of sleep issues with medical concerns such as skin inflammation and impact on heart health, on quality of life issues, different stages of kidney disease, and mention of specific sleep disorders or issues such as sleep apnea and restless leg syndrome (RLS).
In a case study titled “An Atypical Case of Atypical HUS” (Yao et al, 2015) it was noted that 20% of aHUS patients have no kidney involvement which leads us to infer that the remaining 80% of patients with atypical HUS do have some form of kidney function issue.  Here we present a curated list of information about sleep disorders and kidney disease, providing excerpts to provide an overview of how sleep disorders may have potential to impact aHUS patients of various ages and with varied health histories. No cases of atypical HUS present in the same way, with wide variation in symptoms and severity, so contact your physician to discuss issues on this topic or to address any other concerns you have regarding aHUS information or treatment.
(Our Note:  Links are to Full Text, if available to the public. For research abstracts, check with your physician to request a Full Text print copy)
A Better Night’s Sleep in CKD  (Salama A, 2010)
“Sleep disturbance is one of the most significant symptoms that patients complain of if asked, reportedly affecting about 50% of patients with Stages 3–5 CKD. It’s common across the spectrum of ages, affecting children, adolescents, and adults with CKD alike.  Sleeplessness leads to stress and anxiety, themselves factors that can perpetuate the disturbed sleep-waking cycle. And it not only affects quality of life, but quantity, as it is independently associated with increased cardiovascular mortality.”
“It appears that uremic toxins and volume overload may in part account for the augmented risk of sleep apnea, as some authors report a correlation between dialysis efficiency and sleep apnea severity, as well as between total body water and sleep apnea.”
Sleep disordered breathing in patients with chronic kidney disease  (Mavanur M et al, 2010)
“The prevalence of sleep-disordered breathing (SDB) in the advanced chronic kidney disease (CKD) patient population has been estimated to be more than 50 per cent.”
“Clinical consequences of this disorder may include excessive daytime sleepiness, depressed mood, cognitive impairment, hypertension, as well as increased risk for cardiovascular disease and metabolic dysregulation. SDB may also contribute substantially to the daytime sleepiness, poor quality of life, and high rate of cardiovascular disease in CKD patients.”
Sleep disorders in children with chronic kidney disease   (Darwish A and Abdel-Nabi H, 2016)
“Sleep disturbances are very common among children with CKD. Sleep disturbances in patients with CKD include restless legs syndrome (RLS), excessive daytime sleepiness (EDS), sleep-disordered breathing (SDB)”
“Sleep disturbances were detected in 75.9% of the studied children with CKD: 81.8% in children with CKD undergoing dialysis, and 71.8% in children with CKD not on dialysis. Excessive daytime sleepiness (EDS) and RLS symptoms were reported in 22% and 20.4% of the studied children with CKD, respectively.”
Quality of sleep in patients with chronic kidney disease  (Iliescu E et al, 2004)
“Decreased quality of sleep is common in dialysis patients and is associated with decreased health-related quality of life. The reported prevalence of ‘poor sleep’, including sleep-wake complaints, sleep-disordered breathing and excessive sleepiness, in dialysis patients is in the range of 45–80%. The prevalence of ‘poor sleep’ in patients with chronic
kidney disease (CKD) not yet on dialysis is not known.”
“The fact that the prevalence of ‘poor sleep’ in CKD was nearly as high as the prevalence of ‘poor sleep’ in dialysis patients suggests that quality of sleep decreases very early in CKD”
Sleep disturbance in pediatric patients on automated peritoneal dialysis
Our study shows that sleep disturbance (SD) was present in more than half of children on peritoneal dialysis (PD).
*Sleep disturbances are common in children under automated peritoneal dialysis.
*Systematic screening for sleep problems would therefore be warranted.
*The sleep questionnaires revealed underestimation of sleep disturbances.
*Polysomnography is the gold standard for the diagnosis of sleep disturbances.
Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis  (Wadhwa et al, 1992).
“Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights.”
“This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.”
Improvement of Sleep Apnea in Patients with Chronic Renal Failure Who Undergo Nocturnal Hemodialysis  (Hanley P and Pierratos  A, 2001)
“Sleep disorders are common in patients with chronic renal failure. The reported prevalence of sleep apnea in such patients ranges from 50 percent to 70 percent.  Although conventional hemodialysis does not reduce the prevalence or severity of sleep apnea in patients with chronic renal failure, renal transplantation has been reported to correct both obstructive and central sleep apnea.
Nocturnal hemodialysis is a new technique that enables patients to undergo hemodialysis seven nights per week at home while sleeping.  Since nocturnal hemodialysis provides better clearance of uremic toxins than conventional hemodialysis, it may improve sleep disorders, such as sleep apnea, that are associated with chronic renal failure.”
Self-reported sleep disturbances in renal transplant recipients  (Burkhalter H et al 2013)
“Poor sleep quality is common among renal transplant (RTx) recipients, with a prevalence ranging from 30% to 62%”
“The most frequent sleep disorders among hemodialysis patients are conditioned insomnia (unconscious association of bedtime with negative feelings), obstructive or central sleep apnea (repeated cessation of breathing during sleep), restless leg syndrome (an irresistible urge to move the legs) and periodic limb movement disorder (involuntarily limb movements). In patients with end-stage renal disease, several uremic and non-uremic factors are thought to contribute to the pathogenesis of sleep disorders. Sleep apnea appears to be related to displacement of fluids which destabilize the control of breathing and narrow the upper airway. Restless leg syndrome and periodic limb movement disorders are correlated with anemia, iron deficiency, and peripheral and central nervous system abnormalities. Therefore, most such disorders improve post-RTx. Excessive daytime sleepiness occurs in approximately 50% of patients with end-stage renal disease, the etiology of which appears related to both uremia and sleep fragmentation.”
The perception of sleep quality in kidney transplant patients during the first year of transplantation (Souza Silva et al 2012)
“Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. “
“One relevant contribution of our study was to show that the prevalence of poor sleep quality remains high after successful renal transplantation and that clinicians should pay attention to subjective factors associated with sleep quality and quality of life even after the first year post-transplantation.”
“Additionally, social reintegration and a return to professional activities seem to contribute to improved sleep quality in the first year after renal transplantation.”
“In our study, patients who were employed reported significantly better sleep quality early after transplantation compared to the patients who did not work.”
“This is a relevant issue because sleep disorders are highly prevalent in patients with chronic kidney disease and are associated with increased cardiovascular risk in addition to having a negative impact on the quality of life of this population.”

Associated Content

Overview of Common Sleep Disorders and Intersection with Dermatologic Conditions  (Walia H and Mehra R, 2016)
“We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer.
An estimated 50–70 million American adults suffer from one or more sleep disorders. There are approximately eighty different types of sleep disorders.”
Cardiovascular complications in atypical haemolytic uraemic syndrome  (Noris M and Remuzzi G, 2014)
“Cardiac complications occur in 3–10% of patients with complement-mediated aHUS, as a consequence of microangiopathic injury in the coronary microvasculature, and can cause sudden death. Emerging evidence also suggests that either thrombosis or stenosis of the medium and large arteries might complicate disease course, and such disorders occur even after renal function is lost.”

For further information about aHUS patients on Dialysis, listen to the global Patient Voice


aHUS & Dialysis Insights:  2016 aHUS Global Poll, aHUS Alliance White Paper

L Burke  (2017)

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