Comparison of Sleep/Wake Behavior in CKD Stages 4 to 5 and Hemodialysis Populations Using Wrist Actigraphy

Background: Patients with kidney failure have more sleep symptoms than the general population, but the contribution to sleep symptoms of kidney failure versus its treatment with thrice-weekly hemodialysis has been unclear. We assessed the influence of hemodialysis on sleep/wake behavior by using wrist actigraphy and selt-reported sleep quality compared with patients with chronic kidney disease (CKD) stages 4 to 5. Study Design: Cross-sectional study. Setting & Participants: Thirty-six patients with CKD stages 4 to 5 and 51 hemodialysis (HD) patients wore wrist actigraphs and completed sleep diaries for 2 weeks. Predictors: Thrice-weekly HD versus CKD stages 4 to 5, unstable total sleep times (TSTs), early HD shift. Outcomes: Self-reported sleep quality and objective measures of sleep/wake behavior. Measurements: Diaries, sleep questionnaires, and wrist actigraphy were performed. Results: The group with CKD stages 4 to 5 had an average age of 51 years, 69% were men, 19% were African American, and average body mass index was 28.9 kg/m(2). The HD group had an average age of 54 years, 60.8% were men, 49% were African American, and average body mass index was 27.5 kg/m(2). Average TST was 66.8 minutes shorter and sleep efficiency was 5.2% lower in the HD group compared with the population with CKD stages 4 to 5. In the HID population, 28 individuals had a mean change in TST greater than 60 minutes between HD and non-HD nights, and this unstable sleep pattern was associated with daytime sleepiness. The early-HD group had TST 62 minutes (95% confidence interval, similar to 22 to 102) shorter than those with later HD shifts. No significant differences in sleep efficiency or fragmentation index were found between the early- and late-HID groups. Limitations: Study included those older than 18 years. Conclusions: Both patients with CKD stages 4 to 5 and HD patients have short and fragmented sleep. An early-morning HD shift was associated with shorter TST and greater variation in nightly TST. Additional trials of the possible beneficial effect of behavioral sleep interventions, more frequent HD, and later HD shifts on sleep patterns are needed. Am J Kidney Dis 53:665-672. (C) 2009 by the National Kidney Foundation, Inc.