Demographic and clinical risk factors for diagnosis of sleep disorders in ESRD patients

Katlyn Smaha; Andrew Mixson; Jennifer L Waller; Wendy B Bollag; Varsha Taskar; Sandeep Anand Padala; Stephanie L Baer; William J Healy

doi:10.1016/j.amjms.2023.07.002

Demographic and clinical risk factors for diagnosis of sleep disorders in ESRD patients

Am J Med Sci. 2023 Oct;366(4):270-277. doi: 10.1016/j.amjms.2023.07.002. Epub 2023 Jul 15.

Authors

Katlyn Smaha¹, Andrew Mixson¹, Jennifer L Waller², Wendy B Bollag³, Varsha Taskar⁴, Sandeep Anand Padala⁵, Stephanie L Baer⁶, William J Healy⁷

Affiliations

¹ Medical College of Georgia School of Medicine at Augusta University, Augusta, GA, USA.
² Population Health Sciences at Augusta University, Augusta, GA United States.
³ Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States; Charlie Norwood VA Medical Center, Augusta, GA, United States.
⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Augusta University, Augusta, GA, USA.
⁵ Division of Nephrology, Department of Medicine, Augusta University, Augusta, GA, USA.
⁶ Charlie Norwood VA Medical Center, Augusta, GA, United States.
⁷ Medical College of Georgia School of Medicine at Augusta University, Augusta, GA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Augusta University, Augusta, GA, USA. Electronic address: wihealy@augusta.edu.

PMID: 37454928
DOI: 10.1016/j.amjms.2023.07.002

Abstract

Background: Sleep disturbances in patients with end-stage renal disease (ESRD) are common and more prevalent than in the general population. This study aims to assess the demographic and clinical risk factors for the diagnosis of sleep disorders in ESRD patients.

Methods: This study is a retrospective analysis of the United States Renal Data System (USRDS) to evaluate risk factors for the diagnosis of sleep disorders, including hypersomnolence, insomnia, restless leg syndrome (RLS), or obstructive or central sleep apnea (OSA/CSA). All ESRD subjects enrolled in the USRDS between 2004-2015 were eligible for inclusion. The risk factors analyzed were age, race, sex, ethnicity, access type, dialysis modality, and the Charlson Comorbidity Index (CCI). All statistical analysis was performed using SAS 9.4, and statistical significance was assessed using an alpha level of 0.05. Descriptive statistics on all variables overall and by each sleep diagnosis were determined.

Results: Increasing age, black race, other race, and Hispanic ethnicity were associated with decreased risk of each sleep diagnosis while CCI was associated with increased risk. Females were at increased risk of RLS and insomnia while males were at increased risk of OSA/CSA. Catheter and graft access decreased risk of RLS but increased risk of insomnia compared to AVF access. Catheter access increased risk of OSA/CSA compared to graft access. Hemodialysis increased risk of OSA/CSA compared to peritoneal dialysis.

Conclusions: Some ESRD patients are at an increased risk for diagnosis of sleep disorders based on age, race, sex, comorbid health conditions, and dialysis modality.

Keywords: Central sleep apnea (CSA); End-stage renal disease (ESRD); Insomnia; Obstructive sleep apnea (OSA); restless leg syndrome (RLS).